title: Provision of smoking cessation support in UK primary care: impact of the 2012 QOF revision.
abstract: BACKGROUND
  Before 2012, UK GPs were paid only to offer cessation advice to smokers and only to those with smoking-related disease, a minority of all smokers. From 2012, GPs are now paid to offer all smokers referral for behavioural support and medication to assist cessation at least once every 2 years.
  
  
  OBJECTIVE
  To quantify the impact of this new recommendation and payment on indicators of smoking cessation activity.
  
  
  METHODS
  Interrupted time series analysis of data from general practices in England contributing data to The Health Improvement Network (THIN).
  
  
  METHODS
  Data were extracted on monthly rates of recorded delivery of smoking cessation advice, referral to NHS Stop Smoking Services, and prescription of smoking cessation medications, among an average of 3.3 million patients aged >16 years registered each month in THIN. ARIMA models were used to quantify changes in rates of cessation activity after the 2012 Quality and Outcomes Framework (QOF) revision compared with beforehand.
  
  
  RESULTS
  The proportion of patients each month with a record of advice to quit smoking increased by 19.6% (95% CI = 7.9 to 31.4) in the year after the introduction of payments compared with the 8 years beforehand; the recording of referral to Stop Smoking Services increased by 38.8% (95% CI = 15.2 to 62.4). There was no significant change in prescription of smoking cessation medication, -7.7% (95% CI = -21.6 to 6.2).
  
  
  CONCLUSIONS
  Paying GPs to intervene with all smokers and offer support rather than just advice to quit is associated with an increase in recording of advice and referring patients for behavioural support to stop smoking, but no change in prescribing pharmacotherapy for cessation.
authors.affiliation: UK Centre for Tobacco and Alcohol Studies and University of Nottingham Division of Epidemiology and Public Health, Nottingham.
authors.forename: Lisa
authors.initials: L
authors.lastname: Szatkowski
authors.affiliation: UK Centre for Tobacco and Alcohol Studies and University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford.
authors.forename: Paul
authors.initials: P
authors.lastname: Aveyard
mesh_terms: D000293:Adolescent; D000328:Adult; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011320:Primary Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013222:State Medicine; D055815:Young Adult
keywords: financial incentive; interrupted time series analysis; prescribing patterns; primary care; smoking cessation; tobacco use