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Oregon Smoke Free Mothers and Babies Project
Lesa Dixon-Gray, MSW, MPH Office of Family
Health [phone]
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Oregon is working towards improving the health
of pregnant women and their babies
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Smoke Free Mothers and Babies Project

• A collaborative partnership including
• Public Health Maternal and Child Health
  Nurses/Maternity Case Managers
• Prenatal Care Providers (OB-Gyns, CNMs, Family
  Practice Physicians)
• Oregon Quit Line

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What is our System for Delivering the 5 As?
Prenatal Care Providers
Maternity Case Management
Oregon Quit Line
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Who are Maternity Case Managers?

• MCMs are public health nurses, social workers,
  and other professionals trained to address the
  non-medical needs of pregnant clients who have
  risk factors that often contribute to poor
  pregnancy outcomes. Their goal healthy
  outcomes for families.

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Prenatal Care Providers

• 160 OB-GYNs, CNMs, Family Practice Providers in
  10 Counties, Comparison and Intervention Groups.
• Comparison Group becomes Intervention Group over
  time.
• Participating PNC providers receive 5As
  training, fax information from MCMs and the Quit
  Line, materials and cessation info from SFMB.

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Oregons Quitline System

• Public/Private Partnership
• Available for free for ANY Oregonian
• Coordinated effort to encourage Statewide use
• DHS Tobacco Prevention and Education Program
• DHS State Medicaid Office and MCO Partners
• Tobacco Free Coalition of Oregon
• Fax Referral Procedure Currently used in
  several Program Evaluations and Clinical Trials

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What is Smoke Free Mothers and Babies Project?

• Focus on system change
• Behavior change of MCMs and PNCPs
• MCMs and PNCPs use all the "5A's"
• Intervention is focused on low-income pregnant
  women via MCM system and Medicaid
• Collaborative approach between State MCH, State
  Tobacco Program, State Medicaid Program, Local
  Public Health Departments, Private Providers,
  Managed Care, MOD, and ACS

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What do we want to do?
This intervention is designed to increase the use
of the 5As by the Oregon Maternity Case
Management providers and Prenatal Care Providers
(PNCPs), i.e. OB-GYNs, CNMs
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Project Strategies and Activities

• Provide Leadership at the State and Local
  levels
• Provide Strategies for Improvement to MCMs and
  Providers
• Build Community Linkages and Partnerships with
  Community Organizations
• Encourage Continuity of Care
• Provide a Registry at the State and Local
  levels
• Provide feedback mechanisms to MCMs and
  Providers for quality improvement

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Our intervention How do we do it? An Example
OFH activity
MCM/PNCP outcomes
Site activity
Train at least one MCM per site

• Increased use of 5As
• Increased referrals to QL
• Increased coordination of
• activities with PNCPs.

Client outcomes

• Increased smoking
• cessation rates
• Increased rates of
• successful referrals
• to QL

MCM train MCM
Train at least one PNCP recruited by MCM

• Increased use of 5As
• Increased referrals to QL
• Increased coordination of
• activities with MCMs.

Train PNCP staff
PNCP staff train their PNCP
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How do we do it?

• Phase 1 Intervention group of MCMs
• Intervention group of PNCPs
• Comparison group of PNCPs
• Phase 2 Same intervention group of MCMs
• Expanded intervention group of PNCPs
• Smaller comparison group of PNCPs
• Phase 3 Intervention expanded to all PNCPs

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How do we collect the data?
About the "5A's"

• From the client (via MCM)
• FAIR form (5 As at MCM visit)
• PNCP FAIR form (5 As done by PNCP)
• From the client (directly from client)
• Postpartum survey

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How do we collect the data?
About the "5A's"

• From the MCMs
• 3 Surveys (baseline, 12-month follow up,
  24-month follow up)
• From the PNCPs intervention and comparison
• 3 Surveys (baseline, 12-month follow up, 24-month
  follow up)
• From the Quit Line
• Fax Referral Forms (ongoing basis)

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SOME RESULTS
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MCM Delivery of the "5A's" What they ALWAYS Do!

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MCM Delivery of the "5A's" ASSESS

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MCM Counseling and Motivation

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Does your agency follow the recommended tobacco
cessation guidelines?

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Familiarity with the "5A's" Process

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Barriers in Applying the 5As

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What participating PNC providers say
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PNCP Delivery of the "5A's" What they ALWAYS Do!

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Does your office follow the recommended tobacco
cessation guidelines?

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Familiarity with the "5A's" Process

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PNCP Barriers

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Barriers to the Process

• Severe State and Local Funding Cuts
• Loss of State Tobacco Program
• Quit Line loss
• Provider contact
• Data collection
• Buy-in among disseminated MCMs

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Photo by Brent Bradley, Oregon Scenics
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Lessons Learned

• Public Health and Private MD Practice operate in
  different systems. Public Health needs to learn
  their lifestyle.
• Persistence!
• Need for Collaborative Partners
• Documentation issues

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Recommendations

• A Case Management System as a vehicle to
  incorporate and provide the 5As
• A three prong approach for dissemination one
  system doesnt have total responsibility for an
  intervention
• Support to Primary Provider System is a necessity
  in dissemination and implementation of the
  5As.
• The Public Health system needs greater focus on
  developing strong links with private providers.

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Photo by Brent Bradley, Oregon Scenics
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Photo by Brent Bradley, Oregon Scenics