Smoking 04

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Current Smokers - go to this
Smoking exclusions - go to this
Smoking Cessation Codes - Go to this
Rationale - go to this

Patient Population

With co-morbidity of coronary heart disease, 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.(v12)

Current Smokers codes

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 (v18)

Exclusions

9hG1. Excepted from smoking quality indicators: Informed dissent
9hG0. Excepted from smoking quality indicators: Patient unsuitable
9Ndg. Declined consent for follow-up by smoking cessation team (v18)

Smoking Cessation Codes ( Added in the last 15 months)

6791. Health ed. - smoking

67A3. Pregnancy smoking advice
67H6. Brief intervention for smoking cessation

8B2B. Nicotine replacement therapy

8CAL. Smoking cessation advice
8HkQ. Referral to NHS stop smoking service

8HTK. Referral to stop-smoking clinic

13p.. Smoking cessation milestones

13p0. Negotiated date for cessation of smoking

13p1. Smoking status at 4 weeks

13p2. Smoking status between 4 and 52 weeks

13p3. Smoking status at 52 weeks

13p4. Smoking free weeks

13p5. Smoking cessation programme start date

13p6. Carbon monoxide reading at 4 weeks

9OO.. Anti-smoking monitoring admin.

9OO1. Attends stop smoking monitor.

9OO2. Refuses stop smoking monitor

9OO3. Stop smoking monitor default

9OO4. Stop smoking monitor 1st lettr

9OO5. Stop smoking monitor 2nd lettr

9OO6. Stop smoking monitor 3rd lettr

9OO7. Stop smoking monitor verb.inv.

9OO8. Stop smoking monitor phone inv

9OO9. Stop smoking monitoring delete

9OOA. Stop smoking monitor.chck done
9OOB. Stop smoking invitation short message service text message
9OOB0 Stop smoking invitation first short message service text message
9OOB1 Stop smoking invitation second short message service text message
9OOB2 Stop smoking invitation third short message service text message

9OOZ. Stop smoking monitor admin.NOS

9N4M. DNA - Did not attend smoking cessation clinic

9N2k. Seen by smoking cessation advisor

8H7i. Referral to smoking cessation advisor

67H1. Lifestyle advice regarding smoking

8B3Y. Over the counter nicotine replacement therapy

8B3f. Nicotine replacement therapy provided free

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

8IAj : Smoking cessation advice declined
9NS02 Referral for smoking cessation service offered
8CdB. Stop smoking service opportunity signposted

Smoking 4.1 Rationale

Many strategies have been used to help people to stop smoking. A meta-analysis of controlled trials in patients post myocardial infarction showed that a combination of individual and group smoking cessation advice, and assistance reinforced on multiple occasions – initially during cardiac rehabilitation and reinforced by primary care teams – gave the highest success rates.

Further Information: www.sign.ac.uk/guidelines/fulltext/96/index.html
www.sign.ac.uk/guidelines/fulltext/97/index.html

A number of studies have recently shown benefits from the prescription of nicotine replacement therapy or buproprion in patients who have indicated a wish to quit smoking.

In a significant number of PCOs across the UK specialist smoking cessation clinics are now available. Referral to such clinics, where they are available, can be discussed with patients. This should also be recorded as giving smoking cessation advice.

The recording of advice given does not necessarily reflect the quality of the intervention. It is therefore proposed that only smoking advice should be part of the reporting framework. Clinicians may choose to record advice given in relation to other modifiable risk factors.

Further information
NICE public health guidance 10 (2008). Smoking cessation services.
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11925

NHS Health Scotland and ASH Scotland (2007)
www.healthscotland.com/documents/1762.aspx

Smoking Indicator 4.2 Reporting and verification

The practice reports the percentage of patients on any or any combination of the named registers who smoke who have a record of having been offered smoking cessation advice in the preceding 15 months.

Prepared By Jean Keenan