GP Helpline:
Last updated on 21 April 2023
Smoking is a major risk factor, with 13.1% of deaths in Singapore attributed to smoking, both active and passive.
While a reduction in smoking results in lower mortality risk, complete cessation is much more beneficial.2, 3
Target group: all smokers4, especially patients with cardiovascular disease, respiratory disease (asthma/chronic obstructive pulmonary disease [COPD]), chronic kidney disease.
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 back 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.1
*However, 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 order.
There are plans to make available subsidies for NRT and Varenicline to Healthier SG GPs for enrolled patients (exact date TBC). Prescribing guidance will be released to guide appropriate prescription of NRT and Varenicline for the purpose of subsidies.
Referral Resources
For patients who are prepared to quit (preparation stage) or who wish to seek further professional advice, you 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. You may also wish to contact your PCN to see if your 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 practice.
Submission of data fields marked with asterisks* is required for subsidy claims and Healthier SG payments.
Smoking History
Smoking Status*:
Never-smoker
Ex-smoker (defined as a person who does not currently smoke tobacco, and has not smoked for the last 30 days, but has smoked at least 100 cigarettes in his/her lifetime
Current smoker
Year Started Smoking (if smoker) – if patient quit and relapsed, to indicate the first time that patient ever smoked
No. of sticks smoked/day* (if smoker) – if patient smokes less than 1 cigarette a day, to still indicate as 1 stick/day
Stage of change – (i) Pre-contemplation, (ii) Contemplation, (iii) Preparation, (iv) Action, or (v) Maintenance
Fagerstrom Score – For patients who are prepared to quit and are actively participating in a structured smoking cessation counselling programme, GPs can consider administering the Fagerstrom test to determine degree of nicotine dependence. You may direct patients to complete the quiz in HealthHub and submit the score to you. A suggested classification of Fagerstrom Test Scores is as follows^:
0–2: Very low dependence
3–4: Low dependence
5–7: Moderate-high dependence
8–10: Very high dependence
^The Fagerstrom score classifications are not universal and the categorisation of numerical scores may vary.
