Abstract
BackgroundUnited Kingdom (UK) national guidelines recommend that all pregnant women who smoke should be advised to quit at every available opportunity, and brief cessation advice is an efficient and cost-effective means to increase quit rates. The Quality and Outcomes Framework (QOF) implemented in 2004 requires general practitioners to document their delivery of smoking cessation advice in patient records. However, no specific targets have been set in QOF for the recording of this advice in pregnant women. We used a large electronic primary care database from the UK to quantify the pregnancies in which women who smoked were recorded to have been given smoking cessation advice, and the associated maternal characteristics.MethodsUsing The Health Improvement Network database we calculated annual proportions of pregnant smokers between 2000 and 2009 with cessation advice documented in their medical records during pregnancy. Logistic regression was used to assess variation in the recording of cessation advice with maternal characteristics.ResultsAmong 45,296 pregnancies in women who smoked, recorded cessation advice increased from 7% in 2000 to 37% in 2004 when the QOF was introduced and reduced slightly to 30% in 2009. Pregnant smokers from the youngest age group (15–19) were 21% more likely to have a record of cessation advice compared to pregnant smokers aged 25–29 (OR 1.21, 95% CI 1.10-1.35) and pregnant smokers from the most deprived group were 38% more likely to have a record for cessation advice compared to pregnant smokers from the least deprived group (OR 1.38, 95% CI 1.14-1.68). Pregnant smokers with asthma were twice as likely to have documentation of cessation advice in their primary care records compared to pregnant smokers without asthma (OR 1.97, 95% CI 1.80-2.16). Presence of comorbidities such as diabetes, hypertension and mental illness also increased the likelihood of having smoking cessation advice recorded. No marked variations were observed in the recording of cessation advice with body mass index.ConclusionRecorded delivery of smoking cessation advice for pregnant smokers in primary care has increased with some fluctuation over the years, especially after the implementation of the QOF, and varies with maternal characteristics.
Highlights
United Kingdom (UK) national guidelines recommend that all pregnant women who smoke should be advised to quit at every available opportunity, and brief cessation advice is an efficient and cost-effective means to increase quit rates
Offering smokers brief cessation advice lasting no more than five minutes during routine consultations with a general practitioner (GP), during which doctors make clear that smoking is harmful and offer help with cessation [8], is one of the simplest and most cost-effective tools to reduce the burden of smoking in the general population and increases rates of quitting by two-thirds compared to unassisted quit rates of 4% [9]
Baseline characteristics We identified 45,296 pregnancies in 39,781 women resulting in a live birth or stillbirth from 2000 to 2009 and where women were classified as smokers during pregnancy
Summary
United Kingdom (UK) national guidelines recommend that all pregnant women who smoke should be advised to quit at every available opportunity, and brief cessation advice is an efficient and cost-effective means to increase quit rates. We used a large electronic primary care database from the UK to quantify the pregnancies in which women who smoked were recorded to have been given smoking cessation advice, and the associated maternal characteristics. The Quality and Outcomes Framework (QOF) introduced in UK primary care in 2004 financially rewards GPs for offering cessation advice to smokers and documenting this advice in the patients’ electronic medical records [18]. There are no specific QOF targets for offering and recording cessation advice to pregnant women who smoke and little is known about the frequency with which smoking cessation advice is routinely delivered and recorded by primary care health professionals during pregnancy. Data from Health Education Authority (HEA) surveys carried out in the 1990s showed that less than half the women interviewed who were smokers received cessation advice from a health professional [19], and another study conducted in 200 antenatal clinics in Leicester, UK reported that only 34% of current smokers received advice from their GP, 19% from a midwife, 12% from an obstetrician, 9% from family and friends and 26% received no advice at all [20]
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