Smoking cessation guidelines for health professionals: an update

Abstract

This paper updates the evidence base and key recommendations of the Health Education Authority (HEA) smoking cessation guidelines for health professionals published in Thorax in 1998. The strategy for updating the evidence base makes use of updated Cochrane reviews supplemented by individual studies where appropriate. This update contains additional detail concerning the eVectiveness of interventions as well as comments on issues relating to implementation. The recommendations include clarification of some important issues addressed only in general terms in the original guidelines. The conclusion that smoking cessation interventions delivered through the National Health Service are an extremely cost eVective way of preserving life and reducing ill health remains unchanged. The strategy recommended by the guidelines involves: (1) GPs opportunistically advising smokers to stop during routine consultations, giving advice on and/or prescribing eVective medications to help them and referring them to specialist cessation services; (2) specialist smokers' services providing behavioural support (in groups or individually) for smokers who want help with stopping and using eVective medications wherever possible; (3) specialist cessation counsellors providing behavioural support for hospital patients and pregnant smokers who want help with stopping; (4) all health professionals involved in smoking cessation encouraging and assisting smokers in use of nicotine replacement therapies (NRT) or bupropion where appropriate. The key points of clarification of the previous guidelines include: (1) primary health care teams and hospitals should create and maintain readily accessible records on the current smoking status of patients; (2) GPs should aim to advise smokers to stop, and record having done so, at least once a year; (3) inpatient, outpatient, and pregnant smokers should be advised to stop as early as possible and the advice recorded in the notes in a readily accessible form; (4) there is currently little scientific basis for matching individual smokers to particular forms of NRT; (5) NHS specialist smokers' clinics should be the first point of referral for smokers wanting help beyond what can be provided through brief advice from the GP; (6) help from trained health care professionals specialising in smoking cessation such as practice nurses should be available for smokers who do not have access to specialist clinics; (7) the provision of specialist NHS smokers' clinics should be commensurate with demand; this is currently one or two full time clinics or their equivalent per average sized health authority, but demand may rise as publicity surrounding the services increases. (Thorax 2000;55:987-999)

Policy and public health recommendations to promote the initiation and duration of breast-feeding in developed country settings

“…This is consistent with the evidence base for strategies promoting changes in lifestyle which tend to be demonstrated in the medium to long term (39)(40)(41) and in association with increased length of participation in the programme (42,43) .…”

Dental Practitioners Self Reported Performance of Tobacco Cessation Counseling Interventions: A Cross Sectional Study

“…As dental treatment often requires multiple visits, hence it provides a system for initiation; reinforcement and support of tobacco cessation activities (West et al, 2000;Alberta et al, 2005). Dentists have the advantage to correlate cessation advice and subsequent follow up visits with the obvious visible changes in the oral status.…”

Brief smoking cessation advice from practice nurses during routine cervical smear tests appointments: a cluster randomised controlled trial assessing feasibility, acceptability and potential effectiveness

“…The intervention was designed to take about 3 min to deliver. We based the advice on the '5 As' designed for health professionals assisting patients in stopping smoking (Ask, Advise, Assess, Assist and Arrange) for which there is evidence of effectiveness (West, McNeill and Raw, 2000). As recommended in The Expert Patient Programme (Department of Health, 2001), we trained nurses to give advice in a way that builds rapport and is patient-centred.…”