Opportunities to Improve the Role of Family Practice Nurses in Increasing the Uptake of Evidence-Based Smoking Cessation Interventions for Pregnant Women: An Exploratory Survey

Abstract Introduction: Policies to promote smoking cessation among Medicaid-insured pregnant women have the potential to assist a significant proportion of pregnant smokers. In 2010, Kansas Medicaid began covering smoking cessation counseling for pregnant smokers. Our aim was to evaluate the use of smoking cessation benefits provided to pregnant women as a result of the Kansas Medicaid policy change that provided reimbursement for physician-provided smoking cessation counseling. Methods: We examined Kansas Medicaid claims data to estimate rates of delivery of smoking cessation treatment to Medicaid-insured pregnant women in Kansas from fiscal year 2010 through 2013. We analyzed the number of pregnant women who received physician-provided smoking cessation counseling indicated by procedure billing codes (ie, G0436 and G0437) and medication (ie, nicotine replacement therapy, bupropion, or varenicline) located in outpatient managed care encounter and fee-for-service claims data. We estimated the number of Medicaid-insured pregnant smokers using the national smoking prevalence (14%) in this population and the number of live births reported in Kansas. Results: Annually from 2010 to 2013, approximately 27.2%–31.6% of pregnant smokers had claims for nicotine replacement therapy, bupropion, or varenicline. Excluding claims for bupropion, a medication commonly prescribed to treat depression, claims ranged from 9.3% to 11.1%. Following implementation of Medicaid coverage for smoking cessation counseling, less than 1% of estimated smokers had claims for counseling. Conclusions: This low claims rate suggests that simply changing policy is not sufficient to ensure use of newly implemented benefits, and that there probably remain critical gaps in smoking cessation treatment. Implications: This study evaluates the use of Medicaid reimbursement for smoking cessation counseling among low-income pregnant women in Kansas. We describe the Medicaid claims rates of physician-provided smoking cessation counseling for pregnant women, an evidence-based and universally recommended treatment approach for smoking cessation in this population. Our findings show that claims rates for smoking cessation benefits in this population are very low, even after policy changes to support provision of cessation assistance were implemented. Additional studies are needed to determine whether reimbursement is functioning as intended and identify potential gaps between policy and implementation of evidence-based smoking cessation treatment.

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Passé or a time to pause? A phenomenological study of family physicians’ experiences of physical examination

British Journal of General Practice ◽

10.3399/bjgp18x696797 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X696797

Author(s):

Martina Kelly ◽

Lisa Freeman

Keyword(s):

Physical Examination ◽

Family Practice ◽

Phenomenological Study ◽

Essential Element ◽

Family Physicians ◽

The Body ◽

Evidence Based ◽

Structured Interviews ◽

Qualitative Phenomenological

BackgroundOnce the cornerstone of clinical family practice, the role of physical examination is changing. Patients and physicians alike express concern that emphasis on evidence-based medicine and increasing reliance of technology has relegated the role of physical examination in clinical practice.AimTo understand the role of physical examination in contemporary family practice.MethodQualitative phenomenological study, interpreted through the writings of Merleau-Ponty. Semi-structured interviews were conducted with a purposive sample of sixteen family physicians; men, women, recent graduates and experienced physician working in urban, rural and academic practices. Interviews were recorded, transcribed and examined using template analysis, complimented with researcher reflexivity.ResultsStudy participants described physical examination as core to practice, to diagnose, to communicate, and to validate patient and practitioner concerns. Performance of physical examination became routine over time but a disruption to the expected caused physicians to pause. Participants described this as a slowing of time where they became conscious of the body of the patient and their own body, intertwined in a moment. Physicians experienced affective, intellectual, and physical phenomena, which integrated to guide their behaviour, diagnosis, and management of the patient. The role of physical examination was to not only diagnosis as an evidence-based medical expert, but was experienced as a form of embodied, nonverbal communication, which expressed care.ConclusionPhysical examination plays an important role to reassure and communicate trust in the doctor–patient relationship, enacted through the body of the physician. Complimenting diagnosis, the laying on of hands remains an essential element of patient care.

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Strategies to promote practice nurse capacity to deliver evidence-based care

Journal of Health Organization and Management ◽

10.1108/jhom-05-2013-0089 ◽

2015 ◽

Vol 29 (7) ◽

pp. 988-1010 ◽

Cited By ~ 3

Author(s):

Ann Dadich ◽

Penny Abbott ◽

Hassan Hosseinzadeh

Keyword(s):

Knowledge Translation ◽

Practice Nurse ◽

Future Research ◽

Evidence Based ◽

Content Type ◽

Practice Nurses ◽

Nurse Role ◽

Evidence Based Care ◽

Sexual Healthcare

Purpose – Evidence-based practice is pivotal to effective patient care. However, its translation into practice remains limited. Given the central role of primary care in many healthcare systems, it is important to identify strategies that bolster clinician-capacity to promote evidence-based care. The purpose of this paper is to identify strategies to increase Practice Nurse capacity to promote evidence-based sexual healthcare within general practice. Design/methodology/approach – A survey of 217 Practice Nurses in an Australian state and ten respondent-interviews regarding two resources to promote evidence-based sexual healthcare – namely, a clinical aide and online training. Findings – The perceived impact of both resources was determined by views on relevance and design – particularly for the clinical aide. Resource-use was influenced by role and responsibilities within the workplace, accessibility, and support from patients and colleagues. Research limitations/implications – This is the first Australian study to reveal strategies to promote evidence-based sexual healthcare among Practice Nurses. The findings provide a platform for future research on knowledge translation processes, particularly among clinicians who might be disengaged from sexual healthcare. Practical implications – Given the benefits of evidence-based practices, it is important that managers recognize their role, and the role of their services, in promoting these. Without explicit support for evidence-based care and recognition of the Practice Nurse role in such care, knowledge translation is likely to be limited. Originality/value – Knowledge translation among Practice Nurses can be facilitated by: resources-deemed informative, relevant, and user-friendly, as well as support from patients, colleagues, and their workplace.

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Smoking cessation intervention with pregnant women and new parents: A survey of health visitors, midwives and practice nurses

Journal of Neonatal Nursing ◽

10.1016/j.jnn.2006.09.005 ◽

2006 ◽

Vol 12 (6) ◽

pp. 209-215 ◽

Cited By ~ 5

Author(s):

Leona Bull ◽

Emma Whitehead

Keyword(s):

Smoking Cessation ◽

Pregnant Women ◽

Smoking Cessation Intervention ◽

Practice Nurses ◽

Cessation Intervention ◽

Health Visitors

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Smoking cessation support for pregnant women: role of mobile technology

Substance Abuse and Rehabilitation ◽

10.2147/sar.s84239 ◽

2016 ◽

pp. 15 ◽

Cited By ~ 20

Author(s):

Christina Heminger ◽

Jennifer Schindler-Ruwisch ◽

Lorien Lorien Abroms

Keyword(s):

Smoking Cessation ◽

Pregnant Women ◽

Mobile Technology

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Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Health Technology Assessment ◽

10.3310/hta21360 ◽

2017 ◽

Vol 21 (36) ◽

pp. 1-158 ◽

Cited By ~ 27

Author(s):

Linda Bauld ◽

Hilary Graham ◽

Lesley Sinclair ◽

Kate Flemming ◽

Felix Naughton ◽

...

Keyword(s):

Smoking Cessation ◽

Pregnant Women ◽

Smoking Behaviour ◽

Smoking In Pregnancy ◽

Social Ecological ◽

Stop Smoking ◽

Effective Interventions ◽

The Social ◽

In Pregnancy

Background Although many women stop smoking in pregnancy, others continue, causing harm to maternal and child health. Smoking behaviour is influenced by many factors, including the role of women’s significant others (SOs) and support from health-care professionals (HPs). Objectives To enhance understanding of the barriers to, and facilitators of, smoking cessation and the feasibility and acceptability of interventions to reach and support pregnant women to stop smoking. Design Four parts: (1) a description of interventions in the UK for smoking cessation in pregnancy; (2) three systematic reviews (syntheses) of qualitative research of women’s, SOs’ and HPs’ views of smoking in pregnancy using meta-ethnography (interpretative approach for combining findings); (3) semistructured interviews with pregnant women, SOs and HPs, guided by the social–ecological framework (conceptualises behaviour as an outcome of individuals’ interactions with environment); and (4) identification of new/improved interventions for future testing. Setting Studies in reviews conducted in high-income countries. Qualitative research was conducted from October 2013 to December 2014 in two mixed urban/rural study sites: area A (Scotland) and area B (England). Participants Thirty-eight studies (1100 pregnant women) in 42 papers, nine studies (150 partners) in 14 papers and eight studies described in nine papers (190 HPs) included in reviews. Forty-one interviews with pregnant women, 32 interviews with pregnant women’s SOs and 28 individual/group interviews with 48 HPs were conducted. Main outcome measures The perceived barriers to, and facilitators of, smoking cessation in pregnancy and the identification of potential new/modified interventions. Results Syntheses identified smoking-related perceptions and experiences for pregnant women and SOs that were fluid and context dependent with the capacity to help or hinder smoking cessation. Themes were analysed in accordance with the social–ecological framework levels. From the analysis of the interviews, the themes that were central to cessation in pregnancy at an individual level, and that reflected the findings from the reviews, were perception of risk to baby, self-efficacy, influence of close relationships and smoking as a way of coping with stress. Overall, pregnant smokers were faced with more barriers than facilitators. At an interpersonal level, partners’ emotional and practical support, willingness to change smoking behaviour and role of smoking within relationships were important. Across the review and interviews of HPs, education to enhance knowledge and confidence in delivering information about smoking in pregnancy and the centrality of the client relationship, protection of which could be a factor in downplaying risks, were important. HPs acknowledged that they could best assist by providing support and understanding, and access to effective interventions, including an opt-out referral pathway to Stop Smoking Services, routine carbon monoxide screening, behavioural support and access to pharmacotherapy. Additional themes at community, organisational and societal levels were also identified. Limitations Limitations include a design grounded in qualitative studies, difficulties recruiting SOs, and local service configurations and recruitment processes that potentially skewed the sample. Conclusions Perceptions and experiences of barriers to and facilitators of smoking cessation in pregnancy are fluid and context dependent. Effective interventions for smoking cessation in pregnancy should take account of the interplay between the individual, interpersonal and environmental aspects of women’s lives. Future work Research focus: removing barriers to support, improving HPs’ capacity to offer accurate advice, and exploration of weight concerns and relapse prevention. Interventions focus: financial incentives, self-help and social network interventions. Study registration This study is registered as PROSPERO CRD42013004170. Funding The National Institute for Health Research Health Technology Assessment programme.

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