In June 2016, the Victorian Government released the Implementation Plan setting out 246 actions that will be undertaken to implement all recommendations and affirmations of the 2014 and 2015/16 Mine Fire Inquiry Reports.

The Implementation Plan describes that the Government will work collaboratively with the Latrobe Valley community to improve health and well-being outcomes of residents to:              

  • Designate Latrobe Valley as the Latrobe Health Innovation Zone
  • Establish a Latrobe Health Assembly to promote, support and oversee the development of the Latrobe Health Innovation Zone
  • Appoint a Health Advocate
  • Engage with the community to identify local health priorities
  • Support and fund the development and delivery of health improvement strategies to address health priorities

‘Health in the Latrobe Valley’ is a key response area within the Implementation Plan supported by 68 dedicated deliverables. The Latrobe City local government area has been designated as a Health Innovation Zone and is supported by nine key Deliverables (Deliverables 69 – 77) related to Early Detection and Screening including Smoking Cessation.

The Latrobe Health Assembly has been established to oversee commissioning and distribution of funding for health improvement programs in the Latrobe Health Innovation Zone.

Gippsland PHN has been identified and contracted by the Department of Health and Human Services (DHHS) to support a program strategy and implementation of activities related to Deliverables 69-77, given their focus on supporting general practice, health planning, health system integration and commissioning services in line with national and local health priorities.

The objectives of Gippsland PHN is to:

  • Increase the rate of identification and recording of smoking status by health professionals, particularly those working in primary and community care settings
  • Build the knowledge and capacity of local health professionals in smoking cessation, to support their patients to be smoke free, and offers of support to quit/brief interventions
  • Develop and publish new, and collate and analyse existing, evidence to support the development of deliverables and to promote greater knowledge transfer across professionals and communities 
  • Provide all patients, irrespective of the health care service they access, with appropriate and coordinated cessation advice, support, and referral pathways
  • Increase screening rates and opportunistic testing rates and referral into treatment for chronic, communicable and non-communicable diseases
  • Establish and develop new partnerships, and strengthen existing partnerships with the local community and health sector to achieve coordinated, consultative and integrated delivery of activities.

Gippsland PHN will ‘fast track’ activities addressing high smoking rates as its first priority by encouraging health professionals to ask patients about their smoking and offer support to quit.

Gippsland PHN proposes an approach targeting smoking cessation education and quality improvement for general practice and other health organisations located in Latrobe City.

This approach encompasses four key focus areas:

  1. Training for primary care health professionals
  2. General Practice system change
  3. Public education
  4. Improving uptake of evidence-based cessation services.

Gippsland PHN acknowledges the opportunity for shared learnings and successes and will create opportunity to invite general practices outside the Latrobe City to participate in activities.

Gippsland PHN have identified Quit Victoria (Quit) and Alfred Health as key support partners leveraging on their specialist expertise and resources.

Quit is a program of the Cancer Council Victoria (CCV) funded by CCV and the Victorian Government through VicHealth and DHHS. Quit is funded to deliver a range of tobacco control measures including the Quitline, training and social marketing.

Alfred Health has been funded by the DHHS to provide training tools and resources to support healthcare facilities to implement smoking cessation policies and protocols and to provide training on contemporary best practice use of smoking cessation pharmacotherapy.

Implementing a systemic approach to smoking cessation in general practice PDSA.

What is a PDSA?

A Plan, Do, Study, Act (PDSA) cycle uses a ‘trial and learning” approach in which an idea, hypothesis or a suggested solution for improvement is made then tested on a small scale before any changes are made to the whole system. It is a cyclical model because the desired improvement is not always achieved in one cycle so the process is refined and the cycle is repeated. PDSA cycles are Category 1 activities in the RACGP CI&CPD program and are inherent quality improvement (QI) activities. PDSA cycles can be undertaken by an individual GP, a group of GPs or a multidisciplinary team.

Accreditation

RACGP QI&CPD program for the 2017-2019 triennium – Activity ID: 99980 – Total points: 40 Category 1

Link to the online PDSA

Quit Victoria have developed this PDSA and have gained RACGP accreditation under their provider number. The PDSA tool is available online and can be completed electronically through the Quit learning management system. Please click here to access the link (available soon) and start the PDSA.

Download a hard copy of the PDSA implementation document.

Data Extraction Instructions for POLAR GP users:

Two guides, POLAR GP walk throughs for activity 2.1 in the PDSA (extract and examine patient data relating to smoking status) have been developed to assist you when using POLAR GP to extract data:

Download the POLAR GP Walkthrough Smoking Status

Download the POLAR GP Walkthrough Nicotine Replacement Therapy (NRT) and Smoking Status

For more information or support on data extraction using POLAR GP please contact your Gippsland PHN Practice Support Officer (information provided in other resources).

Do you need to chat to someone about the PDSA?

  • Michelle Crosby (michelle.crosby@gphn.org.au), Practice Support Officer, Gippsland PHN, Mobile 0428 282 117
  • Pauline Parr (pauline.parr@gphn.org.au), Practice Support Officer, Gippsland PHN, Mobile 0428 083 114
  • Merissa Judkins (Merissa.Judkins@cancervic.org.au)
    Primary Health Program Coordinator, Cancer Council Vic  – Prevention Division
    T: 03 9514 6431  Monday 8am-4pm, Wednesday 8am-4pm
  • Katie Foster (katie.foster@gphn.org.au), Project Officer Innovation and Health Reform, Gippsland PHN, Mobile 0427 346 896
  • Jenny Whyte (jenny.whyte@gphn.org.au), Education and TrainingOfficer, Gippsland PHN, Mobile 0438 442 187.
  • Smoking tobacco is still the leading cause of preventable death and disease across Australia. Latrobe City and Baw Baw Shire have two of the highest smoking prevalence in local government areas) in Victoria, with more adolescents starting smoking and fewer adults quitting compared to the state averages[1]
  • Helping people in the Latrobe City and other Gippsland communities stop smoking would provide a valuable opportunity for residents to improve their physical and mental health[2], and alleviate some of the increasing financial and social stresses caused by smoking.
  • Most people accept that smoking comes with significant health risks and effects. Those who don’t care about their health are increasingly being motivated to quit because of the cost of their addiction. Someone smoking a pack a day is spending more than $7,000 per annum on cigarettes.
  • Multiple surveys of Victorian smokers, including those experiencing severe social disadvantage (e.g. mental illness or homelessness)[3][4], have shown that more than 80% of smokers want to quit.
  • Approximately half of all smokers in Victoria attempt to quit each year but less than one in five of those who attempt to quit use proven smoking cessation interventions.
  • General practices have a critical role to play in encouraging and supporting their patients to quit, particularly to help people who want to quit succeed in their efforts
  • Smokers listen to GPs when advised to stop. A systematic review of evidence has shown that one in 33 conversations will result in a patient quitting. A brief intervention (asking about smoking, advising the person to stop, and offering a referral to help) delivered by a GP results in at least 5% of the community ceasing to smoke.
  • Research from the UK has shown that if a GP asks someone if they smoke and then doesn’t advise them to quit and provide an offer of help, the likelihood of that person quitting decreases. Asking smoking status but not providing advice and an offer of help is therefore doing harm.
    • Australian guidelines recommend that smoking cessation should be raised, and help provided to quit, in all encounters with health professionals[5]. However, this is not routine practice.
    • Barriers to providing routine smoking cessation in general practice include concerns about the time required, and the confidence and knowledge of the practitioner.

[1] Victorian Department of Health. Victorian population health survey 214

[2] Taylor G, et al. Change in mental health after smoking cessation. BMJ. 2014; 348.

[3] Siru R, et al. Assessing motivation to quit smoking in people with mental illness: a review. Addiction. 2009;104(5):719-33.

[4] Segan C, Maddox S & Borland R. Homeless clients benefit from smoking cessation treatment delivered by a homeless persons’ program. Nicotine and Tobacco research, (in press).

[5] Zwar, N., et al., Supporting smoking cessation: a guide for health Professionals. 2011, Melbourne: The Royal Australian College of General Practitioners.

Gippsland PHN have localised four Gippsland HealthPathways related to Smoking Cessation, NRTs and Smoking in Pregnancy. You can access these pathways by clicking on the below link:

  • Nicotine Replacement Therapy – LIVE
  • Smoking Cessation Advice ( clinical pathway) – under development
  • Smoking in Pregnancy (clinical pathway)  – under development
  • Smoking Cessation Programs (referral pathways)  – under development.

Referrals to Quitline can now be sent as a secure eReferral from ZedMed, Medical Director and Best Practice via Argus secure messaging. For instructions on how to send these eReferrals please select the link below related to your practice software:

  • Medical Director – (in development)
  • ZedMed – (in development)
  • Best Practice – (in development)

Training, education and quality improvement activities

Quit, working with Alfred Health, has refreshed its current smoking cessation education to a discipline specific model focussing on the diversity of health organisations and health professionals.

While the RACGP Smoking Cessation Guideline is the gold-standard for providing cessation support, a briefer three-step model, known as a 3 Step Brief Intervention – Ask, Advise and Help (with “Help” being pharmacotherapy prescriptions and/or referrals to specialist services) has been developed to address several barriers identified for general practice.

Quit has also developed a quality improvement Plan-Do-Study-Act (PDSA) cycle addressing the impact of the training on behaviour within the general practice.

Gippsland PHN, in partnership with Quit, invites general practices and other health professionals to implement a systematic approach to smoking cessation.

Quit has developed:

1)  A training module for general practitioners accredited to the RACGP QI&CPD Program

2)  An on-line learning version of the training module (coming soon)

3)  A Quality Improvement activity for general practice – Plan Do Study Act (PDSA) cycle – eligible for RACGP QI&CPD 40 Category 1 points

4)  A training module suitable for practice nurses, pharmacist, dentists and other allied health professionals

5)  Business and clinical protocols and workflows for general practices for smoking cessation.

The training modules will enable General Practitioners, Practice Nurses, Dentists, Pharmacists and other allied health professionals to identify and support people to cease smoking. Referrals to Quitline or local accredited Quit Educators will provide behavioural support.

 

Quit’s engagement with general practice, health organisations and health professionals will predominantly occur in Latrobe City aligned to Deliverables 70 of the Early Detection and Screening including Smoking Cessation Project. However given the transient nature of our medical workforce and people, all general practices in Gippsland will be offered an opportunity to participate.

Quit will be supported by the Gippsland PHN Practice Support Program; other Gippsland PHN programs will be engaged from time to time to support the development and implementation of the project.

Coinciding activities

Coinciding with education, quality improvement and benchmarking activities other events will occur including:

  • Public awareness: A social media campaign incorporating television, radio and print;
  • Utilising the HealthPathways methodology: Establish local specialist working groups to develop smoking clinical and referral pathways relevant for Gippsland
  • Collaborative and integrated health system: liaise with local health services to endorse an agreed approach for patient screening, intervention and staff training
  • System development and redesign: Working with various IT venders to implement changes to software programs for data analysis, screening prompts and secure electronic referral
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