To enable the Leicestershire Partnership NHS Trust (LPT) Stop Smoking Service to increase its access to a wider range of local people in the region who smoke, the service scoped and then developed and delivered a tobacco harm reduction project. The project uses an outreach model, and so aims to widen the service's reach with local smokers. Through arranging an initial 'go smokefree for 2 days' intervention, the service aims to be able to also engage potential clients who had not previously considered an outright tobacco quit attempt, and to ultimately help increase the number of referrals into the stop smoking service.
Aims and objectives
A key aim for the harm reduction project was to broaden the reach of the LPT Stop Smoking Service, and to enable an intervention to be offered to local people who were not at the stage yet to undertake an outright quit attempt.
The service had identified some confusion regarding NRT, which included some people having concerns about the safety of its use. The project aimed to help demystify messages regarding licensed nicotine replacement therapy (NRT) for their local population, and to provide clear and accurate advice about the benefits that NRT could provide.
Reasons for implementing your project
This project was initiated in response to the publication of the harm reduction guidance. It was clear that in advance of any commissioning changes, we could use what we had available to try and draw in the smokers who were ambivalent about quitting, especially those who had never experienced the benefits of NRT (a bit like olives 'I've never tried them but I know I don't like them'). Commissioners were informed of our intentions, assured that there were no cost implications arising from this, and that they would be kept in the loop. Both sets of commissioners were interested to follow progress, and were pleased that an element of the NICE guidance was to be explored immediately. It was referred to in discussions with both local tobacco control coordinating groups, and the group in LPT (our own organisation) which looks at compliance with NICE guidance. We were lucky to have our placement student Anna Craik to lead on this, given that she had fewer competing priorities and was able to show the rest of the team what the benefits were, and she was able to spread the net widely across city and county at health events that the core team may have struggled to attend.
How did you implement the project
The service is delivered via an outreach based model, to help engage clients who are not already using the stop smoking service, and also those who may not be aware of the service that is available locally. This is based on the suggested recommendations of raising awareness of licensed nicotine products that is feature in the NICE guidance PH45.
Trained outreach workers from the project engage local people via a number of community based settings which also includes outside the local mainline rail station. Once they have established if a person is a smoker, project staff then engage them in a discussion about their tobacco use and whether they have contemplated quitting and whether they have made any previous quit attempts. For those people that are interested, further information is provided along with a free sample of NRT with further advice, information and tips to help each person try and remain smokefree for a 2 day period. For people who plan to embark on a 2 day smokefree period, they are offered a combination of 2 forms of NRT, based on their current needs. The main focus in this project was to encourage an individual to attempt a smokefree day or more using the free sample of NRT. Again, this method was decided upon as a direct result of the NICE harm reduction guidance (PH45) which recommends the support of temporary abstinence alongside behavioural support and a harm reduction approach. This guidance clearly suggests the use of a harm reduction approach when engaging smokers who are unwilling or reluctant to quit and are consequently the targets of this project.
Along with the NRT, people are provided with an information card that explains that they have been provided with NRT and why, and that they will be receiving a follow up call from the project. The card also contains contact details for the project.
To date the project has been running for 6 months, since October 2013. During this time interventions, NRT provision with an agreement for people to undertake a 2 day smokefree period, and follow up plans have been made with 225 local people. This so far has already generated 17 validated 4 week quits with numerous individuals being referred to the service.
Results of initiating a local tobacco harm reduction service using an outreach model based upon NICE guidance PH45.
Data from 01/09/2013 to 10/04/2014
*Individual not ready to quit yet but was provided with information on the service and given advice for when ready to quit. Number for the service was given on all occasions.
**Unable to contact due to invalid phone number; no number given; or after 3 attempts no contact made.
The project has delivered outreach sessions at:
- the local football ground before football matches
- at business health events
- at local stations and transport hubs
- at local community family days
Key learning points
Key learning for the project staff has been that some community venues will be more appropriate and effective for engaging local people than others. For example, outreach at the local football ground provided limited time for the outreach staff to have meaningful conversations and offer outreach interventions with people. Key learning has also found that in order to provide a complete outreach service all members of the team would have to be briefed. This would ensure that all possible venues could be targeted efficiently with appropriate use of the time for intervention.
Additionally, for outreach events where the venue staff has been primed ahead of the event, this was found to increase and enhance proactive signposting to the outreach workers from the venue staff. Due to current monitoring systems - with a focus on 4 week quit attempts - it has been challenging for the project team to be able to distinguish how many of their outreach interventions may have helped generate quit attempts amongst their local population. But it has been possible to track individuals who have attended a session with an advisor at a clinic or pharmacy and also see their progress through the programme provided by the service.
Practice based learning has been important for the project team, and feedback from people they have engaged has also generated useful learning. This feedback helped to refine the messages that are conveyed as part of the outreach service.