slide 1 oregon smoke free mothers and babies project lesa dixon-gray, msw, mph office of family...
TRANSCRIPT
Slide 1
Oregon Smoke Free Mothers and Babies Project
Lesa Dixon-Gray, MSW, MPH
Office of Family Health
(503) 731-8606
Slide 2
Oregon is working towards improving the health of
pregnant women and their babies
Slide 3
Smoke Free Mothers and Babies Project
A collaborative partnership including:
– Public Health Maternal and Child Health Nurses/Maternity Case Managers
– Prenatal Care Providers (OB-Gyns, CNMs, Family Practice Physicians)
– Oregon Quit Line
Slide 4
Slide 5 SFMB IN OREGON
Clatsop Columbia
Tillamook Washington Multnomah
ClackamasYamhill
Polk Marion
Lincoln
LinnBenton
Lane
DouglasCoos
Curry
Josephine JacksonKlamath
Lake
JeffersonWheeler
Crook
Deschutes
Harney
HoodRiver
Wasco
ShermanGilliam
Morrow
Umatilla
Grant
Union
Baker
Wallowa
Malheur
Slide 6
What is our System for Delivering the “5 A’s”?
Maternity Case Maternity Case ManagementManagement
Prenatal Care Prenatal Care ProvidersProviders
Oregon Quit LineOregon Quit Line
Slide 7
Who are Maternity Case Managers?
MCM’s are public health nurses, social workers, and other professionals trained to address the non-medical needs of pregnant clients who have risk factors that often contribute to poor pregnancy outcomes. Their goal – healthy outcomes for families.
Slide 8
Slide 9
Prenatal Care Providers160 OB-GYNs, CNMs, Family Practice
Providers in 10 Counties, Comparison and Intervention Groups.
Comparison Group becomes Intervention Group over time.
Participating PNC providers receive “5A’s” training, fax information from MCMs and the Quit Line, materials and cessation info from SFMB.
Slide 10
Oregon’s Quitline System
• Public/Private Partnership
• Available for free for ANY Oregonian
• Coordinated effort to encourage Statewide use: • DHS Tobacco Prevention and Education
Program• DHS State Medicaid Office and MCO
Partners• Tobacco Free Coalition of Oregon
• Fax Referral Procedure – Currently used in several Program Evaluations and Clinical Trials
Slide 11
What is Smoke Free Mothers and Babies
Project?• Focus on system change
• Behavior change of MCMs and PNCPs
• MCMs and PNCPs use all the "5A's"
• Intervention is focused on low-income pregnant women via MCM system and Medicaid
• Collaborative approach between State MCH, State Tobacco Program, State Medicaid Program, Local Public Health Departments, Private Providers, Managed Care, MOD, and ACS
Slide 12
What do we want to do?
This intervention is designed to increase the use of the “5A’s” by
the Oregon Maternity Case Management providers and
Prenatal Care Providers (PNCPs), i.e. OB-GYNs, CNMs
Slide 13
Project Strategies and Activities
• Provide Leadership at the State and Local levels
• Provide Strategies for Improvement to MCMs and Providers
• Build Community Linkages and Partnerships with Community Organizations
• Encourage Continuity of Care
• Provide a Registry at the State and Local levels
• Provide feedback mechanisms to MCMs and Providers for quality improvement
Slide 14 Our intervention: How do we do it? An Example…
Train at least one MCM per site
Train at least one PNCP recruited
by MCM
Train PNCP staff
PNCP staff train their PNCP
• Increased use of 5A’s• Increased referrals to QL• Increased coordination of activities with PNCPs. • Increased smoking
cessation rates • Increased rates of successful referrals to QL
MCM train MCM
• Increased use of 5A’s• Increased referrals to QL• Increased coordination of activities with MCMs.
Client outcomes
MCM/PNCP outcomesOFH activity
Site activity
Slide 15
How do we do it?
Phase 1: Intervention group of MCMs
Intervention group of PNCPs
Comparison group of PNCPs
Phase 2: Same intervention group of MCMs
Expanded intervention group of PNCPs
Smaller comparison group of PNCPs
Phase 3: Intervention expanded to all PNCPs
Slide 16
How do we collect the data?
From the client: (via MCM)
FAIR form (5 As at MCM visit)
PNCP FAIR form (5 As done by PNCP)
From the client (directly from client):
Postpartum survey
About the "5A's"
Slide 17
How do we collect the data?
From the MCMs: 3 Surveys (baseline, 12-month follow up, 24-
month follow up)
From the PNCPs: intervention and comparison 3 Surveys (baseline, 12-month follow up, 24-
month follow up)
From the Quit Line:Fax Referral Forms (ongoing basis)
About the "5A's"
Slide 18
SOME RESULTS…
Slide 19
0
10
20
30
40
50
60
70
80
90
100
ASK ADVISE ASSESS ASSIST ARRANGE
Baseline n=21 12 Months n=39
MCM Delivery of the "5A's": What they ALWAYS Do!
%
Slide 20
0
5
10
15
20
25
30
35
40
45
50
never rarely sometimes usually always
Baseline n=21 12 Months n=39
MCM Delivery of the "5A's": ASSESS %
Slide 21
0
10
20
30
40
50
60
70
80
General Info QL Info ProblemSolving
MotivationalCounseling
Baseline n=21 12 Months n=39
MCM Counseling and Motivation%
Slide 22
Does your agency follow the recommended tobacco cessation guidelines?
0
10
20
30
40
50
60
70
80
90
don't know no yes
Baseline n=21 12 Months n=39
%
Slide 23
Familiarity with the "5A's" Process
0
10
20
30
40
50
60
not seen before not very fairly very
Baseline n=21 12 Months n=39
%
Slide 24
Barriers in Applying the “5A’s”
0
10
20
30
40
50
60
location time caseload size PNCP response
Baseline n=21 12 Months n=39
%
Slide 25
What participating PNC providers say…
Slide 26
0
10
20
30
40
50
60
70
80
90
100
ASK (new) ADVISE ASSESS ASSIST ARRANGE
Baseline n=13 12 Months n=13
PNCP Delivery of the "5A's": What they ALWAYS Do!%
Slide 27
Does your office follow the recommended tobacco cessation guidelines?
0
10
20
30
40
50
60
70
80
90
100
don't know no yes
Baseline n=13 12 Months n=13
%
Slide 28
Familiarity with the "5A's" Process
0
10
20
30
40
50
60
not see before not very fairly very
Baseline n=13 12 Months n=13
%
Slide 29
PNCP Barriers
0
10
20
30
40
50
60
Staff Time Uncertain Reimbursement
Baseline n=13 12 Months n=13
%
Slide 30
Barriers to the Process
Severe State and Local Funding CutsLoss of State Tobacco ProgramQuit Line lossProvider contactData collection“Buy-in” among disseminated MCMs
Slide 31
Photo by Brent Bradley, Oregon Scenics
Slide 32
Lessons Learned
Public Health and Private MD Practice operate in different systems. Public Health needs to learn their lifestyle.
Persistence!
Need for Collaborative Partners
Documentation issues
Slide 33
Recommendations A Case Management System as a vehicle
to incorporate and provide the “5A’s”
A three prong approach for dissemination; one system doesn’t have total responsibility for an intervention
Support to Primary Provider System is a necessity in dissemination and implementation of the “5A’s”.
The Public Health system needs greater focus on developing strong links with private providers.
Slide 34
Photo by Brent Bradley, Oregon Scenics
Slide 35
Photo by Brent Bradley, Oregon Scenics