National Stop Smoking Clinical Guidelines to Help People Stop Smoking
Ireland’s first National Stop Smoking Clinical Guideline (Guideline No.28) was published in January 2022. This guideline was prioritised and quality assured by the National Clinical Effectiveness Committee (NCEC), Department of Health, and recommended by the Minister of Health to become part of a suite of National Clinical Guidelines for implementation across the health services in Ireland.
Information on the National Stop Smoking Clinical guideline and other national clinical guidelines are provided on the Department of Health website.
What are Clinical Guidelines?
Clinical guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances, across the entire clinical spectrum. This National Clinical Guideline is prepared primarily for all healthcare professionals working in Health Service Executive (HSE) operated and funded health and social care settings, including primary care settings, secondary care settings, and community care settings in Ireland. The guideline is also relevant to healthcare planners and managers. The guideline may also be used by healthcare professionals in other settings and by members of the public.
A Clinical Guideline Development Group was established by the HSE Tobacco Free Ireland Programme in April 2017. The group was chaired by Dr Paul Kavanagh, Consultant in Public Health Medicine and was comprised of clinical experts, senior managers, service providers, research experts and service user representatives.
The Clinical Guideline Development Group screened and critically appraised existing international guidelines and evidence so as to draft recommendations for these clinical guidelines. The draft guidelines were shared widely for public consultation and feedback by all concerned stakeholders, as well as for peer review by experts in smoking cessation internationally. The draft guideline was successfully appraised by NCEC in June 2021 and subsequently recommended for publication by the Minister for Health.
These National Stop Smoking Clinical Guidelines aim to;
- Define best practice for care of people who smoke across a range of settings, regarding the management of smoking cessation among the general adult population, as well as providing a special focus on helping women who are pregnant and users of secondary mental health services.
- Recommend that healthcare professionals across our health services routinely ASK people about their smoking, ADVISE them to stop and ACT by providing or arranging safe and effective support. These simple but powerful steps which when delivered routinely in care can increase the chance that someone will quit and remain smoke-free by 2 to 3 fold.
- Set out the recommended behavioural and pharmacological supports that can be arranged to help people who smoke quit.
How can healthcare professionals help people to stop smoking?
- Ask about smoking status at every consultation and
- Advise on the best way to quit which is using medication and our intensive service which provides behavioural support
- Act by 1) Recommending or prescribing stop smoking medication and 2) Referring to QUIT
Healthcare professionals can refer to local stop smoking advisors for behavioural support. Trained stop smoking advisors can assess a client’s nicotine dependence and advise on which options suit best as well as working with the client over a 12 month period to support the behavioural elements of smoking cessation, examining in detail the clients psychological and emotional dependence and working with them to overcome this.
How can Healthcare Professionals refer to the QUIT Service?
There are a number of ways of making a referral to local or national QUIT services:
- Referrals can be made using the HealthLink application (and selecting HSE QUIT Smoking Services). The HealthLink application is now in a number of acute and community services.
- Any healthcare professional can apply to become a Referrer on QuitManager (the national patient management system for Stop Smoking Services). Using this system, they would populate a minimum data set for the client they want to refer. This includes Name, DOB, Gender, County of residence and contact phone number. See details on how to become a referrer here.
- Referrals can also be made by completing this referral form and emailing the completed form to the secure email at QUIT@healthmail.ie
- Referrals can also be made by emailing the referral to a local service, details of which are available here.
Supporting People to Stop Smoking - Advice for General Practitioners
Supporting People to Stop Smoking - Advice for Pharmacists
Recommended Pharmacological Supports
Evidence also tells us that those who choose to use Stop Smoking Medications and Nicotine Replacement Therapies (NRT) in their quit attempt double their chances of quitting smoking further; therefore, if a smoker engages with behavioural support and uses stop smoking medications or NRT and manages to stay quit for 28 days they are five times more likely to stay quit.
Varenicline (Champix) in combination with a short acting nicotine replacement product is the most effective first line of treatment for those who are suitable for same. Otherwise combination nicotine replacement therapy products (a slow release product such as the patch in combination with a fast acting product like nicotine gum or inhalator) for those that are unsuitable for Varenicline or prefer not to use it.
Background to Development of this Guideline
Ireland has a strong record in tobacco control and ratified the World Health Organisation Framework Convention on Tobacco Control (WHO FCTC) in 2005. However, until 2022, there was no National Stop Smoking Clinical Guideline to support the public, patients, healthcare professionals and health services to strengthen and scale-up quitting in Ireland; a requirement under Article 14 of the WHO FCTC.
Tobacco Free Ireland, the current government policy on tobacco control, included the development of national clinical guidelines in its’ accompanying action plan.
The Health Service Executive (HSE) takes forward its responsibilities under Tobacco Free Ireland through the HSE Tobacco Free Ireland Programme (HSE TFIP), and its priorities and actions are set out in a Programme Plan, including the implementation of national clinical guidelines.
The methodology used in the development of this guideline was a blend of the adaptation of existing international guidelines using the ADAPTE tool (ADAPTE Collaboration, 2009) and de novo guideline development process following the process recommended by NCEC (DOH, 2019).
The main sources of evidence supporting these guideline recommendations were:
- Other international guideline group recommendations,
- The Health Information & Quality Authority Health Technology Assessment on smoking cessation interventions,
- Evidence reviews from the Health Research Board,
- Additional specific literature reviews
Further details on the selection, review and appraisal of the evidence base for inclusion in the drafting of this guideline recommendations are available in the full guideline document.