QOF

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Patient Population

With co-morbidity of coronary heart disease, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD and aged 18 or over, schizophrenia, bipolar affective disorder, other psychoses or Asthma and aged 20 or over.

(Note: A patient need only qualify for ONE of the disease areas to be included in the patient population)

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 005.1 Rationale

This indicator relates to patients who are on the disease registers for CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma and mental health who are recorded as current smokers.

Coronary Heart Disease

Smoking is known to be associated with an increased risk of coronary heart disease.

SIGN Clinical Guideline 97 (2007); European Task Force European Society of Cardiology
www.sign.ac.uk/guidelines/fulltext/97/index.html

European Society of Cardiology. European Guidelines. CVD Prevention in clinical practice.
www.escardio.org/guidelines-surveys/esc-guidelines/pages/cvdprevention.aspx

PAD

Peripheral arterial disease is associated with older age and with smoking. Cigarette smoking is a very important contributor to PAD and management of PAD includes smoking cessation

Stroke/TIA.

There are few randomised clinical trials of the effects of risk factor modification in the secondary prevention of ischaemic or haemorrhagic stroke. However inferences can be drawn from the findings of primary prevention trials that cessation of cigarette smoking should be advocated.

SIGN clinical guideline 108. Management of patients with stroke or TIA: assessment, investigation, immediate management and secondary prevention 2008..
http://www.sign.ac.uk/guidelines/fulltext/108/index.html

Hypertension.

There is no strong direct link between smoking and blood pressure. However, there is overwhelming evidence of the relationship between smoking and cardiovascular and pulmonary diseases. NICE clinical guideline 127 on hypertension recommends that people who smoke are offered advice and help to stop smoking.

http://www.nice.org.uk/guidance/CG127

Diabetes.

The risk of vascular complications in patients with diabetes is substantially increased. Smoking is an established risk factor for cardiovascular and other diseases.

COPD.

Smoking cessation is the single most effective - and cost-effective - intervention to reduce the risk of developing COPD and stop its progression.

NICE clinical guideline 101 (2010). Management of chronic obstructive pulmonary disease in adults in primary and secondary care.
http://guidance.nice.org.uk/CG101

Further Information:
GOLD Guidelines,
www.goldcopd.com/

Asthma.

Asthma There are a surprisingly small number of studies on smoking related to asthma. Starting smoking as a teenager increases the risk of persisting asthma. One controlled cohort study suggested that exposure to passive smoke at home delayed recovery from an acute attack. Smoking reduces the benefits of inhaled steroids and this adds further justification for recording this outcome. There is also epidemiological evidence that smoking is associated with poor asthma control.See Tomlinson et al. Thorax 2005; 60: 282-7.

Chronic Kidney Disease.

There is good evidence from observational studies that people with CKD are at increased cardiovascular risk and hence the rationale for including CKD here.

Schizophrenia, bipolar affective disorder or other psychoses.

People with serious mental illness are far more likely to smoke than the general population (61% of people with schizophrenia and 46% of people with bipolar disorder smoke compared to 33% of the general population). Premature death and smoking related diseases, such as respiratory disorders and heart disease, are however, more common among people with serious mental illness who smoke than in the general population of smokers (Seymour L. Not all in the mind: the physical health of mental health service users. Mentality 2003).

See requirements for recording smoking status for further information.

SMOK 005.2 Reporting and verification

See indicator wording for requirement criteria.

The disease register for the purpose of calculating APDF for SMOK002 and SMOK005 is defined as the sum of the number of patients on the disease registers for each of the conditions listed in the indicator wording. Patients with one or more co-morbidities e.g. diabetes and CHD are only counted once.

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Prepared By Jean Keenan