The Living Smokefree Service at Counties Manukau Health (CM Health) has doubled the number of people who quit smoking with help from the Smokefree Buffet project.
Counties Manukau has an estimated 62,000 people who smoke, with particularly high prevalence among Māori, Pacific Islanders and people with mental illness. In addition, smoking is a cause or contributor to many long-term conditions and has a disproportionate impact on certain groups, such as pregnant women and young people. These high prevalence and high impact groups are priorities for smoking cessation services.
The project has helped strengthen access to a full range of evidence-based support options to stop smoking, encourages people to engage with stop-smoking services, and enables healthcare professionals in four key sectors – secondary care, primary care, mental health and maternity care –to advise and refer people confidently for ongoing support.
The Living Smokefree Service developed Smokefree Buffet in collaboration with the four key sectors. They were supported by a Ko Awatea project manager and improvement advisor as part of the Manaaki Hauora – Supporting Wellness campaign, which was launched in 2015 to provide self-management support for people living with long-term conditions.
The aim of Smokefree Buffet was to increase the number of people engaged with stop-smoking services by 50 per cent and double the number of people still smoke-free four weeks after their quit date.
The project team started by reviewing published evidence and developing a process map.
“The literature review identified which stop-smoking options were most effective, and the process map enabled the team to understand the client journey through the Living Smokefree Service and identify potential barriers and points where intervention could bring value to clients,” says Michelle Lee, smokefree advisor for maternity services.
Next, the team created a change package* aligned around two primary areas of focus to achieve their aim: client engagement and activation; and service delivery and engagement by healthcare professionals and providers.
“We used the Model for Improvement to develop and test our change ideas. The Model requires improvement teams to set clear aims and measures and then develop and test change ideas using plan, do, study, act cycles,” says Danni Farrell, project manager for Smokefree Buffet.
To engage and activate clients, the Living Smokefree Service offered a range of evidence-based stop-smoking options.
These included nicotine replacement therapies, such as Cooldrops and Quickmist, convenient after-hours drop-in clinics, a customised smokefree package for mental health services, and a ‘menu’ of smokefree options to enable clients to choose those that best suited their preference and lifestyle.
To improve engagement with healthcare professionals and providers, the team strengthened links within the healthcare system. They introduced targeted smokefree advisor roles to build relationships with each of the four key sectors. In addition, the team introduced direct antenatal referrals from primary care to help reach pregnant women who needed smoking cessation support. They also provided training in group-based therapy for primary healthcare practitioners, and training in ABC (Ask, Brief Advice, Cessation) documentation for mental health service staff.
To test the effects of their changes, the project team measured the referral rate to Living Smokefree Services, as well as the number of people assessed, the number who set a quit date, and the number who remained smoke-free four weeks after their quit date.
The team achieved a 58 per cent increase in the number of referrals to the Living Smokefree Service, from an average of 198 to 317 per month. The targeted smokefree advisor roles were particularly effective at increasing referrals.
Of the clients who engaged with the Living Smokefree Service and set a quit date, the number who were still smoke-free after four weeks increased by 107 per cent, from an average of 10 to 24 per month.
Other benefits of Smokefree Buffet include closer collaboration with the four key sectors, improved service delivery and addressing the equity gap by improving quit rates for Māori and Pacific Islander people.
*A change package comprises a set of changes that have been proven effective for achieving a defined aim.