in this regard a conspicuous weakness of the qich framework is that it does not currently include quality measures for copd chf smoking status and related measures to incentivise preventive action around quitting smoking primary care professionals should be more active generally in health promotion disease prevention and encouraging healthy lifestyles smoking cessation in particular primary care services operate in a wider health care context and it is imperative for governmentrun public health and prevention services to complement these efforts by strengthening the focus on risk factor modification and promoting health literacy while qich is a qualitymonitoring programme for primary care that many countries could leam from and emulate it can be further developed over time exploiting the potential offered by the use of emrs in primary care