The impact of the 2012 QOF revision on the provision of smoking cessation support in UK primary care

Conference: 
SAPC ASM 2015 - Oxford - Evidence and innovation in primary care
Talk Code: 
EP3C.6

The problem

Prior to 2012, UK general practitioners (GPs) were paid to offer cessation advice only to smokers and offer this advice only to those with smoking-related disease, comprising less than 20% of the smoking population. From 2012, GPs were paid to offer all smokers referral for behavioural support and medication to assist cessation at least once every two years. The aim of this study was to quantify the impact of this new recommendation and payment on indicators of smoking cessation activity in primary care.

The approach

We used an interrupted time series analysis to analyse change in smoking cessation activity before and after the 2012 change using ARIMA modelling. The data were obtained from the The Health Improvement Network (THIN) database including only participants aged at least 16 years. The key outcomes were changes in the monthly rate of recorded delivery of smoking cessation advice, referral to NHS Stop Smoking Services, and prescription of smoking cessation medications.

Findings

The proportion of patients each month with a record of advice to quit smoking increased by 19.6% (95% CI 7.9-31.4) in the year after the introduction of payments compared with the eight years beforehand; the recording of referral of smokers to National Health Service Stop Smoking Services increased by 38.8% (15.2-62.4). There was no significant change in prescribing of smoking cessation medication, -7.7% (-21.6 to 6.2).

Consequences

Paying GPs to intervene with all smokers and offer support rather than just advice to quit was associated with an increase in recording of advice and referring patients for behavioural support to stop smoking but no increase and possibly a decrease in prescribing pharmacotherapy for cessation.

Credits

  • Lisa Szatkowski, University of Nottingham Division of Epidemiology and Public Health, Clinical Sciences Building, Nottingham City Hospital, Nottingham, UK
  • Paul Aveyard, University of Nottingham Division of Epidemiology and Public Health, Clinical Sciences Building, Nottingham City Hospital, Nottingham, UK