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. 2017 May;26(3):300-306.
doi: 10.1136/tobaccocontrol-2015-052662. Epub 2016 May 25.

'Opt-out' referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support

Katarzyna A Campbell  1 , Sue Cooper  1 , Samantha J Fahy  1 , Katharine Bowker  1 , Jo Leonardi-Bee  2 , Andy McEwen  3 , Rachel Whitemore  1 , Tim Coleman  1
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'Opt-out' referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support

Katarzyna A Campbell et al. Tob Control. 2017 May.

Abstract

Background: In the UK, free smoking cessation support is available to pregnant women; only a minority accesses this. 'Opt-out' referrals to stop smoking services (SSS) are recommended by UK guidelines. These involve identifying pregnant smokers using exhaled carbon monoxide (CO) and referring them for support unless they object.

Methods: To assess the impact of 'opt-out' referrals for pregnant smokers on SSS uptake and effectiveness, we conducted a 'before-after' service development evaluation. In the 6-month 'before' period, there was a routine 'opt-in' referral system for self-reported smokers at antenatal 'booking' appointments. In the 6-month 'after' period, additional 'opt-out' referrals were introduced at the 12-week ultrasound appointments; women with CO≥4 ppm were referred to, and outcome data were collected from, local SSS.

Results: Approximately 2300 women attended antenatal care in each period. Before the implementation, 536 (23.4%) women reported smoking at 'booking' and 290 (12.7%) were referred to SSS. After the implementation, 524 (22.9%) women reported smoking at 'booking', an additional 156 smokers (6.8%) were identified via the 'opt-out' referrals and, in total, 421 (18.4%) were referred to SSS. Over twice as many women set a quit date with the SSS after 'opt-out' referrals were implemented (121 (5.3%, 95% CI 4.4% to 6.3%) compared to 57 (2.5%, 95% CI 1.9% to 3.2%) before implementation) and reported being abstinent 4 weeks later (93 (4.1%, 95% CI 3.3% to 4.9%) compared to 46 (2.0%, 1.5% to 2.7%) before implementation).

Conclusions: In a hospital with an 'opt-in' referral system, adding CO screening with 'opt-out' referrals as women attended ultrasound examinations doubled the numbers of pregnant smokers setting quit dates and reporting smoking cessation.

Keywords: Cessation; Health Services; Priority/special populations.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Patient flow and interventions at ‘booking’ and at dating scan appointments before and after implementation of the ‘opt-out’ referral pathway.
Figure 2
Figure 2
Protocol for ‘opt out’ referrals followed by healthcare assistants.
Figure 3
Figure 3
Data sources and data collected.
See this image and copyright information in PMC

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