Treating tobacco use is a team effort. Think about who will perform key steps in workflows (e.g., screening for tobacco use, placing medication orders, delivering counseling, or placing referrals) and who is needed behind the scenes to support these activities (e.g., information technology teams, quality improvement teams, managers, trainers, leaders who allocate resources for program support).
Task sharing can enhance program feasibility and allow team members to make complementary contributions and work at the top of their licenses (e.g., a medical assistant collects tobacco use status, a nurse counsels or refers patients and pends medication orders, a physician approves medication orders).
Who in your organization will help design and launch your tobacco treatment program?
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Tobacco treatment clinic champions
Any team member can become an effective champion for tobacco treatment. Champions help engage teams in change efforts and advocate for program support and implementation in diverse ways. Task sharing creates the opportunity to recruit more champions for tobacco treatment (e.g., medical assistants, quality improvement experts, social workers, information technology experts, etc.). See the American Academy of Family Practice Office Champions resource for more.
Quality improvement staff
Quality improvement staff have valuable expertise and local knowledge about how to plan, support, and monitor system improvements. They can inform efforts to align tobacco treatment with important quality metrics (e.g., Joint Commission, Center for Medicare and Medicaid Services). Such alignment may help secure system support for your tobacco treatment program. See this Project Planning Form from the Institute for Healthcare Improvement for more.
Health information technology specialists
Adapting the EHR to prompt and streamline tobacco screening and treatment can greatly enhance implementation and sustainment of your tobacco program. EHR prompts and automatic workflows for tobacco treatment can also reduce the effort required by clinical staff. Participants in C3I recommend involving health information technology (IT) specialists as early as possible in program planning. These experts can help design and build EHR tools and workflows for the program. Analytics team members can help develop dashboards and reports that will help the team monitor program implementation and impact. See the build guides that can help your IT team develop tools for your tobacco program.
Clinic leaders (Managers, Medical Directors)
Buy-in and support from clinic leaders is critical to engagement of clinic teams in tobacco treatment. Showing clinic leaders how treating tobacco will benefit their patients, without disrupting workflows, can help secure their support. Click here to learn more about obtaining buy-in.
Cancer care clinicians (e.g., medical oncologists, radiation oncologists, surgeons)
Cancer care clinicians can help patients understand how reducing or quitting smoking can enhance cancer treatment response and control. These clinicians can provide care (e.g., brief counseling, medications) directly or can encourage patients to follow through with referrals to tobacco treatment. See these workflows for examples.
Nurses, Medical Assistants, Licensed Practical Nurses (LPNs)
Nurses, medical assistants, and LPNs are often responsible for tobacco screening and can play critical roles in tobacco treatment. Nurse navigators, for example, may routinely integrate tobacco treatment planning into new patient visits. See sample workflows in which these team members play critical roles in tobacco screening and treatment.
Social Workers, Behavioral Health Providers, Health Educators, Pharmacists
Many care team members can deliver psychosocial tobacco treatment and medication management support. Some systems use delegation protocols to empower nicotine replacement medication ordering, and some allow non-prescribers to pend medication orders for prescriber approval. See this workflow for hospital admission for an example.
Tobacco Treatment Specialists
Tobacco Treatment Specialists (TTS) are trained to provide evidence-based treatment for tobacco use. This intensive training prepares providers to deliver behavioral support and select the best medications for patients. See the Council for Tobacco Treatment Training Programs website for more information about accredited TTS trainings.
Primary care clinicians, Advanced Practice Providers (e.g., Physician Assistants, Nurse Practitioners)
Coordinating care with primary care teams can be a great way to enhance follow-up and continuity of care. EHR tools can help facilitate care coordination. See this article for an example of ways tobacco treatment specialists can coordinate care with primary care teams.
Patient/Survivor Advisory Board, Representatives, or Advocates
Engaging patients and patient advocates in the design, marketing, evaluation, and implementation of a tobacco treatment program (e.g., through peer mentoring relationships) can promote program success. See Case Study C for an example of a program that solicited patient engagement in program design and evaluation.
