Consider staff resources and capacity and patient needs and resources when assessing treatment models of interest.
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Point-of-Care Models
In point-of-care models, clinicians and other program staff deliver tobacco cessation counseling and order pharmacotherapy at the point of care, during in-person or telehealth encounters for cancer care.
Physicians, clinicians, nurses, medical assistants, or social workers with tobacco treatment training integrate tobacco counseling and pharmacotherapy recommendations and orders into existing workflows during encounters.
Point of care treatment methods bring cessation opportunities directly to the patient without requiring them to attend an extra appointment. Many patients hope to receive tobacco treatment as part of their clinic visit, and clinicians are usually receptive to treating tobacco use if given efficient tools to do so.
See Case Studies B, C, and E and this article for examples of C3I programs that utilized a point-of-care model for tobacco treatment.
For more information on workflows at the point of care, click here.
Internal Referral Models
In these specialty referral models, trained tobacco treatment specialists receive and act on referrals from clinic teams or a tobacco use registry.
Existing team members integrate internal referrals to tobacco treatment specialists into workflows at the point of care. Where possible, warm handoffs (immediate connections) to tobacco treatment specialists are offered to patients.
Delivering tobacco treatment pharmacotherapy, in-person or remote counseling, and follow-up through your own program may be a great way to engage patients who already know and trust you. This can be supplemented by external referrals to state tobacco quitlines or SmokefreeTXT, as needed.
See these Case Studies and this article to learn about C3I programs that treated tobacco in-house, including programs that utilized an “opt-out” approach to refer patients to their internal tobacco treatment programs.
For more information on workflows for internal referrals, click here.
External Referral Models
There are many workflows that can connect patients who use tobacco with external services offering evidence-based tobacco use treatments, such as state tobacco quitlines or Smokefree.gov resources.
Proactive referrals through electronic orders (eReferrals) to a state tobacco quitline, automated texting programs like SmokefreeTXT, or web-based resources like Smokefree.gov can connect patients with free tobacco treatment they can access anytime and anywhere. Many quitlines offer free nicotine replacement medication along with individual, group, or digital psychosocial support. Some quitlines also have special programs for special populations (e.g., American Indian clients, socioeconomically disadvantaged clients) and offer services in many languages. Your cancer care team can promote referral to programs to encourage patients to follow through with treatment.
External eReferrals can complement point-of-care or internal programs, or can be used as a stand-alone treatment if resources are limited. In either case, it is important to design systems that will prompt proactive referral offers or orders for all patients who use tobacco. Such offers can occur at the point of care or in other ways. For example:
- Nurses, medical assistants, or social workers can integrate referral to external tobacco treatment resources (e.g., quitlines, Smokefree.gov) into workflows.
- Mailed or EHR portal outreach messages can be sent to patients on a tobacco use registry to encourage use of tobacco treatment.
- Electronic tools (e.g., pre-appointment text messages, after-visit summary patient instructions) can invite patients to self-refer to tobacco treatment.
- Automated phone or text programs can offer support and follow up with patients who initiate tobacco treatment with warm transfers to other services such as quitlines.
See the Case Studies and this article for an example of C3I programs that utilized an external referral method for providing tobacco treatment. Detailed build guides for eReferral are also available.
For more information on workflows for external referrals, click here.
