ORLANDO — Family and ob.gyn. practices in Maine improved their identification of pregnant smokers and improved their assessment of cessation after remodeling their office systems based on a chronic care team approach.
The goal of the project was to increase the smoking cessation treatments offered to pregnant women, Dr. Susan Swartz, of the Center for Tobacco Independence at the Maine Medical Center in Portland, said at the annual meeting of the Society for Research on Nicotine and Tobacco.
Dr. Swartz and her colleagues recruited ob.gyn. and family practices across Maine who delivered prenatal care. Each practice was asked to form a team of at least three staff members, including a nurse midwife, nurse, and medical assistant or practice manager, who would focus on making office changes that would make it easier to assess and treat smokers.
Practice members were asked to identify pregnant smokers and recent quitters, advise smokers to quit, assess interest in quitting, and offer help with quitting. “The goal was to categorize every woman who came into their practice for prenatal care and routinely address smoking risk,” Dr. Swartz said.
The 15 practices that completed the office overhaul exceeded the target for assessing interest in quitting.
The researchers had set a goal of 70%, but the practices averaged nearly 80% by month 8 of the study, compared with less than 50% during the first month.
Likewise, during the first month of the investigation only about half of the practices had documented that they assisted patients with quitting, compared with 70% at the end of the eighth month of the study.
Most practices significantly increased the number of pregnant women who were referred to Maine's telephone quit line.
Although some practices fell short of prespecified goals, all the practices showed improvement, according to Dr. Swartz.
The investigation was limited by the lack of a control group and no established baseline before the study began, Dr. Swartz noted. However, the findings did show that team-based quality improvement can enhance the performance in the counseling of smokers.
The project was funded by the Smoke-Free Families National Dissemination Office of the Robert Wood Johnson Foundation.