“evaluating the impact of a regional approach to babyclear, and tackling the high levels of...
TRANSCRIPT
“Evaluating the impact of a regional approach to babyClear, and tackling
the high levels of maternal smoking in North East England”
2015 UKNSCC, Manchester
Martyn Willmore
Fresh Smoke Free North East
Overview
o Current NE position on maternal smoking
o What we`ve done to address this
o What the data is telling us
o Lessons learned in terms of stop smoking support
o We await the academic evaluation of babyClear
o Acknowledgements and thanks go to:
o Hilary Wareing and Tobacco Control Collaborating Centre
o Newcastle University teamo Teesside University teamo Eugene Milneo Jane Beenstocko NE Heads of Midwiferyo NE SSS providers &
commissioners
The North East & Maternal Smoking
o SATOD rates across NE have been consistently high since data started
o They don`t reflect progress made in NE adult/youth smoking levels
o We recognise that maternal smoking is not just a “pregnancy issue” or a cessation issue
o Yet we felt we needed to do more to improve our systems to support pregnant smokers to quit
BabyClear
So after months of negotiations and work done with key partners, we started to implement babyClear
oSystematic approach to CO monitoring and referral by midwives at first booking appointmento“Risk Perception” intervention by midwife at time of scan clinicoSkills training for midwives and SSS staff (advisers and admin teams)oClarifying referral pathways/systemsoSupply of all related materials in Year One
BabyClear planned roll-out
Stepped wedge trial design for evaluation of the intervention2012 2013
Trust allocation blocks
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
1. Durham * *2. South of Tyne & Wear
3. North of Tyne
4. Teesside* First deliveries expected of infants whose mothers have received intervention
Control steps: full data collection, no interventionInitial intervention delivery: training and implementation, leading to full fidelityFull intervention delivery at full fidelity (planned)
BabyClear actual roll-out
Actual time period of intervention2012 2013 2014 2015
Trust allocation blocks
Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
1. Durham & Darlington
2. Sunderland
2. Gateshead
2. South Tyneside
3. Newcastle, N Tyneside
Newcastle
N Tyneside
3. Northumbria
4. North Tees
4. South Tees
Changes in SSS models
o Throughout the implementation, we faced a changing landscape (e.g. CCGs, maternity teams, LAs Public Health)
o But one of the biggest challenges was the move from 6 SSS to effectively 10 separate SSS with a variety of models:
No specialists and pregnant women seen by any willing
provider
No specialists, but clearly defined pregnancy advisors
Traditional hub & spoke model with pregnancy
specialist advisors
Darlington North Tyneside County Durham
Gateshead Northumberland
South Tyneside North Tees
Sunderland South Tees*
Newcastle**
Resources provided
o Two-hour training for all staff who do booking appointmentso Around 450 attendeeso Train the trainer support for localitieso Approx. 350 picobaby CO monitors provided
o All-day training for small cohort of risk perception midwives o Around 55 North East midwives attendedo 20 maternity units provided with relevant software/CO monitor
o One-day training for 28 SSS hub administrative staff
o One or two day SSS pregnancy advisor training for 117 staff
Change in number of quit dates set by pregnant women (Q1-3 12/13 vs. 14/15)
3.4%
-6.3% -7.5% -8.7%
-13.4%-17.4% -18.1%
-32.1%-34.5%
-45.2%-50.0%
-40.0%
-30.0%
-20.0%
-10.0%
0.0%
10.0%
EastMidlands
NorthEast
SouthWest London
WestMidlands England
Yorkshireand theHumber
NorthWest
East ofEngland
SouthEast
Change in number of quit dates set by pregnant women (Q1-3 12/13 vs. 14/15)
Estimated % of pregnant smokers using SSS in 2014/15 and validated quit rates
49.2% 47.5%
40.5%
27.4%
26.1%
24.9% 24.4%
22.2%
22.1%19.2%
8.7% 8.1%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
% of smokers engaging with SSS CO validated 4-week quit rates
SSS models – some thoughts
o There is no obvious correlation between having a “specialist-delivered” SSS and outcomes
o But having specified pregnancy providers is vital in terms of achieving quality outcomes
o If non-specialist providers are active, well-trained and supported (usually by hub), their quit rates can be good
o ……but, if specialist provision is removed without a clear handover strategy, we`ve seen major disruption
o Real difference in attendance levels with arranged one-to-one sessions, rather than drop-ins
Other thoughts….
oHaving stop smoking advisors on-site after dating scan increases engagement. As do morning scans
oYet, there are on-going practical issues around triaging smokers into dedicated scan clinics
oCO screening at every opportunity is vital
oChallenges around who provides CO equipment post-implementation (we are clear it should not be the SSS)
oSmoking rates at booking vary hugely. From 15% to 50%
oAttendance rates at first appointment also vary significantly
Change in NE local smoking at time of delivery rate (Q1-3 14/15 vs.11/12)
-5.5%
-4.2%
-3.8%
-2.8%
-2.5%
-2.3%
-2.2%
-1.7%
-1.1%
-1.1%
-0.9%
1.6%
-6.0% -5.0% -4.0% -3.0% -2.0% -1.0% 0.0% 1.0% 2.0%
Northumberland
Gateshead
Newcastle
South Tees
North East
North Tyneside
County Durham
England
Darlington
Sunderland
North Tees
South Tyneside
Change in regional smoking at time of delivery rate (Q1-3 14/15 vs.11/12)
What next?
o Ensure babyClear (especially the risk perception element) is routinely embedded. Possibly extend beyond midwives?
o Await formal evaluation of babyClear, in terms of attitudinal changes (staff and patients), and impact on birth outcomes
o More PR/Media about reasons to quit
o Greater use of mobile phones/Apps/online resources?
o Incentives? We see the evidence building up in support of well-structured financial incentives
o Greater insight into North East pregnant smokers?
Summary
o Taken longer to get to this point than expected
o Partly due to extent of change in the system
o Still variation across region (in both midwifery and SSS support), but less than before
o babyClear still reliant on the SSS model and the support of maternity teams
o We can`t just treat tackling smoking in pregnancy as an isolated issue
o Signs of progress, but still a long way to go
Contact details….
0191 333 7140
www.freshne.com
https://twitter.com/freshsmokefree