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Specialising in Treating Tobacco Dependency - Lesley Petre

Friday, September 22, 2023

Respiratory Futures recently spoke to respiratory healthcare professional Lesley Petre. Lesley Petre is a Tobacco Dependency Specialist and the lead for South Warwickshire University NHS Foundation and George Elliot trust.  

Can you tell us how you became interested in tobacco dependency and how your role was created? 

From a professional perspective, I felt that I needed a new career challenge. In my previous role I worked in Cardiology and observed numerous patients come into our unit with acute heart conditions, alongside a tobacco addiction, all of whom required expert support in quitting that addiction. However, at the time there was no embedded infrastructure to support said patients with their tobacco addiction. This was further reinforced when patients returned to hospital with deterioration of their long-term illness, and often this was estimated to be attributable to their continued smoking.  

The move to the newly created Tobacco Dependency role provided me with an opportunity to embed a new service across two hospitals and gave me the new career challenge I was after.  

Personally, I used to smoke when I was younger, and I was raised in a family that also smoked and felt that it was normal behaviour. Through this experience, I feel I can empathise with patients battling the addiction, which in turn, has given me the tools and ability to tailor robust treatment plans for my patients. I always felt as a smoker, that non-smokers never understood the control it has upon a person, and I thought through my own experience I could help patients.   

 Can you tell us about how the demographics of your local population impacts how you plan and deliver a tobacco dependency service? 

I am the lead nurse for the Tobacco Dependency Service across two trusts. One trust is in an affluent area whilst the other is in an area of deprivation. For these reasons I hold differing perspectives. I always felt it was crucial to meet the holistic needs of our patients via demographic indicators. The treatment remains the same however, and a patient centred approach that considers social determinants of health is always adopted to ensure the best outcomes. For example, I consider the patient’s home environment and the social network surrounding them.  The patient’s personal opinions, cultural views, beliefs, and risk perceptions surrounding tobacco use are always at the forefront of my mind when delivering the service.  

Witnessing the health inequalities surrounding tobacco dependency, and the impact this has on patient’s lives, motivates me to make positive changes. For the patient’s themselves but, also to ensure this programme is successfully embedded across the Trusts.  

Why do you feel this is a high priority programme to roll out within your trust? 

To begin with I felt it was important mainly from my past experiences within cardiology, and the devastating effects smoking has on a patient’s long-term condition.  

Since launching our service 6 months ago, I can see the number of patients coming through A&E with long term illnesses attributed to tobacco who require lifesaving treatment, receive life changing diagnoses or premature fatalities. Now more than ever I feel it is crucial to continue the hard work we have started within the service, and there needs to be more awareness of the damage tobacco products are causing to our society. This programme not only has the ability to save lives, but also to improve the quality of patient’s lives, and subsequently, reduce health inequalities.  Can you explain what you did within the first 3 months? 

I researched a lot!! Mainly with regards to the top ten long term illnesses linked to smoking, and what health effects smoking causes scientifically. In addition, why smoking is so addictive, both psychologically and physiologically, the different elements to addiction and the best treatment plans. 

From a systems perspective, I researched how I can deliver a service that is going to work with minimal complication and reduced burden on the medical/nursing team. Furthermore, I considered how to engage both patient and colleagues at Trust level, making use of   audience appropriate communication methods to ensure buy-in.  

Understanding the health inequalities for the communities surrounding the two Trusts was a key requirement, for me personally once I started the role. I wanted to have a better appreciation into the challenges my patients were facing and how to embed this learning into the programme.  

A Tobacco Dependency Project Group had launched, for which I was a key partner which I believe was started by my Integrated Care Board lead.  

As part of this group, I contributed guidance and advice regarding Nicotine Replacement Therapy currently utilised within the Trusts. This included information about concerns regarding adverse reactions, and how to ensure consistency with administration of NRT products across the system. It was important to have equity of access across both Trusts and we ensured that prescriptions were individually targeted to patient need. 

What were your main barriers/difficulties in the early stages of starting the programme and how did you overcome these? 

I would say myth busting and navigating differences of opinion regarding tobacco dependency as an addiction which can often be perceived as too much of a challenge to implement change or accepted as a lifestyle behaviour.  

Buy-in was a challenge as tobacco addiction was not seen as a key issue for those providing acute care. However, it must be noted, this view was not shared by the majority. I am delighted to say there has been a real positive shift, with secondary prevention as the future; Secondary prevention is the effort aimed at reducing or halting the progression of re-admissions to hospital due to smoking related illnesses. A clinic may be one of the options to pre-empt these admissions. The efforts of myself and the other members of the Tobacco Dependency Team have been rewarded and awareness has increased as the programme has rolled out across the Trusts.  

From what you have achieved so far, is there anything you would have done differently if you were to start over again?  

It is early days as I am currently still launching both services, however, I have a few points;  

- being clearer about the future funding so I could be more confident about workforce sustainability. 

- One MDT focusing on Tobacco Dependency across the system for all TD team and wider members.  

- Begin the recruitment process with band 4s as opposed to band 3s as the approval and recruitment process was very time consuming. Recruiting band 3’s unfortunately was not successful due to no interest in banding vs responsibility and pay.  

- Dedicated more time to the data collection requirements, factoring in dummy run tests before the NHSE submission window went live 

- Increased buy-in from the Trusts at a strategic level to improve roll out 

-Doctors training and resources to be released prior to roll out so they are fully informed regarding the requirements from themselves in terms of prescribing medications and completing referrals.  How do you feel the programme is benefitting the trust and most notably, patients with a tobacco dependency? 

I am seeing on a day-to-day basis the benefit this service is having on my patients, whether this is through feedback whilst they are in hospital or after they have been discharged. We have already helped patients with their quit management plan, which will hopefully, have helped them with their long-term health condition management, improved their quality of life and reduced the likelihood of premature death. 

It is too early to see the long-term benefits from a Trust perspective, but we know through cost modelling tools that we will be reducing re-admissions, which will have associated financial benefits, alongside improving the number of beds available through reduced unnecessary admissions. 

Do you have any recommendations on how you plan to maintain and sustain the programme to ensure it is embedded within the Trust in the longer term? 

As a system we are looking at how we can ensure the programme is fully embedded within each Trust and I think there are a number of key methods, such as. 

- Showcasing the effectiveness of the programme and promoting the benefits to the Trust, such as a reduction in readmission numbers.  

- Ensuring tobacco dependency training remains within core induction processes for Junior Doctors.  

- On going communication throughout the hospital about the programme, and not just for Stoptober. Furthermore, supporting the Trust workforce to quit smoking too. A healthy workforce is a happy workforce.  

- Reviewing and assessing our communication and processes from the patient’s point of view, to understand what would help them through this journey. It is through these discussions we are in the process of designing a stop smoking patient journal.