Smoking cessation QI module

Learn how you can improve smoking cessation activities in your practice or health service.

Tobacco smoking is the largest cause of preventable disease and death in Australia. Research has shown that advice from a health professional is a major external trigger in prompting a person who smokes to make a quit attempt.5 The primary care team play a significant role in supporting and managing smoking cessation through: 

  • Conversations about smoking status. 
  • Assessing smoking status in patient health assessments including the Aboriginal and Torres Strait Islander 715 Health Checks.
  • Delivering brief interventions.
  • Managing nicotine withdrawal with pharmacotherapy.
  • Referring patients to tailored counselling support at Quitline.

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Smoking cessation

The Cancer Institute NSW is committed to reducing smoking across NSW through the Tobacco Control Program.

While there has been a long-term reduction in smoking over the last ten years among the NSW population, from 17.1% of adults smoking in 2012 to 13.3% in 2020,36 smoking rates remain disproportionately high among focus populations. These focus populations include people with mental health condition, Aboriginal people, people from a low socio-economic area, people unemployed or unable to work and people living in regional or remote areas.23  

Smoking tobacco products produces cancer-causing chemicals that contribute, most notably, to lung cancer, but also other cancers, for example tongue, mouth, throat and stomach.

The tobacco smoking landscape has changed due to the use and prevalence of alternative tobacco products such as electronic cigarettes and water pipes (shishas). The emergence of these alternate products could threaten the progress of tobacco control in Australia, thus requiring the ongoing intervention provided by health professionals to support cessation.

Stopping smoking has immediate health benefits for a patient, and it can further prevent the development of other smoking related diseases such as lung cancer, heart disease, diabetes, other types of cancer, cerebrovascular disease and chronic obstructive pulmonary disease (COPD).1,2

  • In 2020, 9.2% of NSW adults were daily smokers.3
  • In 2018-2019, around 6,700 deaths and more than 62,900 hospitalisations were attributed to smoking in NSW.4
  • Approximately one in five of all cancer deaths are due to tobacco smoking.
  • Smoking is estimated to cost NSW $8.4 billion.

Smoking cessation advice can come from a range of primary care providers, such as general practitioners (GPs), nurses, pharmacists, psychologists, dentists, allied health professionals, Aboriginal health workers and smoking cessation specialists.

Taking a quality improvement (QI) approach to smoking cessation in primary care can assist in identifying interventions that can contribute to better care and outcomes for patients. The most effective preventative intervention that a clinician can provide is smoking cessation. 

More information

Education for Health Professionals

The 'National Quit Training and Resource Centre for Nicotine Cessation' ('Quit Centre') is a national best practice support service for nicotine cessation. Its goal is to ensure Australian health professionals have the latest clinical information, resources and training on smoking and vaping cessation to support their patients as part of routine care


Patient centred care

Knowing your patient population is essential to delivering patient centred care. Having supportive systems and accurate information in clinical software is key to effectively identifying at-risk patients, so that you can ensure information is tailored and care is responsive to people’s individual needs and preferences. 

Learn more information about patient centred care.

Although the overall smoking prevalence in Australia has decreased over time, population groups who experience disadvantage are more likely to start smoking and continue smoking in the long term. Research has demonstrated that tobacco use is associated with poverty and inequality, and a clear relationship exists between smoking and socioeconomic status.23 In this section, key population sub-groups are identified that face disproportionate smoking problems.

PHN Support

Utilise the support of your local PHN to provide dashboard reports to identify priority populations. You could work with your PHN representative to develop targeted reports (utilising clinical audit tools) to identify a priority group such as Aboriginal people or pregnant women who smoke. Once you have reports and data available about your practice population, QI activities can be embedded in your practice.

More information

Refer to RACGP Smoking Cesation Guidelines for health professionals for further information about smoking cessation for high-prevalence groups.

View guidelines


Aboriginal people have higher smoking rates, with 37.3% of adults smoking, compared with 14.9% of non-Aboriginal adults.

Lung cancer is almost twice as common in Aboriginal people in NSW than non-Aboriginal people, and mortality rates are also higher.

Key motivators for smoking cessation for Aboriginal people include:12

  • smoking-related health effects
  • the importance of family and kin, and the impact of smoking on them
  • supporting self-efficacy in the quitting process
  • the cost of smoking, particularly because it affects the family
  • the adverse effects of smoking on sport and physical activity.

The Tackling Indigenous Smoking program aims to improve the health of Aboriginal people by reducing the prevalence of tobacco use through population health promotion activities. Grants are provided by the Australian Government to organisations to work with Aboriginal communities.

The Australian Government also funds up to two courses of nicotine patches or oral forms of NRT (gum, lozenge) per year on the Pharmaceutical Benefits Scheme for people who identify as Aboriginal. 13

Aboriginal people can access Aboriginal Quitline Advisors who are available to provide support to quit. For more information on the Aboriginal Quitline, download the brochure (PDF).

More information

For more information and resources visit the Tackling Indigenous Smoking Resources Centre.

Health professionals should understand and address the barriers to smoking cessation for pregnant women, including:6

  • Lack of understanding of risk to themselves and their babies.
  • Influence of close relationships on smoking status.
  • Use of smoking as a way of coping with stress.

Other considerations for people who smoke during pregnancy is the perceived stigma attached to their smoking, which can prevent them from seeking support or help in the first instance.6 Praise from health professionals to pregnant women for efforts to quit smoking is a significant source of automatic motivation for pregnant women to continue trying to quit smoking.38 Quitline referral is encouraged for continued behavioural support, as the current evidence is insufficient to assess the safety of pharmacological approaches during pregnancy.6 If quit attempts are unsuccessful without the use of pharmacological approaches and the person is motivated to quit, pharmacotherapy (usually oral forms of NRT) should be considered as a second line form of treatment.6

Primary care is often the first point of healthcare provision for people from Culturally and Linguistically Diverse (CALD) backgrounds. Supporting and educating people from CALD backgrounds in smoking cessation is an important step in reducing smoking rates in these population groups. Tailoring smoking cessation interventions to consider appropriate cultural dimensions such as values, beliefs and smoking practices enhances cultural acceptability and may result in improved quit rates.6

Quitline provides in-language support for people who smoke in a non-judgemental and culturally appropriate way, and is available in the following languages: Arabic, Vietnamese, Cantonese and Mandarin. The Quitline is a confidential telephone service, which provides support and advice for people trying to quit smoking by trained Counsellors.

There are opportunities to help CALD communities quit smoking with messaging that:14

  • Promotes the immediate benefits of quitting smoking.
  • Reshapes social norms about smoking.
  • Highlights the benefits of cessation aids such as GP and Quitline services.
Shisha (water-pipe)

Smoking behaviours can be shaped by sociocultural contexts. Research indicates an increasing trend in shisha (also known as argileh, nargila, waterpipe or hookah) smoking, particularly within people of Middle Eastern descent in Western countries.24 A survey by the Australian Institute of Health and Welfare found that 1 in 20 people smoked a water-pipe in 2019.25

One shisha session, which usually lasts between 45 minutes to one hour, is equivalent to smoking 100 cigarettes.

Among Arabic-speaking communities in NSW, shisha smoking is perceived as a social activity and less harmful than cigarettes.26 Smoking cessation interventions that are adapted to meet cultural needs such as values, beliefs and smoking practices may result in improved quit rates.6

The ‘Shisha No Thanks’ project has created multilingual fact sheets for patients and health professionals with information on shisha smoking and its potential harms. In addition, a 30 minute online training module has been developed which covers three key areas:

More information

Do any of your patients need, or prefer to speak languages other than English? 

Access an interpreter through the Translating and Interpreting Service (TIS National) Doctors Priority Line on 131 450.

People living in regional and remote regions often have access to fewer services than people residing in metropolitan area. This means that people residing in regional and remote areas will rely heavily upon their primary care providers for their health needs, which can often be complex and specialised. The availability of and access to pharmacotherapy, telephone base support service (Quitline), and online support services are integral elements of providing smoking cessation support for these communities. 

Addressing smoking in socially and economically disadvantaged groups will contribute to reducing health inequalities over time. A US study found that population-based tobacco treatment, combining counselling and proactive outreach plus free or subsidised cessation treatment, increases engagement in evidence-based treatment and is effective in long-term smoking cessation among socioeconomically disadvantaged smokers.15

Guidelines for quitting smoking apply to socially and or economically disadvantaged communities, and every opportunity should be taken to provide all people who smoke advice and support to stop smoking.6 

Counselling and behavioural interventions may be modified to be appropriate for the individual, with consideration of cost to access pharmacotherapy.6

People with mental health conditions have higher smoking rates than the general population and are more likely to die from their smoking than as a result of their psychiatric condition.16 Health professionals should consider that people who smoke with a mental health condition are just as motivated to quit smoking as the general population and integrating smoking cessation into mental health treatment can assist in reducing the mental health disparities between those with and without a mental health condition.16

Smoking cessation should be encouraged and supported in patients with mental health condition; smoking is likely to lead to improvements in mental health. A combination of face-to-face help supported by Quitline calls has been shown to be as effective as intensive face-to-face help.6 In addition, there is a growing body of evidence showing that quitting is typically not detrimental to psychiatric symptoms.17,6 For health professionals, things to keep in mind include.6

  • The stress of quitting can temporarily trigger neuropsychiatric symptoms, so close monitoring of symptoms is required.
  • People with a mental health conditions should be provided the same smoking cessation interventions that have been shown to be effective in the general population, but may require longer maintenance on pharmacotherapy.
  • Higher levels of nicotine dependence among smokers with a mental health condition mean that larger doses of NRT, combination pharmacotherapy, and a longer duration of therapy may be necessary.
  • Quitline provides tailored cessation support to callers with mental health conditions.

View Quit Victoria’s Training and Resources for mental health services.

When providing smoking cessation support for gender and sexuality diverse people, identifying strategies that address social connections and normalisation of smoking, identity and mental health are important considerations.18

ACON and Central Eastern Sydney PHN have developed the AOD (Alcohol and Other Drugs) LGBTIQ  Inclusive Guidelines for Treatment Providers (PDF). The guidelines can assist providers to identify early signs of problems with their patient’s AOD use, which may require sensitive messaging. Health promotion campaigns such as ACON’s Pivot Point website and health and community workers who are inclusive in their practice can assist LGBTIQ communities to seek support.19

An additional consideration for primary health providers supporting gender and sexuality diverse people to quit smoking is identifying preference for quit support.18 Asking the person if there is a preference for online resources such as ICanQuit or digital apps such as My QuitBuddy.

Research demonstrates that most adults who smoke became addicted to nicotine during adolescence.6,32 Nicotine inhibits adolescent development and exposure to nicotine is associated with:33

  • Poor working memory.
  • Poor attention.
  • Poor auditory processing.
  • Increased impulsivity.
  • Increased anxiety.

There is also evidence to suggest that nicotine has a precursor effect on young people by increasing addiction liability for other drugs.33 There are various reasons that contribute to adolescents taking up smoking, these include genetic factors, peer influence, parental smoking, stress and curiosity.34

General practitioners often have a long-term relationship with adolescents and are perceived as respected sources of health information.35 Key strategies when helping young people to quit smoking include:6

  • Developing a trusting relationship – utilise good listening skills and affirm their experiences.
  • Counselling – ask about smoking, use open-ended questions and be non-judgmental.
  • Provide information about nicotine addiction and the harms of smoking.
  • Reducing parental smoking rates – this intervention has the most distinct effect on youth smoking uptake.
  • NRT – can be provided alongside behavioural support if the adolescent is nicotine dependent and has desire to make a quit attempt. 

For further information on appropriate interventions to address adolescent smoking, refer to chapter 4 of the RACGP Guidelines: Supporting smoking cessation: A guide for health professionals.

Young people and vaping

The use of e-cigarettes (commonly referred to as vaping) is increasing in NSW, with highest use among young people.  Electronic cigarettes or e-cigarettes are battery operated devices which heat a liquid to produce a vapour to inhale.  The liquid within e-cigarettes contains a range of chemicals or flavours and often includes high levels of nicotine.

  • In 2019-2020, 21.4% of young people (aged 16-24 years) had ever vaped, compared to 9.6% of the NSW population.27
  • 4.5% of this younger age group were current users, compared to only 2% of the wider NSW population.27
  • Research indicates that young people who vape are three times more likely to take up regular tobacco smoking in comparison to those that do not vape.28
  • E-cigarettes that do not contain nicotine are still not safe and can have long-term health consequences for young people.30 
  • Vapours can contain toxins, cancer-causing agents, heavy metals, and very fine particles which can lead to cellular toxicity and dysfunction through changes to protein function and gene expression pathways.31

General practitioners are well positioned to identify and assess young patients who vape. General practitioners should educate young people about the harms of vaping and intervene early as this provides the greatest opportunity for positive behaviour change in adulthood.

The HEEADDSSS interview is a recommended psychosocial assessment tool for adolescents and is endorsed by RACGP. A trust-based relationship is vital when dealing with young people, with recommendations to interact with patients in a clear, open and non-judgmental manner when asking about nicotine use (RACGP).6

Suggested questions about vaping can include:6

  • Age at first use and regular use.
  • Type of vaping device used.
  • Pattern of use (e.g. daily, socially, on weekends).
  • Frequency of use.
  • Adverse effects from vaping (e.g. withdrawal, tolerance).

RACGP has developed a webinar on the use of e-cigarettes, present treatment options, non-judgmental conversations about vaping as well as resources and services available to GPs for continuity of cessation care and support. 

Team approach

The toolkit recognises that each team is unique. It provides examples of members’ roles and responsibilities in Quality Improvement projects. Having a team member who champions quality improvement within your practice can be the key to successful quality improvement activities. 

Learn more information about team approach.

Primary care plays a vital role in the prevention and identification of cancers. Tobacco smoking is the leading cause of premature mortality and preventable morbidity. Tobacco use being directly linked to lung cancer and contributing to sixteen types of cancer and other chronic disease, the role of primary care health professionals is vital in helping patients to quit smoking.

  • Four in 5 people have consulted a GP at least once in the previous year, which makes primary care the ideal place for smoking cessation interventions to take place.6
  • One in every 33 conversations about smoking cessation leads to a patient successfully quitting.6 With approximately 800,000 smokers in NSW, there is the potential for approximately 24,000 people in NSW to quit smoking each year through brief interventions delivered by health professionals.

Primary care health professionals should routinely ask all patients if they smoke and provide advice and support to all patients who smoke. With new and alternative methods of tobacco smoking such as e-cigarettes and shishas (also known as argileh, nargila, waterpipe or hookah), people should be asked about their patterns of smoking as well as their methods.

Primary health care professionals can also capitalise on opportunities where smoking is especially related to the presenting condition, for example:6

  • Presenting with tobacco-related diseases (COPD/diabetes).
  • During diagnosis or management of any condition where tobacco use affects treatment or outcomes (chronic disease/mental health/all health assessments).
  • During or after hospitalisation.
  • Preparing for surgery.
  • Before and during pregnancy, and after the birth of a child.
  • Smoking arises in everyday conversations e.g. during health assessments, wound care, vaccinations.
  • During health assessments.

Specific MBS Telehealth Services for Nicotine and Smoking Cessation Counselling are available to support smoking cessation care with your patients.

Find more information about nicotine and smoking cessation MBS items.

Brief intervention

Ask, Advise, Help model

The Royal Australian College of General Practitioners (RACGP) guidelines on smoking cessation recommends that all people who smoke should be offered at least a brief intervention for smoking cessation, consistent with a three-step model: Ask, Advise, Help.6

The Ask, Advise, Help model can be provided by a range of health professionals in a variety of health settings. The three-step model aims to reduce one of the biggest barriers to providing smoking cessation advice: time limitations.6,5 

Quit Victoria: Brief Intervention Video for GPs

Quit Victoria: Brief Intervention Video for Nurses

Brief Intervention (Ask, Advise, Help)
  • ASK and record smoking and/or vaping status.6

  • ADVISE all patients who smoke to quit and provide advice on the most effective methods.6

  • HELP by offering to arrange referral, and encouraging use of behavioural support (such as that offered by Quitline) and evidence-based smoking cessation medications.

All patients who smoke should be offered advice to quit smoking at every opportunity

Health professionals should ask all patients about patterns of smoking as well as their methods, and their smoking status should be recorded. Implementing recording systems that document tobacco use almost doubles the rate at which clinicians intervene with patients who smoke, and results in higher rates of smoking cessation.21

For those patients known to smoke, health professionals should try to continue a conversation about their smoking at each visit, even if it is just an offer to discuss options and importance of action at a subsequent visit. It is important for health professionals to be non-judgemental when asking about smoking.

More information

Access the RACGP’s Smoking Cessation Guidelines: Supporting Smoking Cessation, A Guide for Health Professionals

There is strong evidence that referral to telephone call-back counselling services should be offered to all people who smoke.6 The NSW Quitline is a free and confidential telephone service providing customised assistance to help people who smoke to make a quit attempt. NSW Quitline Counsellors are qualified professionals with specialist training to help people stop smoking. Counsellors can assist you with preparing to quit, avoiding slip-ups, and staying smoke-free. Aboriginal Counsellors and counsellors who speak Arabic, Mandarin, Cantonese and Vietnamese are also available to provide in language and culturally safe support.

The iCanQuit website provides a range of resources for people who smoke, including tips on how to quit, information and tools for quitting, and a supportive peer-support community.


Expired Carbon Monoxide measurement

Consider using CO monitors during consultations as part of an overall smoking cessation intervention. CO readings provides the patient visible and real-time evidence of the effects of smoking on their body. The readings can alert patients and help motivate them to make changes and quit smoking.

CO can be measured by using a hand-held device which analyses the level of CO in the body through a breath test. CO monitors measure the level of expired CO in the breath which is an indirect measure of the percent of carboxyhaemoglobin (COHb) in the bloodstream. These monitors can be used to assess CO levels in adults, adolescents and unborn babies (PDF) and can provide readings for both smokers and passive smokers.

View more information (PDF)


More information

Call 13 7848 (13 QUIT)

NSW Quitline counsellors availability (including Aboriginal and bilingual counsellors):

Monday to Friday: 7am–10:30pm
Saturday, Sunday and public holidays: 9am–5pm


First-line Pharmacotherapy 

First-line pharmacotherapy medicines have been clinically proven to be effective and safe for smoking cessation in Australia. These include Nicotine Replacement Therapy (NRT), varenicline (champix)* and bupropion.6 Pharmacotherapy should be recommended to all people who smoke with nicotine dependence.6

There is a global shortage of champix in place until October 2023. See TGA website for latest information on product alternatives.

The most effective quit approach for those who are nicotine dependent is behavioural support combined with first-line pharmacotherapy and follow-up.6

For advice on prescribing first-line pharmacotherapy visit the RACGP’s Smoking Cessation Guidelines.

Nicotine Vaping Products

From October 1, 2021, consumers are required to obtain a prescription for nicotine vaping products (NVP), which includes nicotine e-cigarettes, nicotine pods and liquid nicotine. To legally purchase these products, consumers require a prescription from an Australian registered medical practitioner.7

More information


It is important to note NVPs are not an approved medicine and have not been assessed by the TGA for safety, quality and efficacy.

NVPs are not recommended as first-line treatments for smoking cessation. NVPs should only be considered for people who have tried to achieve smoking cessation with TGA-approved pharmacotherapies combined with behavioural intervention but failed and are still motivated to quit smoking and should be combined with ongoing behavioural support.

While evidence on long-term health effects continues to be generated, the Australian National University has published a systematic review of global evidence on e-cigarettes and health outcomes. Key findings include:

  • There is strong evidence that never smokers who use e-cigarettes are on average around three times as likely as non-e-cigarette users to initiate cigarette smoking.
  • There is conclusive evidence that the use of e-cigarettes can cause respiratory disease among smokers and non-smokers
  • There is conclusive evidence that e-cigarettes can cause burns and injuries, and exposure can lead to poisoning.

There is limited, insufficient or no available evidence for a range of other health outcomes, though these will continue to be monitored.

The TGA has moved to NVP prescription to balance prevention of adolescents and young adults uptake of NVPs while allowing current smokers to access these products for smoking cessation with appropriate medical advice.7

The RACGP has released a NVP smoking cessation module to accompany the current smoking cessation guidelines. The module outlines details regarding the management of NVPs and includes details on:

  • Prescribing pathways (Authorised Prescriber Scheme, Special Access Scheme, Person Importation Scheme).
  • Prescribing recommendations.
  • Monitoring NVP use and follow-up.
  • Minimising risks.

For more information, refer to the 'Young people and vaping' section under 'Priority Populations' on this page.


More information

Important information for patients

  • Due to lack of available evidence, the long-term health effects of NVPs are unknown.
  • NVPs are not registered therapeutic goods in Australia and therefore their safety, efficacy and quality have not been established.
  • There is a lack of uniformity in vaping devices and NVPs, which increases the uncertainties associated with their use.
  • To maximise possible benefit and minimise risk of harms, dual use should be avoided, and long-term use should be minimised.
  • It is important for patients to return for regular review and monitoring (utilise MBS items to support ongoing care).

NVP Resources

RACGP: Smoking Cessation Nicotine Vaping Product Recommendations  

NPS Medicinewise: Nicotine Vaping Product Pathways to Prescribing (PDF)

TGA: Nicotine e-cigarette hub

TGA: Special Access Scheme

GPs are trusted sources of advice for patients and act as clinical champions for the practice team.  More than 83% of the population consult a GP yearly, which provides excellent opportunities to identify and discuss smoking cessation options.6

  • Provide brief intervention following the AAH model (Ask, Advise, Help).
  • Take every opportunity to ask about smoking behaviours (cigarettes, pipes, shisha/waterpipe, cigars, e-cigarette/vaping, cannabis mixed with tobacco).
  • Aim to embed smoking cessation into everyday conversations/history taking/health assessments for example chronic disease management plans, age and risk related related health assessments and Aboriginal HealthCheck-715.
  • Prescribe pharmacotherapy and refer to Quitline for behavioural support.
  • Engage in and lead QI activities to support patients in smoking cessation.
  • Take on the role as a clinical leader for the practice (see quality improvement section below regarding the roles of the team in QI).
  • Refer to HealthPathways for advice on assessment, management, and referral. Speak to your PHN for access.


Primary care nurses are trusted professionals and play a valuable role in helping patients to quit smoking. Primary care nurses often have longer periods of time with their patients, which provides greater opportunity to discuss smoking cessation.

  • Provide brief intervention following the AAH model.
  • Refer to Quitline for behavioural support to quit smoking.
  • Discuss options for pharmacotherapy and arrange discussion with GP if interested in prescription-based options.
  • Aim to embed smoking cessation into everyday conversations/history taking/health assessments for example chronic disease management plans, age and risk related health assessments and Aboriginal HealthCheck-715.
  • Engage in QI activities to support patients in smoking cessation and supporting a smoke-free practice environment. Primary care nurses can take on the role as clinical leaders and patient care managers (see quality improvement section below regarding the roles of the team in QI).
  • Nurse clinics can support smoking cessation strategies in the general practice setting.1 Visit APNA for more information in establishing nurse-led clinics

Administrative and managerial staff in general practice play a vital role in connecting the team and are often the first point of contact for patients.

  • Directing patients to available smoking cessation information in the practice.
  • Oversee and support data and systems with up-to-date patient records.
  • Data cleaning (e.g. deactivating inactive patients).
  • Utilise clinical audit tools/practice software for capturing accurate patient information.
  • Answering direct queries patients have (over the phone or in person).
  • Engage in QI activities to support patients in smoking cessation by supporting practice facilitation or technical expertise (see quality improvement section below regarding the roles of the team in QI).

Administrative staff plan a vital role in Accreditation for general practices and managing patient information to support preventive care.

View the RACGP’s Standards for General Practices 5th edition (PDF).

  • Aboriginal health workers should provide brief interventions to encourage patients to quit
  • Aboriginal people can access Aboriginal Quitline Advisors who are available to provide support to quit. For more information on the Aboriginal Quitline, download the brochure (PDF).
  • Encouraging Aboriginal patients to have their annual Health Check (715 assessment)is a vital opportunity to ensure patients are being screened not only smoking status, but includes cancer screening and identifying contributing risk factors that lead to chronic disease.
  • Providing access to a range of free NRT products. Some Aboriginal health services in NSW receive funding to provide free NRT to patients through the  Nicotine Replacement Therapy Program, to support the ongoing smoking cessation efforts in AMS/ACCHS.
  • In partnership with NSW Health, the AH&MRC delivers Brief Intervention Training for clinical staff working in ACCHS across NSW. Visit the: Nicotine Replacement Therapy Program for more information.

Aboriginal Community Controlled Health Services (ACCHS) have an important role to play in supporting Aboriginal people in smoking cessation. With the smoking rate among Indigenous Australians more than twice as high as non-Indigenous Australians,8 targeted cessation efforts need to take place in a culturally appropriate and safe manner.

See patient centred care for Aboriginal communities on this page for more information. 

Quality Improvement

Approaching smoking cessation from Quality Improvement (QI) perspective allows practices and health services to identify specific areas in their practice they would like to focus on, take action, and improve processes over time.

Learn more information about QI.

The QI PIP is a payment to general practices that participate in QI activities to improve care they provide to their patients, with a focus on care relating to particular health priority areas.9 Smoking status is one of the 10 Quality Improvement Measures, prompting clinicians to ask about smoking status and recording details in the clinical software. 

Engaging in conversations regarding smoking cessation and recording smoking status, is the first step in undertaking QI activities, once practices have a satisfactory level of clean data, it allows the practice to engage in higher level QI activities in smoking cessation.

Find more information on the QI PIP and QI measures (PDF).

Quality Improvement (QI) activities in relation to smoking cessation can be broken down into three categories, depending on the level of readiness and team capacity.

Level 1 QI activities

Introductory level activity, which starts with improving data quality and is useful if enrolled in PIP QI as smoking status is one of the 10 QI measures. Level 1 QI ideas include:

NB: RACGP recommends Smoking status and interest in quitting should be assessed and documented in the medical record for every patient >10 years of age.

  • Identifying patients with missing smoking status and set a reminder in practice software for the next time they come into the practice.
  • Install a clinical audit tool to assist with data management for smoking status. Speak to your PHN representative for more information.

Download the Smoking Cessation: QI activity - level 1 (PDF).

Speak to your PHN to obtain QI PIP practice level data


Level 2 QI activities

Clinical level. GP or nurse driven tasks for smoking cessation intervention. Level 2 QI ideas include:

  • Embedding smoking cessation into all health assessments, with brief intervention provided to people who smoke.
  • Training all health professionals in delivering brief interventions.

Download the Smoking Cessation: QI activity - level 2 (PDF).

Level 3 QI activities

Whole of practice approach where a practice may choose to focus on smoking cessation as a team. It is recommended to complete level 1 and 2 before progressing to level 3.Level 3 QI ideas include:

  • Run a quit smoking clinic in your practice that is operated by clinicians (see Nurse led clinic information) and supported by practice administration.
  • Set up a high-risk quit smoking clinic (e.g. for patients who smoke and have COPD, Heart disease, cancer).

Download the Smoking Cessation: QI activity - level 3 (PDF).


QI Tools

QI Readiness Checklist
The readiness checklist is designed for Primary Health Networks (PHNs), practices and health services to start with when planning QI activities, which can indicate what level of QI they may like to engage in.

Download the Primary Care Toolkit: readiness checklist (PDF).

Smoking Cessation Quick Reference Guide
This tool can be used by PHNs, general practices and health services in smoking cessation QI activites. This is a brief two-sided resource that summarises the key themes of smoking cessation QI, and it also includes a smoking cessation QI Readiness checklist which can identify ideas for PDSA cyles with an accompanying PDSA template on the back page.

View the Smoking Cessation: a quick reference guide (PDF).

Steps to organising practice data

This tool is an additional tool that assists in prompting practice based activities that support improvements in smoking cessation QI.

Download the steps to organising practice data (PDF).

Data and systems

Good practice data is reliable, valid and unbiased. Without data, the impact of changes cannot be measured effectively. Systems that record tobacco users almost double the rate at which clinicians can intervene with smokers, leading to higher rates of smoking cessation interventions.10

Learn more information about data and systems.

As per the RACGP accreditation standards, all clinicians must document in the patient’s health record discussions or activities relating to preventive health. Lifestyle risk factors such as smoking, poor nutrition, alcohol consumption and inadequate physical activity are associated with many diseases.11 Clinicians must record these risk factors in the patient health record and review management plans at defined intervals in order to provide high-quality care.11

Practices and health services can install Quitline templates into practice software that are ready to be filled out to refer patients to Quitline. Alternatively, referrals can be faxed or the online referral form is found on the iCanQuit website.

Information about referral management and access to referral templates can also be found on your local HealthPathways website.

Recalls and reminders are a crucial element of running an effective practice and often the basis of providing effective preventative care. Examples of when to use recalls and reminders in smoking cessation include: 

  • Set reminders for all patients if they have a missing smoking status.
  • Set recalls and reminders for all health assessments where smoking status/smoking cessation can be integrated.
  • Utilise recalls in the Smoking Cessation: QI activity - level 1 (PDF), e.g. following up high-risk patients who smoke. 

For patients who receive smoking cessation advice, set a recall for follow up in one week, one month and 6 months to track progress. Utilise Temporary MBS items to support these visits. From 21 July 2021, there are 18 new temporary items available for patients to access through General Practitioners (GPs) and Other Medical Practitioners (OMPs) which relate to nicotine and smoking cessation counselling . These items will be extended to 31 December 2023.

The new temporary items include six face-to-face, six telehealth and six phone services. 

The items cover a 20-minute consultation and must include any of the following:
(a) taking a patient history, aimed at identifying disease risk factors attributable to nicotine use and smoking dependence, and/or identifying barriers and enablers to cessation; and
(b) completing an assessment of the patient’s nicotine dependence, including where clinically appropriate a basic physical examination; and
(c) initiating interventions and referrals for the cessation of nicotine, if required; and
(d) implementing a management plan for appropriate treatment; and
(e) providing the patient with nicotine and smoking cessation advice and information, including modifiable lifestyle factors; with appropriate documentation.

Speak with your PHN representative to arrange the installation of a clinical audit tool. There are different providers, depending on which vendor your PHN works with. These tools are invaluable to your practice to assist in QI activities and assist in understanding your practice population.

In the context of smoking cessation, clinical audit tools can help you to:

  • Track patients who have missing smoking status and smoking history recorded. Use point of care software prompts to remind clinicians to ask about and record smoking status. 
  • Identify priority populations who smoke e.g. Aboriginal people, pregnant women, or people with high-risk comorbidity (e.g. COPD).
  • Share de-identified data with your PHN, who may use this data to provide you with dashboard reports, which can assist in quality improvement activities and tracking preventative activities within your practice.

Clinical audit tool companies provide a wide range of ‘how to’ guides or ‘recipes’ to support general practices and health services. Some smoking-based examples are below:

Refer to the steps to organising practice data (PDF).


1. J. Anczak and R. Nogler, "Tobacco cessation in primary care: maximizing intervention strategies," Clin Med Res, vol. 1, no. 3, p. 201, 2003. 

2."Reasons to quit," Cancer Institute of NSW, 2021. [Online]. Available: [Accessed April 2021].

HealthStats, "Health Stats," NSW Ministry of Health , 2021. [Online]. Available: [Accessed September 2021].

3. "Harms of tobacco smoking and second-hand smoke," Centre for Population Health, NSW Health, 2020. [Online]. Available: [Accessed April 2021].

4. Quit, "Training and resources for general practice," Quit Victoria, [Online]. Available: [Accessed April 2021].

5. RACGP, "Supporting smoking cessation: A guide for health professionals. 2nd edn," The Royal Australian College of General Practitioners, East Melbourne , 2019.

6. TGA, "Nictine vaping products," Therapeutic Goods Administration, 2021. [Online]. Available: [Accessed 2021].

7. HealthStats, "Daily smoking rates in adults 2018-2019," NSW Minitry of Health, [Online]. Available:,self%2Dreported%20using%20CATI).. [Accessed April 2021].

8. "PIP QI Incentive guidance," Australian Department of Health, 2021. [Online]. Available: [Accessed May 2021].

9. PENCS, "PIP Q: Practice Incentive Program Quality Improvement and CAT Plus," PenCS, 2019. [Online]. Available: [Accessed April 2021].

10. RACGP, "Standards for general practices," Royal Australian College of General Practitioners, East Melbourne, 2020.

11. A. Van der Sterren, E. Greenhalgh, D. Knoche and M. & Winstanley, "Smoking cessation and Aboriginal and Torres Strait Islander peoples. Tobacco in Australia: Facts and issues.," Cancer Council Victoria, Melbourne, 2016.

12. AH&MRC, "Nicotine Replacement Therapy Program," Aboriginal Health and Medical Research Council of NSW, 2019. [Online]. Available: [Accessed June 2021].

13. CINSW, "Culturally and Linguistically Diverse Priority Populations - Formative Research for Tobacco Control," Cancer Institute of NSW, 2019. [Online]. Available: [Accessed June 2021].

14. F. SS, v. R. M, N. D, B. DJ, T. JL and e. al, "Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: A randomised clinical trial.," Thorax, 2016. 

15. E. Greenhalgh, S. Jenkins, S. Stillman and C. Ford, "Tobacco in Australia: Facts and issues 7.12 Smoking and mental health," Cancer Council Victoria, Melbourne, 2020.

16. E. Greenhalgh, S. Jenkins, S. Stillman and C. & Ford, "Smoking Cessation," Tobacco Australia - Cancer Council Victoria, [Online]. Available: [Accessed May 2021].

17. ACON, "Health Outcomes Strategy 2013-2018 - Smoking," 2013. [Online]. Available: [Accessed June 2021].

18. ACON, "AOD LGBTIQ Inclusive Guidelines for Treatment Providers," [Online]. Available: [Accessed June 2021].

19. RACGP, "Smoking, nutrition, alcohol, physical activity (SNAP): A population health guide to behavioural risk factors in general practice, 2nd edition," Royal Australian College of General Practitioners, East Melbourne, 2015.

20. TIS, "Brief Intervention," Tackling Indigenous Smoking , [Online]. Available: [Accessed May 2021].

21. E. Greenhalgh, M. Bayly, S. Hanley-Jones and M. Scollo, "Tobacco in Australia: Facts and issues. 1.10 Prevalence of smoking in other high-risk sub-groups of the population," Melbourne: Cancer Council, Melbourne, 2021. 

22. AIHW, "Tobacoo Smoking", [Online]. Available: [Accessed February 2022]

23. D. Raad, S. Schunemann, H. Irani, J. Abou Jaoude, P. Honeine and R. Akl, “Effects of water-pipe smoking on lung function: a systematic review and meta-analysis,” Chest, 139(4), 764-774. 

24. AIHW, “National Drug Strategy Household Survey 2019 – Tobacco Smoking”, [Online]. Available: [Accessed February 2022]

25. R. Kearns, K. Gardner, M. Silveira, et al. “Shaping interventions to address waterpipe smoking in Arabic-speaking communities in Sydney, Australia: a qualitative study”. BMC Public Health, 2018. 

26. HealthStats NSW, "Electronic cigarette use”. NSW Population Health Survey (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health. [Online]. Available:,Current%20user,Ever%20used [Accessed February 2022]

27. E. Banks, K. Beckwith, G. Joshy, “Summary report on use of e-cigarettes and impact on tobacco smoking uptake and cessation, relevant to the Australian context”. Commissioned Report for the Australian Government Department of Health, 2020. 

28. J. Gotts, S. Jordt, R. McConnell, R. Tarran, “What are the respiratory effects of e-cigarettes?” Bmj 366, 2019. 

29. S. Byrne, E. Brindal, G. Williams, et al. “E-cigarettes, smoking and health”. A Literature Review Update. CSIRO Australia, 2018. 

30. M. Perez, L. Crotty Alexander, “Why is vaping going up in flames?”. Annals of the American Thoracic Society, 2020. 

31. E. Greenhalgh, M. Winstanley, "Tobacco in Australia: Facts and issues. 1.6 Prevalence of smoking – teenagers,” Melbourne: Cancer Council Victoria, 2018.  

32. L. England, K. Aagaard, M. Block et al., “Developmental toxicity of nicotine: a transdisciplinary synthesis and implications for emerging tobacco products”. Neuroscience & Biobehavioral Reviews, 2017. 

33. L. Wood, E. Greenhalgh, A. Vittiglia, “Tobacco in Australia: Facts and issues. 5.2 Factors influecne uptake by young people: overview” Melbourne: Cancer Council Victoria, 2019. 

34. C. Mendelsohn, “Teenage smoking: how can the GP help?”. Medicine Today, Volume 11, Number 11, 2010. 

35. HealthStats NSW, “Current smoking adults”. NSW Population Health Survey (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health. [Online]. Available: 

36. N. Zwar, “Smoking cessation”. Australian journal of general practice, 49(8), 2020. 

37. R. Kumar, L. Stevenson, J. Jobling, et al. “Health providers' and pregnant women's perspectives about smoking cessation support: a COM-B analysis of a global systematic review of qualitative studies”. BMC Pregnancy Childbirth, 21(1), 613