Clinical Review ABC of smoking cessation

Cessation interventions in routine health care

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7440.631 (Published 11 March 2004) Cite this as: BMJ 2004;328:631
  1. Tim Coleman, senior lecturer in general practice
  1. School of Community Health Sciences in the Division of Primary Care at University Hospital, Queen's Medical Centre, Nottingham

    Introduction

    Smoking cessation interventions are widely underused in primary and secondary care despite being effective and easy to deliver (see earlier articles in this series). Smoking causes much greater harm than, say, hypertension (which is generally identified and managed entirely in primary care by health professionals working to agreed routine, systematic, and structured protocols), yet few primary healthcare teams manage smoking as methodically as they approach hypertension.

    Maximising the delivery of cessation interventions to smokers wanting to quit can probably achieve more in terms of years of life saved and provide better value for money (see later article in this series) than almost any other simple medical intervention.

    Example of record sheet for noting information on smoking status and intervention. The sheet can be inserted into paper records; computer templates enable a similar electronic record to be kept

    Smoking as a vital sign

    The first step towards developing a systematic approach for the management of smoking is to treat smoking as a “vital sign.” To do this, health professionals must regularly inquire about patients' smoking status and have a methodical approach towards documenting and updating this in medical records. This information needs to be recorded in a prominent place so that it can be seen whenever medical records are accessed during consultations. In paper records, a summary card can be used, and, in electronic records, smoking status data should be lodged with other important summary information on a patient's health. Recording information where it is easily noticed prompts health professionals to raise the topic of smoking more frequently with patients.

    The minimum information to record is whether the patient smokes and the date on which this was ascertained. It is also useful to record the average number of cigarettes smoked each day, not least because those who smoke more heavily are more likely to benefit from …

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