Brief Summary Of Stoke-On-Trent: A Case Study

Smoking is the cause of many of the health issues encountered when reviewing the health summary for Stoke-on-Trent. The amount of smoking related deaths is 427.9/100,000 for people aged 35 and over; very close to England’s worst (471.6). Smoking increases the risk of cardiovascular disease (CVD) and cancer. The mortality rate is significantly higher in this city from CVD than England’s average and close to England’s worst for cancer (183.9/100,000 for people aged under 75, 202.9 for England’s worst). A smoker’s CVD risk is exacerbated if also having diabetes; important as percent of recorded diabetes here is higher than England’s average. Deprivation, another problem in this city, is much higher than England’s average and is linked to the high smoking related deaths. People in more deprived areas are more likely to smoke than those of lower deprived areas. Finally, smoking status at time of delivery is higher than England’s average and can be linked to the high number of infant mortality (6.7/1,000 live births); very close to England’s worst (7.6). Smoking during pregnancy increases the risk of infant mortality. Smoking is thus an important health issue here that needs addressing.
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• Increase accessibility to a stop smoking service in Stoke-on-Trent
• Educate about the harm of smoking on the body
• Educate about the effects of smoking while pregnant on infant mortality
• Be able to assess the patient’s experience and attitude towards quitting smoking and use this information to provide cost-effective patient-suitable stop smoking interventions
• Support and encourage patients in their journey to quit
• Reduce smoking related deaths in the city, including infant
mortality

The target population would be women smokers who are pregnant (with or without diabetes) who live in the most deprived areas (in the most deprived quintile) of Stoke-on-Trent. People with diabetes (whether pregnant or not pregnant) in these areas who are smokers are also considered, as they are at more of a risk of a cardiovascular event (CVE) than the other group listed above. Both of these populations are the target and must be aged 35 and over. 20,000 patients are aimed to be recruited.

This stop smoking service will be advertised in all community pharmacies in the most deprived areas of the city. The advertisements will also list the requirements needed to qualify for the service (Age 35+ and having diabetes or being pregnant, or both). Staff members in all these pharmacies will be trained in advance in ways to deliver the service. This includes recommending NRT, consultation skills, and asking relevant questions which would reveal the course of action most suitable for the patient (i.e. if the patient has tried quitting before). All staff and pharmacists, after trained, will qualify to deliver the service. Smokers can be recruited either voluntarily, after seeing the advertisement, or alternatively, any staff member can ask patients if they smoke and want to participate. In any case, the patient’s GP must provide evidence of whether he or she has diabetes or is pregnant.
Qualified recruited participants are then booked an appointment at a time suitable for both the advisor and patient, and an appointment is booked a week after each one for a total of 7 appointments. In appointment 1, all patients are questioned on their smoking history and any previous attempts to quit (i.e. buying NRT). Any barriers between quitting smoking and ways to overcome them must also be discussed between the advisor and patient. The patient will then set a quit date for themselves, after which they will stop smoking. 4 more appointments each week after the quit date will be booked to assess patient progress after quitting, and if they have had any relapses.
In all sessions, treatment and advice provided, and action to take based on treatment status, will be based on the Stop Smoking Services NICE guidance. The risks of infant mortality and developing gestational diabetes (including type 2 diabetes in offspring) in pregnant patients, and, the exacerbated CVE risk in diabetes patients, should be educated on, and be reinforced at each appointment to increase motivation.

The measured outcome assessed to determine the efficacy of the service is the percent of recruited patients who have quit smoking within 1 year of implementation. An aim of a minimum of 20% of the users of this service who quit smoking should be achieved. This abstinence will be confirmed by use of carbon monoxide monitoring in the blood using a breath test. This is used for each patient at the start and end of the service; results taken from patients who quit with a reading of < 10 ppm.

Pharmacies should be remunerated 155 pounds for every smoker that successfully quits smoking using the service (175 pounds if patient is pregnant and diabetic at the same time), and 80 pounds for every smoker that completes the service but was not successful in quitting.