Quality statement 3: Behavioural support with pharmacotherapy

Quality statement

People who smoke are offered behavioural support with pharmacotherapy by an evidence‑based smoking cessation service.

Rationale

People who smoke are more likely to stop smoking if they are offered a combination of interventions, with combined behavioural support and pharmacotherapy the most likely to be successful.

Quality measures

Structure

Evidence of local arrangements to ensure that people who smoke are offered behavioural support with pharmacotherapy by an evidence‑based smoking cessation service.

Data source: Local data collection.

Process

Proportion of people who receive behavioural support with pharmacotherapy from an evidence‑based smoking cessation service.

Numerator – the number of people in the denominator who receive behavioural support with pharmacotherapy from an evidence‑based smoking cessation service.

Denominator – the number of people referred to an evidence‑based smoking cessation service.

Data source: Local data collection. Statistics on NHS Stop Smoking Services: England, April 2011 to March 2012 from the Health and Social Care Information Centre reports on smoking cessation interventions.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that systems are in place for people who smoke to be offered behavioural support with pharmacotherapy by an evidence‑based smoking cessation service.

Healthcare practitioners offer behavioural support with pharmacotherapy to people who have been referred to an evidence‑based smoking cessation service.

Commissioners ensure that they commission evidence‑based smoking cessation services that offer people who smoke behavioural support with pharmacotherapy.

What the quality statement means for patients, service users and carers

People who have been referred to an evidence‑based smoking cessation service are offered behavioural support (which may be either individual or group counselling) together with drug treatment.

Source guidance

Definitions of terms used in this quality statement

Behavioural support

This can be individual or group behavioural support.

NICE's guideline on stop smoking interventions and services states that individual behavioural support involves scheduled face‑to‑face meetings between someone who smokes and a counsellor trained in smoking cessation. Typically, it involves weekly sessions over a period of at least 4 weeks after the quit date and is normally combined with pharmacotherapy.

It also states that group behavioural support involves scheduled meetings in which people who smoke receive information, advice and encouragement and some form of behavioural intervention (for example, cognitive behavioural therapy). This therapy is offered weekly for at least the first 4 weeks of a quit attempt (that is, for 4 weeks following the quit date). It is normally combined with pharmacotherapy.

Pharmacotherapy

Pharmacotherapies for smoking cessation are nicotine replacement therapy (NRT), varenicline or bupropion.

NICE's guideline on stopping smoking in pregnancy and after childbirth states that there should be a discussion about the risks and benefits of NRT with pregnant women who smoke. Nicotine replacement therapy should be offered if smoking cessation without NRT fails, or practitioner judgement should be used if women express a clear preference for NRT. Neither varenicline nor bupropion should be offered to pregnant or breastfeeding women.

A summary of further considerations relating to pharmacotherapy is provided in quality statement 4.

Evidence‑based smoking cessation services

These are local services providing accessible, evidence‑based and cost‑effective support to people who want to stop smoking.