QOF

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Patient Population

Patients aged 15 years and over who are recorded as current smokers.

Current Smokers codes

137.. Tobacco consumption (v28)
1372. Trivial smoker - <1 cig/day
1373. Light smoker - 1-9 cigs/day
1374. Moderate smoker - 10-19 cigs/day
1375. Heavy smoker - 20-39 cigs/day
1376. Very heavy smoker - 40+ cigs/day
137C. Keeps trying to stop smoking
137D. Admitted tobacco cons untrue?
137G. Trying to give up smoking
137H. Pipe smoker
137J. Cigar smoker
137M. Rolls own cigarettes
137P. Cigarette smoker
137Q. Smoking started
137R. Current smoker
137V. Smoking reduced
137X. Cigarette consumption
137Y. Cigar consumption
137Z. Tobacco consumption NOS
137a. Pipe tobacco consumption
137b. Ready to stop smoking
137c. Thinking about stopping smoking
137d. Not interested in stopping smoking
137e. Smoking restarted
137f. Reason for restarting smoking
137h. Minutes from waking to first tobacco consumption
137m. Failed attempt to stop smoking
137o. Waterpipe tobacco consumption
 
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Exclusions

9hG1. Excepted from smoking quality indicators: Informed dissent
9hG0. Excepted from smoking quality indicators: Patient unsuitable
137k. Refusal to give smoking status
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Smoking Cessation Treatment ( Added in the last 12 months)

745H. Smoking cessation therapy
745H0 Nicotine replacement therapy using nicotine patches
745H1 Nicotine replacement therapy using nicotine gum
745H2 Nicotine replacement therapy using nicotine inhalator
745H3 Nicotine replacement therapy using nicotine lozenges
745H4 Smoking cessation drug therapy
745Hy Other specified smoking cessation therapy
745Hz Smoking cessation therapy NOS
8B3f. Nicotine replacement therapy provided free
8B2B. Nicotine replacement therapy
8B3Y. Over the counter nicotine replacement therapy
8IEM. Smoking cessation drug therapy declined
du3% NICOTINE
du6% BUPROPION
du7% NICOTINE 2
du8% VARENICLINE
duB.. NICOTINE 3
duB1. NIQUITIN STRIPS 2.5mg mint flm o
duBz. NICOTINE 2.5mg oral film
8B2B0 Issue of nicotine replacement therapy voucher (v30)

Or a Smoking Cessation Code ( Added in the last 12 months)

8CAL. Smoking cessation advice
8HTK. Referral to stop-smoking clinic
8HkQ. Referral to NHS stop smoking service
8H7i. Referral to smoking cessation advisor
8IAj. Smoking cessation advice declined
8IEK. Smoking cessation programme declined
9N2k. Seen by smoking cessation advisor
13p50 Practice based smoking cessation programme start date
9Ndf. Consent given for follow-up by smoking cessation team
9Ndg. Declined consent for follow-up by smoking cessation team
8T08. Referral to smoking cessation service (v26)
8IEo. Referral to smoking cessation service declined (v26)

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SMOK 004.1 Rationale

The aim of this domain is to increase the proportion of successful smoking quit attempts by providing the best available support and treatment. A wide range of diseases and conditions are caused by cigarette smoking, including cancers, respiratory diseases, CHD and other circulatory diseases, stomach and duodenal ulcers, ED and infertility, osteoporosis, cataracts, age-related macular degeneration and periodontitis (US DH and Human Services 2004). Women who smoke during pregnancy are also at substantially higher risk of spontaneous abortion (miscarriage) than those who do no smoke. Smoking can also cause complications in pregnancy and labour, including ectopic pregnancy, bleeding during pregnancy, premature detachment of the placenta and premature rupture of the membranes

. In 2011, 20 per cent of the adult population of Great Britain were cigarette smokers. The overall prevalence of smoking has been at approximately this level since 2007174. Around 33 per cent of the population of England tried to stop in 2011, but only two to three per cent of the population succeed in stopping. Many of these attempts fail because they are made without treatment.

There is good evidence to suggest that offering support and treatment is sufficient to motivate some smokers to attempt to stop who would not have done so with brief advice to quit alone. For example, a Cochrane review that included 132 trials of nicotine replacement therapy (NRT), with over 40,000 people in the main analysis, found evidence that all forms of NRT made it more likely that a person's attempt to quit smoking would succeed. The chances of stopping smoking were increased by 50 to 70 per cent.

NHS Stop Smoking Services, combine psychological support and medication. Results for April 2012 to March 2013 showed that 724,247 people who had contact with the service had set a quit date. Four weeks later, 373,872 people had successfully quit (based on self-report) representing half of those who set a quit date.

'An offer of support and treatment' means offering a referral or self-referral to a local NHS Stop Smoking Service adviser (who might be a member of the practice team) plus pharmacotherapy. Where such support is not acceptable to the patient, an alternative form of brief support, such as follow-up appointments with a GP or practice nurse trained in smoking cessation, may be offered.

The NICE public health guidance on smoking cessation states that healthcare professionals who advise on, or prescribe, NRT, varenicline or bupropion:

1. Offer NRT, varenicline or bupropion, as appropriate, to patients who are planning to stop smoking

2. Offer advice, encouragement and support, including referral to the NHS Stop Smoking Service

3. When deciding which therapies to use and in which order,discuss the options with the client, and take into account:

The guidance also states that managers and providers of NHS Stop Smoking Services:

1. Offer behavioural counselling, group therapy, pharmacotherapy, or a combination of treatments that have been proven to be effective.

2. Ensure clients receive behavioural support from a person who has had training and supervision that complies with the "Standard for training in smoking cessation treatments" or its updates

3. provide tailored advice, counselling and support, particularly to clients from minority ethnic and disadvantaged groups

4. Provides services in the language chosen by clients, wherever possible.

NICE public health guidance also states that stop smoking advisers and other healthcare practitioners who advise on, supply, or prescribe, pharmacotherapies should encourage people who are already using an unlicensed nicotine-containing product (such as unlicensed electronic cigarettes) to switch to a licensed product.

Due to the potential for ex-smokers to resume smoking within three years of cessation, it is good clinical practice to ask patients with a history of smoking their current smoking status and offer treatment and advice where necessary. It is also good practice to ask and record the smoking status of newly registered patients and to offer support and treatment where necessary.

For further information see NICE public health guidance 1, 10, 45 and 48.

SMOK 004.2 Reporting and verification

See indicator wording for requirement criteria.

There is no APDF calculation for SMOK003 and SMOK004.

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Prepared By Jean Keenan