Improving Quality in Stop Smoking Services

David Tumilty

Senior Health & Social Wellbeing

Improvement Officer

Public Health Agency, Belfast

Dr Gillian GilmoreHealth Intelligence Manager

Public Health Agency, Belfast

UKNSSC, 12 June 2014, London

Overview • Setting the context

• Quality Standards & Monitoring Systems

• Why Quality Improvement

• Quality Improvement Process & Outcomes

• key learning & Next Steps

• 2,300

• 50%

• 24%

• £164m

• Ten Year Tobacco Strategy

• Improve structure, process and outcomes

Context to this Quality Improvement Initiative

Implementation of Strategy

Quality Standards & Stop Smoking Services in NI

Northern IrelandStop Smoking Services – Electronic MonitoringSystem

Quality Improvement Programme

 

 

Uptake of Stop Smoking Services NI and 4 week quit rates 2007/08 – 2012/13

Introduction of smoke free legislation

Source: Stop Smoking Services monitoring data 2012/13

Examining the success of services 2011/12

 

Client Uptake

 Average 4 week quit

rate of provider %

(n- provider number)

    

Pharmacist 28977 (73%) 49.9% (407)  

GP practices 5582 (14%) 48.4% (132)  

Hospital 3136 (8%) 67.5% (13)  

Community 1934 (5%) 65.4% (44)  

TOTAL 39,629 51.8% (596)  

  Number of providers achieving 4 week quit rate of

  35% or under (n)

35.1% - <45.0%

(n)

45.0% and over (n)

  69 62 276

  38 22 72

  2 1 10

  7 3 34

  116 88 392

Uptake and 4 week quit rate by provider type 2011/12

Online self-monitoring & support services

Pharmacy quality improvement

process and outcomes

Steering group

Pharmacy quality improvement process Above 45

quit rate

4 week quit rate >35% Notification to

all providers of ongoing QI Process

Annual review of quit rates

Mid year review

QI support

4 week quit rate < 35% - direct entry into QI programme

QI support

End of year review

Service continuity

4 week quit rate > 35%

Steering group

Pharmacy quality improvement process Above 45

quit rate

4 week quit rate >35% Notification to

all providers of ongoing QI Process

Annual review of quit rates

Mid year review QI support

4 week quit rate < 35% - direct entry into QI programme

QI support

End of year review

4 week quit rate <35%

QI support

Suspension

Temporary Reinstatement

Termination

QI Support mechanisms…… Online exercise

QI Support mechanisms…… Update training• Delivered throughout the region• Aligned with commissioner review timelines• Key learning • Links back to commissioner on attendance

QI Support mechanisms…… Individualised support

• Written communication • One to one phone calls• Visits to service • Signposting to other services

Outcomes for supported quality

improvement pharmacies

Mid year review • 13 of 69 taken no action - further individualised support

End of year review • 9 /69 providers still under 35% • Continuity of care for current clients but no new registrations. • Further one to one service discussion

• Service issues identified/ remedies discussed

• End of first QI group -only 1 termination

Impact of quality improvement overall

Average 4 week quit rate of providers % (n)

Provider type 2011/12 2012/13

Pharmacy 49.9 (407) 55.6 (445)

GP 48.4 (132) 48.2 (133)

Hospital sites 67.5 (13) 65.7 (10)

Community 65.4 (44) 65.2 (57)

TOTAL 51.8 (596) 56.6 (645)

Proportion of providers achieving 4 week quit rate of 35% or under %(n)

2011/12 

2012/13

16.0 (69) 7.9 (35)

28.8 (38) 30.8 (41)

15.4 (2) 10 (1)

15.9 (7) 10.5 (6)

19.4 (116) 12.9 (83)

Key Learning Joint working approach necessary

Stakeholder communication key

Raises awareness of service issues

Additional pharmacy support fundamental to success

Next steps Pharmacy - annual process

Promotion of other standards

Work with other providers