Barriers and Enablers to the use of NRT in primary care in the Hawke’s Bay

Catherine Marshall, Katherine Archer, Grant Carpenter, Roy Hoerara, Debbie Ryan

Identify the barriers faced by health practitioners prescribing or recommending nicotine replacement therapy

Gather ideas and suggestions about the range of support that would help them recommend NRT

17 General practitioners, 29 nurses and 2 health assistants and 2 smoking cessation advisers.

Primary Care Practice Practitioners

Dannevirke Medical Centre, Total 16 people3 GPs, 2 GP registrars, 11 nurses

Taiwhenua o Heretaunga, Hastings Total 5 people2 Aukati Kai Paipa advisers, 2 nurses, 1 smoking cessation nurse from HBDHB

Taradale Medical Centre Total 7 people1 GP, 6 nurses

Central Medical, Napier Total 7 people4 GPs, 1 nurse, 2 health assistants

Hastings Medical Centre Total 6 people2 GPs, 4 nurses

The Doctors Hastings Total 7 people4 GPs, 3 nurses

Takapau Health Centre Total 2 people2 Nurse practitioners

High awareness of the NZ Smoking Cessation Guidelines, the ABC model and effectiveness of NRT

Increased interest from primary care patients/ clients about quitting

64% GPs and nurses not trained in smoking cessation & don’t know NRT products

Nurses are nervous and uncertain about the appropriate doses - May lead to under-dosing

GPs and nurses not aware of support services for smoking cessation

Low use of Māori or Pacific focussed smoking cessation services

Areas where best practice is uncertain, include:◦ treating people with multiple addictions ◦ treating people with head injuries and/or mental health

problems◦ combination NRT therapies and double and triple patching◦whether reduction in the number of cigarettes is a valid goal,

and ◦whether patients/ clients can use NRT while smoking.

Low community awareness that cigarette smoking is a drug, and that it is more harmful than NRT

Practitioners know what “ABC” stands for, but don’t understand what brief is

GPs don’t have time to talk about smoking cessation and NRT and aren’t paid to do this

Practitioners feel awkward/ patronising GPs refer their patient/ client to people with a special

interest or training in smoking cessation Nurses are highly motivated to get actively involved in

smoking cessation

Lack of onsite access to NRT supplies creates barriers to capturing the moment, problems of cost and access

Subsidised NRT is only available from pharmacies Smoking cessation available at restricted times Low public understanding of NRT, other meds and

supports available No clear feedback and follow up for referrrals Family and whānau not seen as part of the team Goal of being smokefree may be too hard

High awareness of the NZ Smoking Cessation Guidelines, the ABC model and effectiveness of NRT

High awareness of the ways to advise use of NRT with pregnant women

Increased interest from primary care patients/ clients about quitting

Primary care is routinely recording smoking status Some practices have introduced excellent smoking

cessation services eg Nurse led healthy lifestyle clinics

Training programmes for all practitioners be reviewed to ensure that they meet minimum competency

Face to face training or education is required to assist busy, overworked health practitioners understand their roles

A menu of conversation starters GPs and practice nurses should meet advisers in their

local area Nurses should be given wider opportunities to

participate in training on smoking cessation

Lunchtime workshops at clinics to introduce health practitioners to NRT products and to show them how to use tools such as the ‘heart forecast’ tool

All training courses should provide professional development points

Smokingcessationabc.org.nz online course updated to have more information about the practicalities of NRT

Extend the range of people who can provide access to subsidised NRT products eg pharmacists , community leaders and workplace cessation advisers.

Provide a standing order template for NRT for nurses Electronic Quit Cards (redesigned) Electronic follow-up systems between Quitline and

other smoking cessation specialists Reduce read codes Promote yourheartforecast.org.nz tool

BPAC should conduct an audit of NRT use

GPs suggested that smoking cessation should be included in the PHO Performance Management System and funding should be linked to this

Develop a wallet card that shows much is saved and the health benefits

Have a video of heroes/real people talking about NRT Positive and encouraging posters Promote greater awareness of the telephone and text

support systems available to people giving up smoking Redefine how NRT works and tastes Identifying ways that the family/ whānau and

workplaces can support people Provide waiting room TV

Focus on positive messages that promote health and respect for the need to give up, the use of NRT and reinforce the value of the smoker

Create a campaign with a well known icon who can talk about giving up smoking using NRT

Highlight the specialist smoking cessation services – want them visible to both the primary care practitioners and community

Explain that smoking is a drug – and is more harmful than NRT

Clinical opinion leaders to model ways to talk about smoking cessation as part of routine clinical care for chronic condition management

Create Smokefree heroes or ambassadors (this would help practitioners)

Create mentors for smoking cessation advisers to offer professional support to the nursing workforce

Teach GPs that their role is a very limited, brief - 1 minute responsibility

Swift and effective referral to either an onsite trained smoking cessation expert for immediate advice or Fast track referral system to Quitline or Aukati Kai Paipa (with electronic feedback)

Reduce the time from discussion about smoking cessation to the point of getting NRT

Arrange services that are more convenient for smokers and their families to attend eg evenings and weekends

Consider value of funding more GPs time to discuss smoking cessation

Access to samples and free demonstration packs of NRT available through MPSO needed

Extend range of subsidised NRT products eg inhaler Widen the range of outlets for subsidised and free NRT Develop a network of local community mentors and

supporters

W

GP – 1 minute message

Trained referral adviser

Family and whānau

Mentors

Champions

Heroes

WorkplacesWhānau

Wairua Hinengaro

Tinana

Promotion of NRT and pharmacotherapies to consumers

Production of an educational video about how to use pharmacotherapies

Development of:◦ a downloadable consumer brochure on patches◦ Goodfellow Unit Quizzes◦ BPAC Case Studies and Audit

Education sessions and launch of the new products in March 2011.

To the GPs and nurses of the Hawke’s Bay

James Curtis and Carolyn Murphy HBDHB

The Ministry of Health and PHARMAC

The people at Silver Fern Farms Waipukurau