QOF Plus Year 1 - Imperial College London
QOF Plus Year 1 - Imperial College London QOF Plus Year 1 - Imperial College London
The NICE Clinical Guideline on Antenatal Care (NICE, 2008) include recommendations for smokingin pregnancy. These include:“At the first contact with the woman, discuss her smoking status, provide informationabout the risks of smoking to the unborn child and the hazards of exposure tosecondhand smoke. Address any concerns she and her partner or family may have aboutstopping smoking. Pregnant women should be informed about the specific risks ofsmoking during pregnancy (such as the risks of having a baby with low birthweight andpreterm birth). The benefits of quitting at any stage should be emphasized,”and:“Offer personalised information, advice and support on how to stop smoking. Encouragepregnant women to use local NHS Stop Smoking Services and the NHS pregnancysmoking helpline, by providing details on when, where and how to access them. Monitorsmoking status and offer smoking cessation advice, encouragement and supportthroughout the pregnancy and beyond.”Prevalence of conditionSurvey data found that 27% of women in the UK declared themselves to be current smokers atthe birth of their baby (Owen, 1998). When interpreting these figures, it is important to recognizethat this is likely to be an underestimate, as a proportion of women deny their smoking (West,2002).Associated morbidity and mortalityIt is now well recognized that cigarette smoking during pregnancy is associated with harm to bothfoetus and mother (West, 2002). Risks to the foetus include miscarriage, stillbirth, Sudden InfantDeath Syndrome (SIDS) and respiratory problems in the young child. Longer term problemsinclude intellectual impairment, problem behaviour, infertility, high blood pressure andcardiovascular disease. Potential harms to the mother include increased risk from pregnancycomplications such as abruption and possibly an increased risk of early onset breast cancer (West,2002; Innes et al., 2001). A study by DiFranza et al. (1995) estimated that tobacco use in the USdetermines between 19,000 to 141,000 spontaneous abortions annually, 32,000 to 61,000 casesof low birthweight and up to 26,000 admissions to neonatal intensive care. The same workestimated 1,900 to 4,800 cases of tobacco-related perinatal mortality and 1,200 to 2,200 cases ofSIDS. In pregnancy, passive smoking can reduce foetal growth and increase the risk of pretermbirth (British Medical Association, 2004).Local contextAround 7% of mothers in Hammersmith and Fulham and in London smoke during pregnancy. Lowbirth weight is strongly associated with infant mortality and smoking in pregnancy is a risk factorfor low birth weight. Although the low birth weight rate is not particularly high (9% inHammersmith and Fulham, 8% in England), it is strongly related to deprivation (Zeuner, 2008).40
Evidence to support the proposed indicatorsA Cochrane review by Silagy (2000) found that a single episode of brief physician advice given tosmoking patients can increase the proportion who stop smoking long-term by 1±2%. West (2002)comments that “while this is a small effect, the fact that the advice takes only a few minutes andso is inexpensive and the health gains from cessation are so great, makes this an extremelyimportant and cost-effective life-preserving intervention”. There is some evidence to suggest thatthe effect of this advice on pregnant smokers is similar to that for other smokers (Haug et al.,1994; Senore et al., 1998).A Cochrane systematic review by Lumley et al. (2001) found a significant reduction in smoking inlate pregnancy among women who attended smoking cessation programmes compared with noprogramme. Another systematic review by Law et al. (1995) included a trial of physician advice, atrial of advice from a health educator, a trial of group sessions, and seven trials on behaviouraltherapy based on self-help manuals. This review found that cessation programmes significantlyincreased the rate of quitting.The NICE Clinical Guideline on Antenatal Care (2008) concludes that “there is good-qualityevidence to show that smoking cessation interventions help women reduce smoking anddecrease adverse neonatal outcomes.”Degree of perceived professional consensusEvidence suggests that health professionals recognize the dangers of smoking during pregnancyand support the idea that pregnant women should stop smoking (West, 2002). A consultationwith local stakeholders, including representatives from primary care and public health, showedoverall consensus for the scientific soundness, importance and feasibility of these indicators inQOF+.Degree of perceived support from patients and carersSurveys suggest that, even among women who continue to smoke during pregnancy, almost twothirds say they would like to stop (Hughes et al., 1982; Haslam et al., 1997). The NICE ClinicalGuideline on Antenatal Care (2008) conclude that “most women preferred information to beprovided on a face-to-face basis” and that women required a wide range of informationantenatally including advice on smoking cessation.Impact on health inequalitiesResearch has identified a number of factors associated with continuation of smoking inpregnancy. These include younger age, deprived socio-economic backgrounds and lowereducational level (Cnattingius et al., 1992; Mas et al., 1996). Therefore including an indicator inQOF+ relating to smoking in pregnancy may help to address health inequalities.41
- Page 10 and 11: CreditsProject boardJosip CarMiles
- Page 12: AcknowledgementsWe are indebted to
- Page 15 and 16: Executive summaryIntroductionPrevio
- Page 18: Support with QOF+If you have a prob
- Page 22 and 23: The quality and outcomes framework
- Page 24 and 25: Effect of measurement on health ine
- Page 26 and 27: How might a local QOF operate in pr
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- Page 32 and 33: Alcohol Chapter 4 (p27)IndicatorQOF
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- Page 36 and 37: Patient experience Chapter 12 (p77)
- Page 39 and 40: C3QOF+ report on cardiovasculardise
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- Page 43 and 44: achieved through primary prevention
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- Page 47 and 48: QOF+ report on alcoholProposed indi
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- Page 55 and 56: Local context24% of adults (35,000)
- Page 57: ReferencesBritish Medical Associati
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- Page 67 and 68: Local contextIn 2006/7, the percent
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- Page 71 and 72: QOF+ report on ethnicityProposed In
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- Page 85 and 86: QOF+ report on newpatient screening
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- Page 89 and 90: QOF+ report onpatient informationPr
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- Page 95 and 96: ReferencesCarpenter A and Mayers A
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- Page 106 and 107: BackgroundThe United Nations Conven
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The NICE Clinical Guideline on Antenatal Care (NICE, 2008) include recommendations for smokingin pregnancy. These include:“At the first contact with the woman, discuss her smoking status, provide informationabout the risks of smoking to the unborn child and the hazards of exposure tosecondhand smoke. Address any concerns she and her partner or family may have aboutstopping smoking. Pregnant women should be informed about the specific risks ofsmoking during pregnancy (such as the risks of having a baby with low birthweight andpreterm birth). The benefits of quitting at any stage should be emphasized,”and:“Offer personalised information, advice and support on how to stop smoking. Encouragepregnant women to use local NHS Stop Smoking Services and the NHS pregnancysmoking helpline, by providing details on when, where and how to access them. Monitorsmoking status and offer smoking cessation advice, encouragement and supportthroughout the pregnancy and beyond.”Prevalence of conditionSurvey data found that 27% of women in the UK declared themselves to be current smokers atthe birth of their baby (Owen, 1998). When interpreting these figures, it is important to recognizethat this is likely to be an underestimate, as a proportion of women deny their smoking (West,2002).Associated morbidity and mortalityIt is now well recognized that cigarette smoking during pregnancy is associated with harm to bothfoetus and mother (West, 2002). Risks to the foetus include miscarriage, stillbirth, Sudden InfantDeath Syndrome (SIDS) and respiratory problems in the young child. Longer term problemsinclude intellectual impairment, problem behaviour, infertility, high blood pressure andcardiovascular disease. Potential harms to the mother include increased risk from pregnancycomplications such as abruption and possibly an increased risk of early onset breast cancer (West,2002; Innes et al., 2001). A study by DiFranza et al. (1995) estimated that tobacco use in the USdetermines between 19,000 to 141,000 spontaneous abortions annually, 32,000 to 61,000 casesof low birthweight and up to 26,000 admissions to neonatal intensive care. The same workestimated 1,900 to 4,800 cases of tobacco-related perinatal mortality and 1,200 to 2,200 cases ofSIDS. In pregnancy, passive smoking can reduce foetal growth and increase the risk of pretermbirth (British Medical Association, 2004).Local contextAround 7% of mothers in Hammersmith and Fulham and in <strong>London</strong> smoke during pregnancy. Lowbirth weight is strongly associated with infant mortality and smoking in pregnancy is a risk factorfor low birth weight. Although the low birth weight rate is not particularly high (9% inHammersmith and Fulham, 8% in England), it is strongly related to deprivation (Zeuner, 2008).40
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