better help for smokers to quit – tobacco health target helen troke-thomas tobacco policy and...
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Better Help for Smokers to Quit – Tobacco Health Target
Helen Troke-Thomas
Tobacco Policy and Implementation TeamMinistry of Health
People who smoke want to stop
• 72% of 15-19 year-old that smoke would not if they had their life again
• 69% tried to quit in last 5 years
• 44% tried to quit at least once in last year
• Māori, Pacific and young people are as likely to have tried to quit
MoH. NZTUS 2006
Health Effects of Smoking• Cause of approximately 5000 deaths a year in New Zealand
• Societal costs, costs to health service, lost productivity
• Loss of on average 15 years of life
• Second hand smoke
• High rates of smoking amongst Maori and Pacific
Why Brief Advice?
• Proven efficacy
• Relatively small effect (1-3%)*
• Useful when delivered to a large population of people that smoke
*Silagy C, Stead LF. Physician advice for smoking cessation. Cochrane Database Syst Rev
Health Target -Better help for smokers to quit
• 2009/10 - 80% of hospitalised smokers will be provided with advice and help to quit by July 2010
• 2010/11 - 90% of hospitalised smokers will be provided with advice and help to quit by July 2011
Health Target -Better help for smokers to quit
But there are Challenges…..
The Target requires:
• Systems Change
• Behaviour Change
16.6% of
hospitalised smokers provided with brief advice and help to quit
Quarter 1 2009/10
DHB Activity
• Training
• Systems development and Implementation
• Clinician buy-in
• Promotion of ABC
Health Target Results 2009/10
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Hutt Valley
Waitemata
Taranaki
Capital & Coast
Counties Manukau
South Canterbury
Northland
Auckland
MidCentral
Nelson Marlborough
Otago
Bay of Plenty
West Coast
Whanganui
Canterbury
Lakes
Hawke's Bay
Southland
Tairawhiti
Waikato
Wairarapa
% of hospitalised smokers offered advice and help to quit
Quarter 1 Quarter 4
TARGET July 2010
17,800Smokers offered Brief Advice and or cessation support in Q4 of 2009/10
Progress in 2009/10
• Over 37,400 offers of brief advice in 2009/10. It is estimated that 1 in 40 of these smokers will have a successful quit attempt = approximately 935 successful quit attempts will occur because of this activity.
• Note that this is the minimum as many hospitalised smokers will also will receive NRT/cessation support which increases the quit success rate.
Progress in 2009/10
• Behaviour change amongst clinicians and cultural change in the hospital setting.
• Change in the profile of smoking status in the hospital setting – a clinical ‘vital sign’.
• Significant work and commitment to get systems and processes in place to make this happen.
Considerations
Disclosure and Target Gap
• Prevalence – not all smokers identified.
• Target Gap – not all smokers that are identified are provided with brief advice and help to quit.
Considerations Cont...
Ethnicity
• Vital that all smokers are receiving ABC and that there are not ethnic disparities.
• Initial analysis gives us confidence that Maori and Pacific smokers are being offered brief advice as often as others.
• Ministry now collecting data from DHBs to undertake further ongoing analysis.
Based on what we have learned from 2009/10…….
….key predictors of success for health target achievement include:
•Commitment and Leadership from Senior Management and Senior Clinicians
•Training of staff
•Appropriate and accurate systems to record and report results
•Sustainability
Smoking is too BIG to ignore