Report No. 028-12

TO: Chair and Members of the Board of Health
FROM: Graham L. Pollett, MD, FRCPC, Medical Officer of Health
DATE: 2012 February 16

Smoking Cessation for Clients in the Home Visiting Program

Recommendation

It is recommended that Report No. 028-12 re Smoking Cessation for Clients in the Home Visiting Program be received for information.

Background

Over the past year, the Healthy Babies Healthy Children (HBHC) program has been providing more intensive interventions for clients who have expressed a desire to quit or reduce smoking.  The Public Health Nurses (PHN) and Family Home Visitors on this program received education to enhance their ability to assess their clients’ readiness to quit and to be able to adequately implement interventions and support.  In particular, free Nicotine Replacement Therapy (NRT) has been made available for many clients who otherwise have limited ability to be able to financially afford NRT. This report is in follow-up to Report No. 042-11 and will share the results of the first year of implementation of the Registered Nurses Association of Ontario Best Practice Guideline: Integrating Smoking Cessation. 

Changes in Nursing Practice

Over this past year, a number of strategies were implemented to assist HBHC staff in their abilities to assess clients’ desire to quit smoking and to implement interventions inclusive of NRT.  The staff participated in a workshop in January of 2011.  In October of the same year, a follow-up in-service was offered.  Prior to the in-service, a fluid survey was undertaken to assess the extent to which the staff practice has incorporated knowledge and skills to facilitate smoking cessation strategies with their clients.  Of the 18 public health nurses, 14 responded to the survey.  Survey finding included:

§   All PHNs asked routinely about smoking with 64% indicating that they always ask this question of their client

§   All provided advice about the importance of quitting smoking

§   72% of PHNs assessed a client’s nicotine dependence and 85% assess to determine a client’s reason for smoking

§   Just over 85% of PHNs determined client’s stage of change and identify potential triggers for smoking

§   64% of PHNs assisted clients to set a ‘quit date,’ and

§   86% talked with their clients about arranging NRT and referral to the Smokers Helpline

Prior to January 2011, these smoking cessation strategies were not part of staff members’ daily practice.  The results of the survey are an indication of how successful implementation of the best practice guidelines has been. The Family Home Visitors continue to provide encouragement and support and to remind clients of ways to cope with their stress and other triggers for smoking. 

The Results of Access to Free Nicotine Replacement Therapy

From January 2011 to January 2012, twenty four clients in the HBHC program have been given access to free NRT.  Some of these clients (6) were on NRT for only a short period of time (1 to 3 weeks) and were not successful in reducing or quitting.  The five clients who were successful in reducing the number of cigarettes were on NRT from 4 to 16.5 weeks.  The two clients who successfully quit at 3 months used NRT for 8 and 16 weeks.  Eight clients are still using NRT or require the 3 month follow-up.  Unfortunately, 3 clients have been lost to follow-up. 

Providing Ongoing Support in 2012

In 2012, the Healthy Babies Healthy Children program staff members plan to continue to provide access to Nicotine Replacement Therapy and to support clients in creating a smoke free environment, reducing their smoking, or helping them quit.  The Public Health Nurses and Family Home Visitors are aware that Ontario Works now provides clients with free medications such as Champix and Zyban and will encourage clients to see their doctors to receive these medications.  The Smokers Helpline is another free and confidential service that provides personalized support, advice and information about quitting smoking.  The goal is to encourage any client who is wishing to quit to register with the Smokers Helpline. 

This report was prepared by Ms. Nancy Summers, Manager, Family Health Services.

Graham L. Pollett, MD, FRCPC
Medical Officer of Health

This report addresses the following requirement(s) of the Ontario Public Health Standards:
Reproductuve Health Standard Requirements 4, Child Health Standard Requirement 6 and Chronic Disease and Injury Prevention Requirement 9.