title: Best practice in smoking cessation services for pregnant women: results of a survey of three services reporting the highest national returns, and three beacon services.
abstract: OBJECTIVE
  The NHS allocated dedicated funds to establish specialist smoking cessation services for pregnant smokers in England in 2000. An early survey revealed some uncertainty as to how the new services should work and monitor their outcome. The current survey focused on identifying examples of good practice in this difficult new field.
  
  
  METHODS
  Three services with the highest number of successful four-week quitters reported for the 2003/4 monitoring year were identified from Department of Health (DH) monitoring records, and three services were nominated from those known in the field as examples of best practice. There was no overlap between the two groups. All six services provided in-depth interviews.
  
  
  RESULTS
  All three highest ranking services that reported close to 100 per cent success rates included unaided quitters identified from hospital wards, rather then smokers actually treated. They had only minimal or average genuine treatment provision for pregnant smokers in place. The three beacon services far exceeded the national throughput and outcome average identified in the previous survey, and provided a wealth of useful information. Although they differed in staffing levels and other aspects of their activities, they all shared several key elements, including a systematic training of midwives in how to refer pregnant smokers, offering nicotine replacement treatment to almost all clients and having an efficient system of providing the prescriptions, offering flexible home visits, and providing intensive multi-session treatment delivered by a small number of dedicated staff.
  
  
  CONCLUSIONS
  Smoking cessation services for pregnant women may need clearer guidance on what they are expected to provide, and how they should monitor their outcome. The key features of the beacon services can serve as a practical model of current best practice applicable across most PCTs.
authors.affiliation: Tobacco Dependence Research & Treatment Centre, Barts and The London, Queen Mary's School of Medicine and Dentistry, Turner Street, London E1 2AD.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
authors.forename: Peter
authors.initials: P
authors.lastname: Hajek
authors.forename: Hayden
authors.initials: H
authors.lastname: McRobbie
authors.forename: Lesley
authors.initials: L
authors.lastname: Owen
mesh_terms: D019985:Benchmarking; D005260:Female; D006293:Health Promotion / Q000379:methods / Q000592:standards*; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D008880:Midwifery / Q000193:education; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods / Q000592:standards*; D015397:Program Evaluation; D012017:Referral and Consultation; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data; D040241:Social Marketing; D013222:State Medicine; D006113:United Kingdom