title: The delivery of smoking cessation interventions to primary care patients with mental health problems.
abstract: OBJECTIVE
  To quantify the extent to which smokers with indicators of poor mental health receive smoking cessation support in primary care consultations compared with those without.
  
  
  METHODS
  Cross-sectional study within a database of electronic primary care medical records.
  
  
  METHODS
  A total of 495 general practices in the United Kingdom contributing data to The Health Improvement Network (THIN) database.
  
  
  METHODS
  A total of 2 493 085 patients aged 16+ registered with a THIN practice for the year from 1 July 2009 to 30 June 2010.
  
  
  METHODS
  The proportion of patients with a diagnostic Read code or British National Formulary (BNF) drug code indicating a mental health diagnosis or psychoactive medication prescription, respectively, who smoke and who have cessation advice or a smoking cessation medication prescription recorded during consultations within the 1-year study period.
  
  
  RESULTS
  Of 32 154 smokers, 50.6% [95% confidence interval (CI): 50.0-51.2] with a mental health diagnosis and 49.3% (95% CI: 49.0-49.7) of 96 285 smokers prescribed a psychoactive medication had a record of cessation advice, higher than the prevalence of advice recording in smokers without these indicators (33.4%, 95% CI: 33.3-33.6). Similarly, smoking cessation medication prescribing was higher: 11.2% (95% CI: 10.8-11.6) of smokers with a mental health diagnosis and 11.0% (95% CI: 10.8-11.2) of smokers prescribed psychoactive medication received a prescription, compared with 6.73% of smokers without these indicators (95% CI: 6.65-6.81). Smoking cessation support was offered in a lower proportion of consultations for smokers with indicators of poor mental health than for those without. Advice was recorded in 7.9% of consultations with smokers with a mental health diagnosis, 8.2% of consultations with smokers prescribed psychoactive medication and 12.3% of consultations with smokers without these indicators; comparable figures for prescribing of cessation medication were 2.9%, 3.2% and 4.4%, respectively.
  
  
  CONCLUSIONS
  Approximately half of smokers with indicators of poor mental health receive advice to quit during primary care consultations in the United Kingdom, and one in 10 receive a cessation medication. Interventions are lower per consultation for smokers with mental health indicators compared with smokers without mental health indicators.
authors.affiliation: UK Centre for Tobacco Control Studies, University of Nottingham, Division of Epidemiology and Public Health, Nottingham, UK. lisa.szatkowski@nottingham.ac.uk
authors.forename: Lisa
authors.initials: L
authors.lastname: Szatkowski
authors.forename: Ann
authors.initials: A
authors.lastname: McNeill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Mental health; primary care; smoking cessation