Handling of Smokers

Introduction

"Smoking is injurious to health" this statement is available on all cigarette packets in US. In fact, cigarettes worldwide are among the legal drugs that are damaging health of people as well as leading to deadly diseases. The nicotine substance in cigarettes is addictive, which means anyone who started smoking, must satisfy the addiction to nicotine which compels smokers to buy this hazardous material.

In the US, smoking accounts for less than 80% of deaths from chronic obstructive pulmonary disease and a third and a fifth of deaths from cancer and ischaemic heart disease, respectively. Half of all smokers die prematurely but stopping significantly extends life expectancy. The success of a quit attempt using nicotine addiction treatment (NAT) and behavioural support is about three times more likely to succeed after a year than an unsupported attempt (15% compared to 5%).

Thesis Statement

General practice remains the most common source of effective advice about smoking, and the GP contract sets targets for advice about cessation. In National Institute for Health and Clinical Excellence (NICE) guidelines recommend GPs to offer brief advice to all smokers and to refer those motivated to quit to a support programme from trained advisers, offering NAT with follow-up only to those who decline referral. This guidance differs from that given in some other countries; for example, Australian guidelines suggest follow-up and medication by the GP with additional rather than substitute support from external agencies (Doll, 1519-28).

Discussion and Analyses

In the US, Stop Smoking Services (SSS), employing trained advisers, are now established nationally in community settings, including some general practices, and have been shown to be effective, although a majority of GPs welcome their existence, referral rates remain low. In a recent survey of patients prescribed NAT by their GP, we found that only 64% reported that they were advised to attend SSS. Between practices, this rate ranged from 18% to 90% of patients. Furthermore, of those referred to SSS, only 63% attended. Some GPs have concerns about the effectiveness of SSS and feel that they are not sufficiently personal or easy to access. GPs may also choose to treat smokers themselves as part of their management of smoking-related conditions and to utilize the continuity and trust of an established doctor-patient relationship. In the US, there has been no direct comparison between in-house and external support, but a recent trial in Australia found that additional support from a telephone support line more than doubled cessation rates.

Another reason that SSS are underutilized could be that smokers wishing to stop want support quickly, rather than waiting for an appointment to make a planned quit attempt. This is supported by observational evidence that unplanned quit attempts may be more successful than planned attempts and 37% of quit attempts are made without planning. The authors of these studies have suggested that their findings point to the need to make treatment available for unplanned quit attempts (Wilson, 284-8).

In this study, we explored how the decision to treat and/or refer motivated smokers is negotiated from the perspective ...