Evaluation of a complex healthcare intervention to increase smoking cessation in pregnant women: interrupted time series analysis with economic evaluation

Abstract

ObjectivesTo evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking.DesignInterrupted time series analysis of routine data before and after introducing the intervention, within-study economic evaluation.SettingEight acute NHS hospital trusts and 12 local authority areas in North East England.Participants37 726 records of singleton delivery including 10 594 to mothers classified as smoking during pregnancy.InterventionsA package of measures implemented in trusts and smoking cessation services, aimed at increasing the proportion of pregnant smokers quitting during pregnancy, comprising skills training for healthcare and smoking cessation staff; universal carbon monoxide monitoring with routine opt-out referral for smoking cessation support; provision of carbon monoxide monitors and supporting materials; and an explicit referral pathway and follow-up protocol.Main outcome measuresReferrals to smoking cessation services; probability of quitting smoking during pregnancy; additional costs to health services; incremental cost per additional woman quitting.ResultsAfter introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter.ConclusionsThe implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery.

Barriers and facilitators to smoking cessation in pregnancy and in the post‐partum period: The health care professionals’ perspective

“…Some pregnant smokers with experience of an opt‐out referral have reported being unhappy with the lack of choice with some even describing powerlessness and resentment (Sloan et al ., 2016). Yet opt‐out pathways have been shown to increase support, access, and abstinence (Bell et al ., 2017; Campbell et al ., 2017). Informing health care professionals of the potential benefits of opt‐out over opt‐in referrals, including emphasizing that many pre‐implementation concerns do not emerge post‐implementation (Campbell et al ., 2016), could help with adoption and delivery (Jordan et al ., 2006).…”

“…Integrating agreed scripts to aid discussion around smoking could help professionals present a clear and comprehensive picture of the risks and avoid the common practice of raising only certain risks to minimize upset, which is largely at odds with the information preferences of pregnant smokers (Arborelius & Nyberg, 1997; Lendahls et al ., 2002). Health care professionals have reported interest in scripts for discussing smoking with pregnant women (Colomar et al ., 2015), and a midwife‐delivered standardized ‘risk perception’ intervention has already been implemented in North East England as part of an opt‐out referral pathway (‘BabyClear’) (Bell et al ., 2017). …”

“…Despite growing implementation of the opt‐out protocol, comparatively little is known about the views of health care professionals on this intervention. While the implementation of an opt‐out pathway has been associated with a twofold increase in support access and cessation during pregnancy (Bell et al ., 2017; Campbell et al ., 2017), only a minority of pregnant smokers ultimately have access to this pathway (Health and Social Care Information Centre, 2015). Therefore, it is important to increase our understanding of interactions between health care professionals and pregnant smokers generally, as well as those connected with opt‐out referrals.…”

Application of Interrupted Time Series Modelling to Prime Motor Spirit Distribution in Nigeria

“…By the use of this approach the establishment of Federal Road Safety Corps in Nigeria has been shown to have the impact of reducing the number of accidents on Nigerian roads temporarily by Oreko et al [6]. Bell et al [7] evaluated the impact of healthcare intervention on the smoking habits of some pregnant women and observed that it produced the expected effect of increased quitting of the habit by the pregnant women on delivery. Etuk and Victor-Edema [8] proposed an intervention model for monthly Naira/Euro exchange rates.…”

“…CONCLUSIONS It may be concluded that PMS distribution has been significantly affected by the deregulation of the downstream sector of the Nigerian crude oil industry. An adequate intervention model in this respect is given by equation (7). This might be used to explain and control this phenomenon.…”