Authors (including presenting author) :
Lee SH, Wong TK, Yau LM, Chao DVK
Affiliation :
Department of Family Medicine and Primary Health Care, United Christian Hospital
Introduction :
Smoking is a major risk factor linked to multiple non-communicable diseases. Smoking cessation has been shown to reduce mortality and morbidity in patients, regardless of the age. This audit aims to evaluate and improve the quality of care on management of smoking cessation in patients with chronic diseases in a Family Medicine Specialist Clinic (FMSC).
Objectives :
1) To set the evaluation criteria and standard of care on smoking cessation according to evidence-based guidelines. 2) To evaluate the quality of care on the management of smoking cessation based on the pre-set criteria and standard. 3) To identify areas of deficiency in the management of smoking cessation in FMSC. 4) To implement a plan of changes in the management of smoking cessation to improve the quality of care. 5) To evaluate the outcome performance after implementation of these changes.
Methodology :
Seven audit criteria, including five process criteria and two outcome criteria, and their standard were developed according to guidelines. The outcome criteria included: (1) Percentage of smokers who quitted smoking for at least 1 month (quit rate). (2) Percentage of smokers with forward movement of stage of behaviour change. The audit was carried out in two phases. In phase I (7/2018–6/2019), a randomly selected sample of smokers that had FMSC follow-up were recruited. The performance of each criteria was assessed against the corresponding standard. Deficiencies in the management of smoking cessation were identified. Changes were then implemented accordingly since 8/2019 to improve the quality of care in smoking cessation. In phase II (8/2019–7/2020), smokers that had FMSC follow-up were sampled and analyzed similarly. Results from the two phases were compared using statistical analysis.
Result & Outcome :
All process criteria achieved statistically significant improvements. The quit rate of smokers raised from 5.3% in phase I to 9.4% in phase II. There was a statistically significant increase in the percentage of smokers with forward movement of stage of behavior change towards quitting tobacco, from 6.0% in phase I to 17.8% in phase II (p-value <0.01). Four out of seven of the criteria reached the pre-set standard in phase II, compared with none in phase I. To conclude, this audit has achieved significant improvement in smoking cessation intervention in the clinic and can be served as a reference for future enhancement.
