The area of recording smoking status, advising smokers and offering cessation treatment is pretty complex in the QOF this year. In this article I try to clarify who needs what doing, what codes are required and how often patients need their smoking status adding again.
There are five smoking indicators in the 2013-4 QOF. SMOKING 1 and 4 relate to all patients from 15 years old upwards, and record whether we have documented their smoking status in the 24 months before the reference date (that is, 1 April 2014). It also checks whether the practice has engaged with smokers in this group by offering advice and/or support or treatment.
SMOKING 2 and 5 are recorded in relation to a cut-down group of patients with one or more of the following nine diseases:
- asthma (patients aged 20 and over on the reference date)
- diabetes (patients aged 17 and over on the reference date)
- CKD (patients aged 18 and over on the reference date)
- MH (the QOF code covering schizophrenia, bipolar affective disorder or other psychoses)
Again, SMOKING 2 relates to whether the GP has recorded their smoking status, but in the last 12 months rather than in the 24 months to the reference date.
SMOKING 5 relates again, as per SMOKING 4, to whether we have engaged with smokers in this group by offering advice and/or support or treatment.
SMOKING 3 has moved from Information 7 for QOF 2013-14 and relates to whether we provide smoking support services and literature for people hoping to stop.
Offer referral or advice for SMOKING 5
Under Version 22.0 rulesets (April 2012), patients needed evidence of an offer of referral to a smoking cessation service (relevant read codes below) as well as evidence of pharmacological intervention or advice (again, relevant read codes below). Smoking patients with any of the nine diseases mentioned now needed to be offered ‘a record of an offer of support and treatment within the preceding 15 months’ (worth 25 points, 50-90%). However an addendum (Version 22.1) was released (May/June 2012) whereby one Read code from A or B would suffice (as opposed to both).
Evidence of an offer of referral to a smoking cessation service
- 8CAL Smoking cessation advice (used previously, still counts)
- 8HTK. Referral to stop-smoking clinic
- 8HkQ. Referral to NHS stop smoking service
- 8H7i. Referral to smoking cessation advisor
- 8IAj. Smoking cessation advice declined
- 8IEK. Smoking cessation program declined
- 9N2k. Seen by smoking cessation advisor
- 13p50 Practice based smoking cessation programme start date
- 9Ndf. Consent given for follow-up by smoking cessation team
- 9Ndg. Declined consent for follow-up by smoking cessation team
Evidence of pharmacological intervention or advice
- 745H.% Smoking cessation therapy
- 8B3f. Nicotine replacement therapy provided free
- 8B2B. Nicotine replacement therapy
- 8B3Y. Over-the-counter nicotine replacement therapy
- du3..% Nicotine prescribed products (lozenges, gum and patches)
- du6..% Bupropion (Zyban)
- du7..% More nicotine products
- du8..% Varenicline (Champix)
- 8IEM. Smoking cessation drug therapy declined
Record everyone’s smoking status every two years
- You don’t have to collect smoking status for anyone under the age 15 on 1 April 2014.
- If the patient is a current smoker, you only need to record that within 24 months of next April.
- If the patient is 26 or over and you have recorded ‘never smoker’ as their last smoking code (after they reached 26), you do not need to record it again.
- If the patient is aged 15-25 and a ‘never-smoker’ then you need to re-record smoking status every 24 months.
- If the patient is an ex-smoker then you need to either have the ex-smoking status recorded within the last 24 months, or have a record of ex-smoker status in three consecutive years in their history.
Stop producing evidence of cessation drugs for Smoking 4 and 5
For SMOKING 4 and SMOKING 5, patients now do not need evidence of pharmacotherapy as well as advice as they did under Version 22.0). They need:
- a code from the ‘offer of referral’ list (for example, advice to stop) or,
- referral to a clinic, or
- a code from the ‘evidence of pharmacological intervention or advice’ list (for example, evidence of pharmacotherapy) or,
- the read code that documents them declining pharmacotherapy (8IEM).
Any one of these four will score SMOKING 5 (if added in last 12 months) and SMOK 4 (if added in last 24/12 months).
Search for ex-smokers
For the smoking ruleset, there are two ‘tricks’ I would commend to you. Firstly, say you ask a patient if they smoke and they say, ‘oh yes, I gave up in 1980’ as some patients do. There’s therefore nothing to stop you adding three ‘ex-smoker’ codes consecutively. The second trick for the smoking ruleset is to run a search on any ‘secret’ or ‘hidden’ ex-smokers on your list. At my practice we ran a report looking for patients aged 15 and over, coded an ex-smoker before 1 April 2012, whose records had free text added to the entry which might indicate a quit date some time before. To run this search, the key codes to search for are
- 1377 to 137B
- 137S and 137T
- 137j. and 137l
For the more organised or obsessive practices, this may be an idea worth looking at.
Dr Simon Clay is a GP in Birmingham. For information on Dr Clay’s QOF Resource Disc go to www.tinyurl.com/qofdisc