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NICE Underpinning Review
This review aims to answer the following two questions posed by NICE: Question 1: How effective are smoking cessation interventions in helping people from the populations of interest? Question 2: How effective are interventions for temporary abstinence in helping people from the populations of interest?
The review is divided into two chapters that address the two populations of interest: (1) users of acute secondary care services and staff and visitors of these services, and (2) users of maternity services and their partners.
The NHS practice currently involves interventions at bed-side accompanied by medications and/or referrals to specialist stop-smoking service for treatment after discharge which combines extended face-to-face support with smoking cessation medications. The reviewed evidence confirms that this is likely to be the optimal approach. The high cost of such approach is mitigated by the fact that the NHS provides centrally funded stop-smoking serviceswhich are proactively recruiting smokers and have ample capacity to accept such referrals and to treat them without further costs and without any delays.
The NHS practice currently involves referral of pregnant women who smoke to specialist smoking cessation treatment that typically consists of multi-session behavioural support for at least 4-weeks following a target quit date supplemented by the use of NRT and usually also by home visits. This is more intensive and sophisticated than any of the interventions evaluated so far. Women are referred by midwives and the intervention is provided by specialist pregnancy advisors employed for this purpose. The service is expensive because only a relatively small number of pregnant smokers attend treatment and the success rates are lower than in the mainstream service, but it is felt that if pregnant smokers were referred to mainstream service instead, the proportion of women taking up the referral would be even lower. In this sense, the current UK practice have overtaken research results.