TABLE 3.

Service use questionnaire.

In the past month, how many times have you used the following health services that were NOT provided by the ESCAPE trial?
	For smoking cessation/reduction	For any other purposes
	(Please enter the number of times you have used each service; if none, enter zero)
Not in the hospital
a. How many times have you seen your GP?	______times	______times
b. How many times have you seen a practice nurse?	______times	______times
c. How many times have you seen a pharmacist?	______times	______times
d. How many times have you attended a session with someone from a smoking cessation service?	______times
e. How many times have you called the NHS Smoking Helpline service?	______times
f. How many times have you seen a mental health worker in the community or at your home?	______times	______times
g. How many prescription items of the NRT product have you received? a	______ items	______ items
h. How many prescription items of Zyban (bupropion) have you received?	______ items	______ items
i. How many prescription items of Champix (varenicline) have you received?	______ items	______ items
j. How many prescription items have you received other than NRT, Zyban or Champix?	______ items	______ items
In the hospital
k. How many times have you visited a hospital A&E department?		______times
l. How many times have you visited a hospital as an outpatient?		______times
m. How many times have you visited a hospital for a day case? b		______nights
n. How many nights have you stayed in a hospital as an inpatient?		______times
o. How many times have you been taken to the hospital by an emergency ambulance?		______times
p. None of the above	Yes

^a One prescription item refers to a single prescribed medication, product or device on a prescription. If you have picked up the same medicine on several occasions over the period stated above, it counts as separate items for each occasion.

^b Day case: attended hospital for a procedure but stayed for less than 24 hours.