Grey Bruce Health Services, Grey Bruce Health Unit & Owen Sound Family Health Team (ON)

  • May Elhajj, Chief of Obstetrics and Gynecology, Grey Bruce Health Services, Owen Sound, Ontario
  • Hazel Lynn, Medical Officer of Health, Grey Bruce Health Unit, Owen Sound, Ontario
  • Christie Webster, Primary Health Care Nurse Practitioner, Owen Sound Family Health Team, Owen Sound, Ontario

A Multi-Institutional Approach to Improving Maternal and Fetal Health

The Better Outcome Registry and Network (BORN) database provided the characterization and quantification of many problems in the antenatal health of women in the Grey Bruce area. These problems included the higher than average incidence of obesity, teenage pregnancy, smoking, and the lack of support for postpartum depression. Our data showed that our smoking rates were twice higher than the provincial average with the majority of these antenatal smokers in the less than 20 age group.

Our intervention project focused on increasing the provider initiated referral rate of antenatal smokers to smoking cessation counselling programs. Our goal was to move away from vertical silos to horizontal flow of service provision between three institutions: Grey Bruce Health Services, Grey Bruce Health Unit, and Owen Sound Family Health Team. Pregnant smokers needed to be identified early in the gestation, ideally prior to conception, to minimize the potential deleterious effects it could have both on the fetus and the mother. Sharing a common vision to address smoking in our population, it was decided that the Family Health Team was best poised to address the issue given that primary healthcare is often the first point of entry into the healthcare system.

Each healthcare provider is supposed to address the issue of smoking with patients and direct the patient for smoking cessation counselling. However, the exact delivery of such a program may vary between clinicians due to such factors as experience, training, time constraints, and reimbursement model. The EMR was utilized to both identify antenatal smokers and refer to the clinical pharmacist.  This referral was both automatic and electronic. Results were promising with a 30% increase in referral rates. 

Lessons learned include the need for constant communication that is both simple and consistent with a feedback loop of results to report back to healthcare providers. Different venues of communication may have to be incorporated into programs such as twitter, facebook and texting. Transportation to appointments is an issue that may be better addressed by partnering with programs specifically addressing a younger antenatal patient.

Smoking is a modifiable risk factor with potential fetal and maternal health effects. This program can be reproduced by other institutions. A basic template was developed for implementation of a similar program that is adaptable to the resources that are available. If team members do not possess the credentials to offer smoking cessation counselling, Smoker’s Helpline is available to assist and track statistics.