K: Good morning Edith, I was wondering if we could chat about what I learnt at the national meeting I recently attended where we talked about Tackling Indigenous Smoking?
E: Hi Kane, yes of course, but with our combined experience in the health service I’m sure we already know a fair bit between us.
K: That’s what I thought too Edith with my six years working as an Aboriginal Health Practitioner in the chronic conditions team. And now working in the health promotion team on tackling smoking I thought I understood the key issues and management tools already, but the meeting really opened my eyes to some new options.
E: What else is there to know? I have been working in the chronic conditions team for ten years as an Aboriginal Health Practitioner and I know it’s important to keep up to date.
K: I have come away from the national meeting feeling really positive. There is so much going on aimed at helping Aboriginal and Torres Strait Islander people to quit and to also help kids to not start smoking and to protect them from secondhand smoke.
E: Isn’t the challenge to make sure what we are doing will work? Did they go through the research evidence? You know, the stuff that shows what works and what doesn’t.
K: Yes and not just the usual stuff about how many of us mob smoke and how it is making us sick.
E: But smoking rates are still more than double other Australians.
K: Sure, but the rates are going down, and more improvement is definitely achievable. They said research now shows most Aboriginal and Torres Strait Islander smokers want to quit and half of smokers had made a quit attempt in the past year, just like other Aussie smokers.
E: So what did the researchers say works?
K: Lots of things! Increasing the price of cigarettes through taxes, laws to make more places smokefree, and anti-smoking TV and radio campaigns. I was really interested in what they said about stopping the tobacco industry being able to market cigarettes…
E: Yes, I always remind other people in our team that it is the tobacco industry who are the problem, not smokers themselves.
K: Exactly, they just care about profits not the people they are killing. We heard about all sorts of dirty legal tricks they are using to fight the new plain packs here in Australia.
E: Did they say whether these new methods to reduce smoking make a difference?
K: Yes, there is now some good research evidence that plain packs are working, and even some early evidence that they are also working for our mob too. And have you seen the warning labels are now bigger on the packs? These are a really good way to get messages to smokers every time they pull out a smoke.
E: That’s all good but what can we do here at our health service to get those messages out to our brothers and sisters?
K: I know what you mean, I don’t think we can start increasing cigarette taxes or doing national TV campaigns…
E: No we can’t, but maybe the obvious place to start being a leader for this sort of change is in the clinic…
K: Yes, the evidence shows the clinic is a great place to start. The first thing is to make sure with every patient we see we record in their clinical record if they are a smoker, ex-smoker or have never smoked.
E: Of course we can’t help our patients to quit if we don’t know that they smoke. We already know we are doing pretty well at collecting this information because we have to report on this as part of the health service’s national reporting on our nKPIs.
K: What are nKPIs?
E: National key performance indicators. We have to provide information on them every 6 months to the Australian Institute of Health and Welfare.
K: When we are talking to our patients about their smoking status we should also take this opportunity to advise smokers about quitting. Even brief advice has been shown to make a difference.
E: Some people call that ‘Brief Interventions’, which we also do for nutrition, alcohol, physical activity and emotional and social well-being.
K: It is important that as many people as possible get training in how to give this brief advice.
E: Yes Kane, not just people like you working in tobacco, but everyone in the clinic, even people like receptionists can help to share the message.
K: There is lots of training available, and we heard that research shows that it seems to be working. More Aboriginal and Torres Strait Islander smokers remember being advised to quit than other Australian smokers.
E: We are on the right track there!
K: The presenters at the meeting said more needs to be done with other ways of helping people to quit. They talked about using Nicotine Replacement Therapy and other medications like ‘Varenicline’ which lots of people call ‘Champix’. Using the medications as well as referring people to quit groups, quit courses and to the telephone Quitline have shown to be more effective.
E: Yes that’s right, I know people who used the Quitline and it helped them make a plan to quit, as well as how to manage situations where they might feel like having a smoke when they are actually trying to quit.
K: We can also do better with the smokefree rules at the health service.
E: Sure, we put in a lot of effort when the policy started but things do slip a bit.
K: And our team can do more outside the health service by helping other organisations in town to go smokefree, or by making sure that community events like NAIDOC are smokefree.
E: Kane do you think we can also promote smokefree homes more? Even smokers want to protect their kids from secondhand smoke.
K: Yes. The researchers said that Aboriginal and Torres Strait Islander smokers were just as likely as other Australian smokers to live in a smokefree home. And smokefree homes can help smokers to quit too.
E: Is there anything you heard about the research around the TV campaigns that we could use here at the health service?
K: Well the big message was that these campaigns work if they are seen a lot by many people: in marketing speak it’s what they call ‘intensity and reach’. I think we can use those ideas with our health information
E: So do you mean we need to make sure anti-smoking posters and banners are not just displayed around the health service, but that we make sure they are also displayed at other local organisations and at lots of local events?
K: Yes, and also start to think about quit smoking messages on the radio, our website and even the new health service Facebook page. The researchers said there were extra benefits from having locally made messages with local Aboriginal and Torres Strait Islander people. They also said to make sure we include messages about smokefree homes and cars to protect other people like children.
E: That’s all good, but we should remember that we need to do this in our way. My experience is that programs always work best if Aboriginal and Torres Strait Islander people are involved.
K: I agree, I think it is really important to make sure that the Aboriginal staff here and the community members are involved as much as possible in what we should do about promoting a healthy lifestyle and quitting smoking.
E: Yes, and don’t forget involving other organisations, not just as places to put up posters. They could host events, or discussion forums.
E: Did they talk about the Aboriginal and Torres Strait Islander Tobacco Control Audit Tool?
K: Yes, but I didn’t follow it all. I haven’t been a part of the CQI stuff here. What’s it all about Edith? What does CQI even mean?
E: Continuous Quality Improvement. It involves collecting information, assessing the information, planning, taking action and then reviewing that action again. All in an ongoing cyclical process to improve services and concentrate on agreed priorities.
K: So it’s much more than just collecting data and information?
E: Yes, the planning and prioritising of services is critical. You can find out more here
E: The first step in the CQI cycle is to collect data about tobacco control at our health service. Researchers developed the Aboriginal and Torres Strait Islander Tobacco Control Audit Tool to help collect this information in a standardised way. But before you do anything read the Audit Protocol. It will tell you all about how to answer each question in the audit tool. There are a lot of questions, but it’s easy if you read the Protocol first.
E: Section 2 of the audit tool is all about smoking outcomes. This section tells us about our clients smoking status. It should be recorded in their health care record. It is easy for us because we collect this information every 6 months as part of our nKPIs.
K: So do we just have to go to our Data Officer and ask them for our most recent results for these?
E: Yes Kane. But other services might have to do this based on a sample of clinical records.
E: Section 3 looks at what we’ve been doing to support smokers to quit.
K: So how do we do this?
E: In the protocol you will see we have to go through the clinical records of a sample of regular clients who are smokers. The tool includes some tally sheets we can use for each record. I noticed this section will take a bit more time as our Data Officer can’t get the answers straight from the electronic patient record system.
K: How do we decide which records and how many records to include in the sample?
E: The training manual explains this in detail (link). It is really important to do it right, so that our results are accurate and as representative of our clients as possible.
E: Collecting information about smoke-free spaces, social marketing, and systems and processes is quite different to collecting information for other sections of the audit tool. A small group of local staff who know what’s going on in tobacco control here at the clinic can sit down and fill these out together.
K: I think you and I could just do these together, and then just get help from others if there were any answers we weren’t sure about.
E: Sure.
E: We can enter the information straight into the computer on the One21seventy website. But don’t forget to check the Protocol for each question to check we are answering the question properly. (at bottom of screen (webcast): click on here for a demonstration of how to enter data).
E: The tool also includes suggestions for recording supplementary information in Appendix 2 of the Protocol. This will help us make sense of changes when we do the audit again.
K: What then happens to our data?
E: The website immediately produces a report with our local results highlighting key messages which we can use to plan what we need to do next to improve tobacco control.
K: Ok, let’s talk about the planning.
E: We are going to need to get others involved in this process. These results will require a lot of analysis and discussion.
K: Let’s think about who are the key groups of people we need involved from the health service? We can get them together for a meeting to go through the results and start planning what to do next.
E: I think we need some others from the clinic like the clinic manager, a doctor, a nurse and some of the other Aboriginal Health Practitioners, we also need some other people from the health promotion team, including all of us who work on smoking. Let’s call a meeting.
E: Thanks everyone for coming it’s been a very useful meeting. And so much better because everyone has contributed. We found out that there are some things that we are doing really well in tobacco control but there are still some things we can do better. When we went through all the results from the audit, we wrote down all the suggestions for improvement on the white board. Now we have prioritised them to just three things to concentrate on in the next year. Can you read them out Kane?
K: We are going to ensure that NRT patches are always available in the clinic pharmacy so they can be easily dispensed. We are going to do more staff training about the smokefree policy. And finally we are going to work with more local organisations to make sure they have anti-smoking posters in their waiting areas.
E: OK, now for each of these we want to be really clear about what will happen exactly. We need to ask who will be involved, when will it be done, and do they need any new resources?
K: Well I can start with the last one, that’s easy. Our tobacco team will visit all of the local organisations and deliver our collection of posters. We will make sure each organisation has our posters in the public areas. And especially concentrate on our local ones about smokefree posters with Aunty Mavis. People really connect with that one. Then we will go back every 6 months, and offer them new and different ones.
E: Now that we have agreed on our goals and planned activities we can get started doing all of these things to improve tobacco control at our health service.
K: I’m really looking forward to doing this all again in a year to see how we are going and how to improve what we do even more.
E: Do you think the tool and the CQI process has been useful Kane?
K: Sure, it took a bit of time but we have concentrated on the areas with the most research evidence, and now we have a really clear and achievable plan for improvement that we have all agreed on.