Referrals to stop smoking services

In the UK, the NHS stop smoking services were set up with the simple aim of helping people to stop smoking. These services implement different cessation methods which can be based around behaviour change techniques.

Whilst these can be used in combination with nicotine replacement therapy, it is counselling services that are unique to the stop smoking services. Dependent on multiple factors, such as funding and service setup, behaviour change sessions can be via group therapy or individual support. It is shown that both methods in isolation have a positive outcome on cessation techniques.

We must note that not all individuals wish to utilise stop smoking services, meaning brief intervention from potential referral sources should always be undertaken in the first instance. When we consider it can take smokers up to 30 attempts to successfully quit, it is important for practitioners to reinforce simple cessation advice and offer stop smoking service referral at every opportunity.

In 1998, the UK government outlined new policies to combat tobacco addiction in the White Paper ‘Smoking Kills.’ By 2001, this guidance had resulted in the nationwide introduction of the precursor to the current stop smoking service; the ‘Smoking Cessation Services.’. These services were ultimately shown to be successful.

Gradually, this service has evolved into the ‘NHS Stop Smoking Service,’ we currently utilise to assist individuals in their cessation attempts. For example, it was found initially that cessation attempts in poorer areas were less likely to be successful than those in less socioeconomically deprived areas.

Increased advertising, alongside encouraging healthcare practitioners to refer these individuals to stop smoking services, means during the past 15 years there has been an increased amount of successful engagement with smokers from disadvantaged communities.

Referral Sources

General Practice
General medical practitioners hold an important role in smoking cessation, with 70% of smokers visiting their GP at least once a year. There is also evidence to show that motivated physicians facilitate successful smoking cessation. If all physicians offered routine, standardised cessation advice the cumulative increase in quit rates could be substantial.

GPs may choose not to discuss smoking cessation as they believe it can damage the doctor patient relationship, however there is evidence that well managed cessation techniques can actually improve the doctor patient relationship.

GPs also have the ability to prescribe smoking cessation aids, which can enhance successful quit attempts two-fold.

We must view every GP appointment with a smoker where cessation is not discussed as a missed opportunity.

99% of the UK population live within 20minutes of a pharmacy, either by foot or by public transport. An estimated 1.6 million individuals visit a pharmacy every day. The pharmacist is therefore in a privileged position as they have regular interactions with large numbers of individuals when they are both ‘healthy’ and ‘sick’.

Whilst pharmacists are trained in nicotine replacement therapy use and behavioural support to assist in smoking cessation, there are issues identified by pharmacists in delivery of this information.

For example, pharmacists believe they don’t always have enough time due to dispensing duties to give adequate advice. It is shown, however, that cessation advice given by pharmacists is beneficial in increasing successful cessation.

59% of the UK population regularly visit a dentist. Dentists are perfectly positioned to notice the impact of tobacco use in the mouth, in both smoked and smokeless forms. Potential oral sequelae experienced by smokers include red and white patches, nicotinic stomatitis and periodontitis.

More threatening to patients than these is that tobacco exposes the oral cavity to carcinogens which initiate and promote oral cancers; these account for 2% of all cancer diagnoses in the UK.

Dental teams are in the enviable position of being able to offer advice to a largely ‘healthy’ section of the population who engage in tobacco use. Brief 2-minute advice from dental practitioners can lead to a 2% increase in successful smoking cessation.

Smoking is the single greatest controllable risk factor in the development and proliferation of age relatedmacular degeneration. It is also implicated in the development of nuclear cataract.

It is documented that the use of optometrists as a healthcare professional to provide brief smoking cessation is underutilised. Despite this, it appears there is an appetite by optometrists to be involved in provision of cessation advice.

We can conclude optometrists provide a further opportunity to deliver brief advice to those who utilise tobacco and offer referral to stop smoking services when appropriate.

Maternity Services
Smoking has numerous effects on a mother and her baby. It reduces the amount of available oxygen to mother and baby, it increases the heart rate of the child alongside increasing the incidence of premature birth, low birth weight, miscarriage and stillbirth.

Smoking can also cause sudden infant death syndrome and increases the risk of the baby developing respiratory problems. 12% of pregnant women smoke throughout their pregnancy term, with these infants more likely to become smokers themselves.

As maternity services have the largest access to pregnant smokers, they can give brief cessation to these individuals alongside referral to NHS stop smoking services.

Interestingly, NRT is found to be of limited use amongst pregnant women beyond their first trimester.

Behaviour management strategies are shown to be effective for pregnant women, but not their partners. This is problematic, as second hand smoke can have similar deleterious health outcomes for the mother and her child.

Secondary Care
Smokers have a significantly increased risk of cardiopulmonary and wound related post-operative complications than their non-smoking counterparts. A preoperative period of cessation of 6-8 weeks shows to greatly reduce the risks of post-operative complications.

In head and neck cancer patients, a cessation period of just three weeks has shown to be beneficial. Therefore, a pre-operative assessment within a secondary care environment gives a perfect opportunity to recommend cessation and advise of potential post-operative risks to smokers.

Hospital admission can be useful in promoting smoking cessation; it imposes temporary smoking abstinence and the environment assists in making individuals aware of the health implications of smoking.

If initial cessation ideology is imparted during the inpatient stay, followed by one month of continued support (for example from stop smoking services) individuals are more likely to successfully stop smoking.

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Quit Smoking by Henrik Jensen. Available at Licenced under CC BY-SA 2.0
teeth black. breath black. lungs black. stop smoking by Ava Randa. Available at licenced under CC BY-ND 2.0
AMD by National eye Institute. Available at licenced under CC BY 2.0
Man with Periodontitis in Dhaka Housing Slum by United Nations Photo. Available at licenced under CC BY-NC-ND 2.0