Staff involved in the delivery of stop smoking interventions who have been trained to HDA standards and who are paid to provide these services outside their normal working hours.
Carbon monoxide-verified four-week quitter
A treated smoker whose Co reading is assessed 28 days from their quit date (-3 or + 14 days) and whose Co reading is less than 10ppm. The -3 or +14 day rule allows for cases where it is impossible to carry out a face-to-face follow-up at the normal four-week point (although in most cases it is expected that follow-up will be carried out at four weeks from the quit date). This means that follow-up must occur 25 to 42 days from the quit date (Russell Standard). Clients whose follow-up date falls outside this timespan may not be counted for the purposes of quarterly data submissions to the IC. Co verification should be conducted face-to-face and carried out for at least 85% of self-reported four-week quitters. The percentage of Co-verified clients should be calculated as shown below:
Number of treated smokers who self-report continuous abstinence from smoking from day 14 to the four-week follow-up point, and who have a Co reading of less than 10ppm
Exception reporting system
A data verification and checking system designed to improve data quality and identify the reasons for outlying data (i.e. data that falls outside the expected success rate range derived from the evidence base on smoking cessation).
Voluntary monthly collection and reporting system for which local stop smoking services collect and report data on the numbers of smokers entering treatment and setting a quit date, and the numbers recorded as quit. This return is now optional (as of November 2008).
Stop smoking service
An Stop Smoking Service is defined as a locally managed, co-ordinated and provided service, funded by DH nationally, to provide accessible, evidence-based, cost-effective clinical services to support smokers who want to stop. Service delivery should be in accordance with the quality principles for clinical and financial management contained within this guidance.
A smoker who receives no support or is given brief or very brief advice and/or supplied with leaflets, helpline cards or pharmacotherapy only, and who does not set a quit date or consent to treatment. Examples may include smokers seen at a health fair or community event, during a GP consultation or during a hospital stay, where a quit date is not set and a quit attempt is not made.
Stop smoking service data that is submitted to the IC on a quarterly basis.
Date a smoker plans to stop smoking altogether with support from a stop smoking adviser as part of an NHS-assisted quit attempt.
Renewed quit attempt
A quit attempt that takes place immediately following the end of one treatment episode. A new treatment episode should be commenced in thedatabase/service records.
Routine and manual smoker
A smoker whose self-reported occupational grouping is that of a routine and manual worker, as defined by the NSEC.142 Smoking prevalence among the R/M socio-economic grouping is significantly higher than among other groupings. This has a major impact on the health and life expectancy of this grouping.
Self-reported four-week quitter
A treated smoker whose quit status at four weeks from their quit date (or within 25 to 42 days of the quit date) has been assessed either face-to-face or by telephone, text, or email or postal questionnaire. The percentage of self-reported four-week quitters should be calculated as shown below: Number of treated smokers who self-report continuous abstinence from smoking from day 14 post-quit date to the four-week follow-up point
Any product that contains tobacco and produces smoke is a smoked product, including cigarettes (hand-rolled or tailor-made), cigars and pipes. Pipes include shisha, hookah, narghile and hubble-bubble pipes.
There is evidence that the use of smokeless tobacco products (e.g. chewing tobacco, paan, khat etc.) can have negative health effects, including oral cancers. There is some evidence to suggest that behavioural support can be effective.
Note for commissioners
NHS Stop Smoking Services that identify communities within their localities who use such products may wish to develop services to help them to stop, although this relies on the capacity of individual services. Services will also need to consider methods of clinically validating the cessation of smokeless tobacco use. Clients who attend such services are not to be included in data monitoring returns, as the primary aim of NHS Stop Smoking Services is to help people who smoke tobacco to stop smoking, and the purpose of the data monitoring system is to measure the efficacy of the services. To measure efficacy, the number of successful four-week quits submitted is used as the numerator and the number of smokers entering treatment (i.e. treated smokers) the denominator. In light of this, and in line with the treated smoker definition as per the Russell Standard, only those who smoke tobacco should be included in monitoring data submissions.
A person who smokes a smoked product. In adulthood this is defined in terms of daily use, whereas in adolescence (i.e. for those aged 16 or under) it is defined in terms of weekly use.
In clinical terminology, used to denote activities relating to supporting smokers to stop.
Smokers who have already stopped smoking when they first come to the attention of the service may be counted as having been ‘treated’ for local accounting purposes (e.g. to justify resources used or analyse performance) only if they have quit within the 14 days prior to coming to the attention of the service and have attended the first session of a structured multi-session treatment plan within 14 days of their spontaneous quit date (which should be recorded as the quit date).
Services should note that these patients should not be included in the data submitted to the national dataset. The results of spontaneous quitters may be recorded for local monitoring only.
Examples of such quitters include clients who experience an unplanned admission to hospital and stop smoking before receiving support, and pregnant smokers who have already stopped smoking before approaching their local NHS Stop Smoking Service or one of the service’s trained agents. While it is recognised that it is desirable to offer as many smokers as possible support to quit and maintain abstinence, local commissioners will need to balance the needs of their smoking population against available service resources.
Preferred term to denote patient-facing communications relating to smoking cessation activity.
Stop smoking adviser
An individual who has received stop smoking service training that meets the published HDA standards143 for one-to-one and/or group support and is either an NHS Stop Smoking Service core team member or a trained associate of an NHS Stop Smoking Service.
Time between treatment episodes
When a client has not managed to stop smoking there is no definitive period of time required between the end of a treatment episode and the start of another. The stop smoking adviser should use discretion to professional judgement when considering whether a client is ready to receive support to immediately attempt to stop again. If this is the case, the client must start a new treatment episode, i.e. attend one session of a structured, multi-session intervention, consent to treatment and set a quit date with a stop smoking adviser, in order to be counted as a new data entry on the quarterly return.
A smoker who has received at least one session of a structured, multi-session intervention (delivered by a stop smoking adviser) on or prior to the quit date, who consents to treatment and sets a quit date with a stop smoking adviser. Smokers who attend a first session but do not consent to treatment or set a quit date should not be counted.
At the point of attending one session of a structured, multi-session intervention, consenting to treatment and setting a quit date with a stop smoking adviser, a client becomes a treated smoker and the treatment episode begins. The treatment episode ends when a client either has been completely abstinent for at least the two weeks prior to the four-week follow-up (see flow chart below) or is lost to follow-up at the four-week point, or when a four-week follow-up reveals that a client has lapsed during the two weeks immediately prior to the follow-up and is therefore recorded as a non-quitter. Good practice dictates that if the client wishes to continue treatment after a lapse, treatment should be continued if it seems appropriate, but the client will not count as a four-week quitter for the purposes of that treatment episode.
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