Q clinic Q clinic Hospital experience Hospital experience

Lau Chee Lan

Hospital UKM

BackgroundBackground

Counselling week HUKM :Counselling week HUKM : Good response to Quit smoking boothGood response to Quit smoking booth : avr 80-119 visits: avr 80-119 visitssmokers population in Cheras : 12.9% smokers population in Cheras : 12.9% CSCSP programmeCSCSP programme ’’TAK NAK’ campaignTAK NAK’ campaign

ObjectiveObjective

To provide professional help to aid To provide professional help to aid smokers quit smokingsmokers quit smoking

To provide continuous support and To provide continuous support and monitoring for smoker to quitmonitoring for smoker to quit

To prevent or reduce smoking related To prevent or reduce smoking related disease among HUKM patientsdisease among HUKM patients

Set upSet up

Support from hospital administratorSupport from hospital administratorConsultation : Prof. HanikiConsultation : Prof. Haniki

Pn. FaridahPn. FaridahTraining : MPS- CSCSPTraining : MPS- CSCSP

PreparationPreparation

Literature search and counselling aidsLiterature search and counselling aidsProposal and Budget approvalProposal and Budget approvalProtocol and work flowProtocol and work flowClinic Location and DayClinic Location and DayStaffStaffTraining and certificationTraining and certification

EquipmentsEquipments

Breath AnalyzerBreath Analyzer (PICO®) (PICO®) Nicotine Replacement Therapy (Patch Nicotine Replacement Therapy (Patch

+Gums)+Gums) - FOC for 1 - FOC for 1stst 3 mth for staff 3 mth for staffBP setBP setWeighing scaleWeighing scalePosters and leafletsPosters and leafletsAppointment logAppointment logBed Head TicketsBed Head Tickets

ImplementationImplementation

Consultant : Doctor Consultant : Doctor Medical assistantMedical assistant 11 pharmacists : 2 per clinic session11 pharmacists : 2 per clinic session DietitianDietitian

Staff clinicStaff clinic Tuesday : 2.00-4.30p.mTuesday : 2.00-4.30p.m

ImplementationImplementation

HUKM staff referred from Polyclinic or ‘walk in’HUKM staff referred from Polyclinic or ‘walk in’ Each clinic session : Each clinic session :

- max 8 clients- max 8 clients

(including max 4 new clients)(including max 4 new clients)

Flow chart /Work ProcessFlow chart /Work ProcessPre-clinicPre-clinic

Patients walk-in or referred - Gives name and contact to MA at Klinik Warga

MA arranges appointment date, calls to inform patients

Every Monday - informs Pharmacist number of appointments and prepare patients BHT

Take Blood Pressure and weight.

- Assess patient - fagerstrom test - CO level - counselling

Pharmacist dispense NRT to staff and fill in log book. Non-staff to buy NRT from Kedai Farmasi (Pharmacist to fill in Order Form for patient)

Follow up appointment :1st month : Every week2nd & 3rd month : Every 2 weeklyTill 6th month : Every month

On clinic day On clinic day

- Refer to Doctor / Dietitian

MonitoringMonitoring

Initial visit Initial visit Initialvisit_form25.5.06.docInitialvisit_form25.5.06.doc

Follow up Follow up FU_form25.5.06.docFU_form25.5.06.doc

Treatment chart Treatment chart Txchart_formTxchart_form 03.04.07.doc 03.04.07.doc

Monitoring chart Monitoring chart Patient monitoring Patient monitoring chart_Quitchart_Quit clinic.xlsclinic.xls

Statistics ( Apr 06- Jan 07)Statistics ( Apr 06- Jan 07)

Number of client and stage of follow upNumber of client and stage of follow up

FrequencyFrequency Percent (%)Percent (%)

< 3 months< 3 months 55 1212

3- < 6 months3- < 6 months 1111 2727

6 - 9 months6 - 9 months 99 2222

>9 months>9 months 44 1010

Only one visitOnly one visit 77 1717

Defaulted F/up or Defaulted F/up or withdrawnwithdrawn

55 1212

TotalTotal 4141 100100

Demographic of clients

Characteristics Number of client

No (%)  

Fagerstrom score 1-3 Low 12 (41)

4-5 Medium 9 (31)

6-7 High 6 (21)

8-10 Very High 2 ( 7)

Smoking history 1-5 years 2 ( 7)

6-10 years 14 (48)

> 10 years 13 (45)

Characteristics Number of client

No (%)  

Cigarettes smoked /day

10 or less 8 (28)

11 to 20 16 (55)

21 to 30 2 ( 7)

31 or more 3 (10)

Previous quit attempts Never 8 (27)

1-2 times 9 (31)

3-4 times 9 (31)

> 4 times 3 (10)

Characteristics Number of client

No (%)  

Expired CO ≤ 10 ppm 7 (24)

11-20 ppm 14 (48)

>20 ppm 8 (28)

4

1

7

4

8

5

0%

20%

40%

60%

80%

100%

Pe

rce

nt

<3 mths 3-<6mths 6-<12mths

Stage of follow up

Non abstinent

Abstinent

N = 29

Abstinence rate

ObstaclesObstacles

Fluctuating client motivation /determinationFluctuating client motivation /determination

- Default appointment- Default appointment

- ? Stress at work - ? Stress at work ? Counsellor – young, nonsmoker? Counsellor – young, nonsmoker? Rapport issue? Rapport issueLocation? – privacyLocation? – privacy

- -

Client surveyClient surveyImpression on pharmacistImpression on pharmacist %% Mean Mean

scorescore

Pharmacist is reliable and helpfulPharmacist is reliable and helpful 9292 4.14.1

understand what was bothering meunderstand what was bothering me 8888 3.83.8

Hardly explain my problemHardly explain my problem 17.817.8 2.62.6

made me feel foolishmade me feel foolish 5757 2.72.7

should tell more how to manage my should tell more how to manage my conditioncondition

7171 3.93.9

Strongly agree : 5 agree : 4 uncertain: 3 Disagree : 2 Strongly disagree:1

N = 28

Client SurveyClient Survey

ConvenienceConvenience %% Mean Mean scorescore

Missed appointment due to work Missed appointment due to work commitmentcommitment

86%86%

Appointment should be remindedAppointment should be reminded 82%82% 3.83.8

Client SurveyClient Survey

Overall SatisfactionOverall Satisfaction %% Mean Mean scorescore

felt much better after clinicfelt much better after clinic 6868 3.93.9

will recommend to other smokerswill recommend to other smokers 8686 4.24.2

All things considered satisfactoryAll things considered satisfactory 8282 4.04.0

Future planFuture plan

One to one counsellingOne to one counsellingMotivational Interviewing (MI) skillMotivational Interviewing (MI) skillUpdates and trainingUpdates and training

Audience at CSCSP refresher course

CSCSP Refresher course