Last updated on 5 June 2023
Smoking is a major risk factor, with 13.1% of deaths in Singapore attributed to smoking, both active and passive.1
While a reduction in smoking results in lower mortality risk, complete cessation is much more beneficial.2, 3
Target group: all smokers,2-5 especially patients with cardiovascular disease, respiratory disease (asthma/chronic obstructive pulmonary disease [COPD]), chronic kidney disease.
2A Approach to Smoking Cessation
For more information on the stages of change, click here .
For the Fagerstrom score, click here
GPs should re-assess the stage of change and re-perform the steps within the “Act" section of the approach to smoking cessation for patients who have either returned to smoking after previously quitting or have failed a smoking cessation programme.
Pharmacotherapy has been shown to be cost beneficial for smokers who are assessed to have nicotine dependence and keen to quit, provided there are no contraindications.6,7
To note, smokers with very low nicotine dependence (Fagerstrom score <3) will
not be eligible for MAF subsidies at Public Health Institutions.
Licensing for Bupropion for smoking cessation under the Zyban® brand has been discontinued. The existing brand of Bupropion, Wellbutrin®, is only approved for treatment of major depressive disorder.
There are plans to make available subsidies for NRT and Varenicline to Healthier SG GPs for enrolled patients (exact date to be confirmed). Prescribing guidance will be released to guide appropriate prescription of NRT and Varenicline for the purpose of subsidies.
For patients who are prepared to quit (preparation stage) or who wish to seek further professional advice, GPs may encourage them to sign up for HPB I Quit, the national programme for smoking cessation, for counselling.
MOH will work on linking GP CMSes to Healthier SG modules, where you can receive regular updates on the status of your patients who are enrolled in I Quit, and their quit outcomes via CMS.
GPs may also wish to contact their PCN to see if their PCN nurse is able to provide structured counselling support.
The following data fields should also be documented in GPs' case notes as part of good clinical practice for all patients enrolled to their
Submission of data fields marked with asterisks* is required for subsidy claims and Healthier SG payments.
Stage of change – (i) Pre-contemplation, (ii) Contemplation, (iii) Preparation, (iv) Action, or (v) Maintenance
^The Fagerstrom score classifications are not universal and the categorisation of numerical scores may vary.