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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.
Prepared By Jean Keenan