Implementation of a clinical practice guideline for smoking cessation in a public antenatal care setting.
BACKGROUND
Despite high level evidence showing that antenatal smoking cessation programs are effective in reducing the number of women who smoke during pregnancy and the number of low birthweight and preterm births, few Australian hospitals have adopted a systematic approach to assist pregnant women to stop smoking.


OBJECTIVE
The aim of this study was to assess the effectiveness of a smoking cessation guideline, developed specifically for clinicians providing antenatal care in public maternity hospitals, combined with an implementation program on the uptake of evidence-based practice.


METHODS
A clinical practice guideline was developed and an implementation strategy was tested, using a prospective before-and-after study design, at the Mater Mothers' Hospital in Brisbane. Women were surveyed in late pregnancy, pre- and post-implementation. The primary outcome measures were women's report of appropriate smoking cessation support received, specifically, information brochures and referral to Quitline. Secondary outcome measures included women's report of smoking status in late pregnancy and relapse rates.


RESULTS
Post-implementation, more women reported receiving written materials on smoking cessation (76% vs 35%; relative risk (RR) 3.4; 95% confidence interval (CI) 2.7, 4.2) and referral to Quitline (67% vs 14%; RR 4.9; 95% CI 3.0, 8.0). While not statistically significant, fewer women post-implementation reported smoking in late pregnancy (19.5% vs 16.7%) and fewer reported smoking > 10 cigarettes per day (38% vs 25%).


CONCLUSIONS
Clinical practice guidelines specifically designed for a public maternity care setting combined with an implementation program resulted in an increase in evidence-based practice with some indication of improved smoking behaviour for women.
Flenady
Vicki
V
Centre for Clinical Studies, Mater-Health Services, Brisbane, Queensland, Australia.
Macphail
Julie
J
New
Karen
K
Devenish-Meares
Paul
P
Smith
Julie
J
D000293:Adolescent; D000328:Adult; D003376:Counseling; D019317:Evidence-Based Medicine; D005260:Female; D006771:Hospitals, Maternity; D006801:Humans; D009035:Mothers / Q000193:education* / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods; D011322:Primary Prevention / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D016540:Smoking Cessation / Q000208:ethnology / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D055815:Young Adult