Provision of smoking cessation support in UK primary care: impact of the 2012 QOF revision

Szatkowski, Lisa; Aveyard, Paul

doi:10.3399/bjgp15x688117

Cited by 22 publications

(27 citation statements)

References 16 publications

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“…Tying reimbursement of tobacco treatment to a medical illness is also a problem. The United Kingdom recently changed policy to remove illness requirement for tobacco billing; this policy change resulted in increased physician recording of advice and referring patients for behavioral support to stop smoking ( Szatkowski and Aveyard, 2016 ). Medical necessity is a concept used by third-party payers and managed care organizations.…”

Section: Discussionmentioning

confidence: 99%

An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement

Williams

Steinberg

Kenefake

et al. 2016

Journal of Addiction Medicine

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Tobacco use is a major threat to public health in the United States, and the number one cause of preventable death. Although most smokers try to quit unaided, robust data indicate that pairing behavioral support to US Food Drug Administration-approved cessation medications significantly increase cessation rates. Those who do receive assistance in quitting usually receive very low intensity treatment, regardless of the severity of their dependence or their medical and environmental circumstances. This is in stark contrast to how other substance use disorders are treated, where there are varying levels of care depending on addiction severity and biopsychosocial circumstances. The American Society of Addiction Medicine (ASAM) developed a formal algorithm for assessing substance use disorders and determining the optimal level of care. The ASAM Patient Placement Criteria are regularly used to determine the appropriate level of care for all substance use disorders except tobacco. This paper will review key aspects of the ASAM dimensions of care and placement levels, with emphasis on how they apply to tobacco use and present case examples of typical smokers who would benefit from a higher intensity of tobacco dependence treatment. We also present current barriers to reimbursing healthcare providers for these services. We conclude with a commentary and discussion regarding recommendations for improvements in tobacco dependence treatment care.

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Section: Discussionmentioning

confidence: 99%

An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement

Williams

Steinberg

Kenefake

et al. 2016

Journal of Addiction Medicine

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“… 37 However, prescribing data from UK general practices suggests that despite providing financial incentives to healthcare providers, there has been little change in the rates of prescribing pharmacological interventions to reduce smoking and prescription rates are likely to be lower in those with serious mental illness. 38 A much more assertive strategy to promote smoking cessation using pharmacological interventions could lead to an enormous improvement in the physical health of people with serious mental illness. 39 …”

Section: Pharmacological Support For Smoking Cessationmentioning

confidence: 99%

Improving life expectancy in people with serious mental illness: Should we place more emphasis on primary prevention?

2017

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People with serious mental illness have a reduced life expectancy that is partly attributable to increased cardiovascular disease. One approach to address this is regular physical health monitoring. However, physical health monitoring is poorly implemented in everyday clinical practice and there is little evidence to suggest that it improves physical health. We argue that greater emphasis should be placed on primary prevention strategies such as assertive smoking cessation, dietary and exercise interventions and more judicious psychotropic prescribing.

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“…The provision of VBA during a hospital admission or a community treatment episode is recommended in the English National Institute for Health and Care Excellence (NICE) guidelines [6], although historically, VBA provision and treatment among hospitalised patients has been poor [3]. Health system-level changes, including enhancements to electronic healthcare records (EHCR) [12], the use of financial incentives [13], and introducing smoke-free polices [14], have the potential to improve VBA provision. A Cochrane review of 16 studies to evaluate the use of EHCR enhancements to improve smoking cessation support reported that the documentation of tobacco status and referral to cessation counselling increased following the introduction of EHCR reminders to staff [12].…”

Section: Introductionmentioning

confidence: 99%

“…just ASK or ACT) have been associated with improvements in VBA provision [17][18][19]. In England, VBA has been systematised in primary and secondary care settings by financially-incentivising health care provider organisations through Quality and Outcomes Framework (QOF) targets for General Practitioners, and the Commissioning for Quality Improvement and Innovation (CQUIN) payment framework for NHS secondary acute and mental health settings [13,14]. CQUINs were established in 2009 to encourage health service providers in England to continually improve the quality of care provided to patients.…”

Section: Introductionmentioning

confidence: 99%

An observational study of system-level changes to improve the recording of very brief advice for smoking cessation in an inpatient mental health setting

et al. 2020

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Background: Smoking prevalence among people with psychosis remains high. Providing Very Brief Advice (VBA) comprising: i) ASK, identifying a patient's smoking status ii) ADVISE, advising on the best way to stop and iii) ACT (OFFER), offering a referral to specialist smoking cessation support, increases quit attempts in the general population. We assessed whether system-level changes in a UK mental health organisation improved the recording of the provision of ASK, ADVISE, ACT (OFFER) and consent to referral to specialist smoking cessation support (ACT (CONSENT)). Methods: We conducted a study using a regression discontinuity design in four psychiatric hospitals with patients who received treatment from an inpatient psychosis service over 52 months (May 2012-September 2016). The system-level changes to facilitate the provision of VBA comprised: A) financially incentivising recording smoking status and offer of support (ASK and ACT (OFFER)); B) introduction of a comprehensive smoke-free policy; C) enhancements to the patient electronic healthcare record (EHCR) which included C1) a temporary form to record the financial incentivisation of ASK and ACT (OFFER) C2) amendments to how VBA was recorded in the EHCR and C3) the integration of a new electronic national referral system in the EHCR. The recording of ASK, ADVISE, ACT (OFFER/CONSENT) were extracted using a de-identified psychiatric case register. Results: There were 8976 admissions of 5434 unique individuals during the study period. Following A) financial incentive, the odds of recording ASK increased (OR: 1.56, 95%CI: 1.24-1.95). Following B) comprehensive smoke-free policy, the odds of recording ADVICE increased (OR: 3.36, 95%CI: 1.39-8.13). Following C1) temporary recording form, the odds of recording ASK (OR:1.99, 95%CI:1.59-2.48) and recording ACT (OFFER) increased (OR: 4.22, 95%CI: 2.51-7.12). Following C3) electronic referral system, the odds of recording ASK (OR:1.79, 95%CI: 1.31-2.43) and ACT (OFFER; OR: 1.09, 95%CI: 0.59-1.99) increased. There was no change in recording VBA outcomes following C2) amendments to VBA recording.

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Provision of smoking cessation support in UK primary care: impact of the 2012 QOF revision

Cited by 22 publications

References 16 publications

An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement

An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement

Improving life expectancy in people with serious mental illness: Should we place more emphasis on primary prevention?

An observational study of system-level changes to improve the recording of very brief advice for smoking cessation in an inpatient mental health setting

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