Recommendations

• Up-to-date and readily accessible records of patients’ smoking status should be maintained by primary care physicians and hospitals. Primary care physicians should advise patients to stop and where appropriate refer to specialist services at least once a year. Hospital staff should advise patients to stop and refer at the earliest opportunity.
• Smokers of 10 or more cigarettes per day should normally be encouraged to use NRT or bupropion as a cessation aid.
• Smokers should be given accurate and balanced information on the effectiveness and safety of these drugs.
• A structured programme of behavioural support should be available to all smokers who want it, and for reasons of cost-effectiveness should involve group treatment unless practical or other considerations dictate otherwise.

• Clinic screening systems such as expanding the vital signs to include tobacco use status, or the use of other reminder systems such as chart stickers or computer prompts, are essential for the consistent assessment, documentation and intervention with tobacco use.
• All patients should be screened for tobacco use and assessed for their interest in quitting.
• All physicians and clinicians should strongly advise every patient who smokes to quit.
• All healthcare personnel and clinicians should repeatedly and consistently deliver smoking cessation interventions to their patients.
• Patients should be encouraged to use varenicline, NRT or bupropion for smoking cessation (see Safety section for more information about use in special populations).
• To be most effective, interventions should include either individual, group or telephone counselling/contact.
• Intensive interventions are more effective than brief interventions and should be used when resources permit, but every smoker should be offered at least a minimal or brief intervention.
• Smoking cessation interventions should help smokers recognize and cope with problems encountered in quitting (problem solving/skills training), should provide social support as part of treatment, and should encourage smokers to seek support from family and friends.
• Where feasible, smokers attempting to quit with self-help material alone should be provided with access to support through a telephone hotline/helpline.

• Increasing the unit price for tobacco products (strongly recommended)
• Mass media campaigns when combined with other interventions
• Healthcare provider reminders to identify tobacco users and advise on cessation. Techniques include chart stickers, vital sign stamps, medical record flow sheets and checklists. Provider reminders combined with provider education are strongly recommended
• Reducing patient out-of-pocket cost for effective cessation therapies
• Multicomponent patient telephone support (strongly recommended). As a minimum, telephone support should be combined with patient education materials.