Document Sample
                             NAVAL HOSPITAL GREAT LAKES
                               Tobacco Cessation Services
                              Standard Operating Procedure

Ref:    (a)   SECNAVINST 5100.13C
        (b)   OPNAVINST 6100.2
        (d)   VA/DoD Clinical Practice Guideline for the Management of Tobacco Use

Encl:   (1) Tobacco Cessation Center Decision Tree
        (2) Tobacco Cessation Form

1. Purpose. To provide prompt and efficient tobacco cessation treatment to every
beneficiary who wants to quit. Procedures will reflect evidence-based DoD/VA Clinical
Practice Guideline for the Management of Tobacco Use.

2. Scope. All NHGL outpatient clinics and inpatient areas will follow this SOP. Tobacco
Cessation (TC) treatment will take place in the offices of command-trained providers or in the
Tobacco Cessation Center (TCC), per patient’s preference.

3. Responsibility. Providers offering TC medications will have attended NHGL Tobacco
Cessation provider training. TCC staff will maintain records, perform follow-up contacts, and
track success rates among patients. Health Promotion Division staff will provide monthly
group quit classes for patients who need intensive intervention. Prescriptions will be
accepted exclusively from providers who have successfully completed Naval Hospital Great
Lakes required TC training. Medications will be non-formulary. Outpatient clinic support staff
should be familiar with this SOP to assist patients who inquire about quitting.

4. Procedures. The Tobacco Cessation Form (TCF) is generated when patient inquires
about quitting. Patient fills out all questions on page 1 of the form. Staff will fill out the
identifying information on the bottom of page 1. NHGL staff will recommend the most
intensive treatment patient agrees to. Patient will be given an appointment with a provider OR
will choose to receive a consult to the TCC per the following criteria:

   a. If patient agrees to intensive treatment, or prefers moderate treatment with a physician,
   he/she will be given an appointment with a TCC-trained provider.

   b. If patient prefers moderate treatment in a different setting or minimal treatment, he/she
   may be referred to the TCC for initial counseling.

   c. See decision tree, encl. 1.

5. A copy of the NHGL TCF will be forwarded to the TCC for all cessation patients. Patients
who choose intensive treatment will also be urged to attend the next available group
cessation class facilitated by the Health Promotion Division.
6. To summarize:

  a. Minimal treatment: Consult to TCC. Counseling will consist of 1 or 2 short visits.

   b. Intermediate treatment: TCC or clinic provider. Patient will have longer contact with
staff and/or more visits.

  c. Intensive treatment: Provider session(s) and group program with HP Division. Patient
should call 688-2617 to register for the next available group program. Group program is NOT
required for patient to receive medications. Patient will have more follow-up contacts with the

7. Inpatients.
    a. Ensure inpatient staff members receive TC training.

   b. Inpatient staff will assess every patient for tobacco use and provide users with a TC
Booklet. Provide TCC with the patient’s name, workplace, and a good daytime telephone

  c. Once discharged, patients can continue meds and cessation support either through the
TCC or via the classroom.

8. Training Requirements. TC script-writing privileges will only be granted to those providers
who complete the following free trainings from Medscape:

   a. Smoking Cessation Approaches in Primary Care (1.5 CME online)

   b. Treating Tobacco Use and Dependence (1.0 CME online)

9. Completion certificates must be submitted to TCC before prescription writing privileges are
granted. A list of credentialed providers will be kept in each pharmacy and in the TCC.

10. The following clinics must have at least 2 credentialed providers with TC prescription
writing privileges: Family Practice, Internal Medicine, Pediatrics, Sick Call 200H, Sick Call
237, Dental Clinic 237, and Sick Call 1007.

11. Additionally, all clinic staff must attend a 1-hour brief covering the following topics:

   a. Current information on health effects of tobacco

   b. Brief messaging to encourage tobacco use cessation for patients

   c. Current NHGL tobacco cessation treatment SOP

12. TC Prescriptions. Patient may receive TC prescription at initial visit. First refill should be
at 2 weeks. Subsequent refills may be ordered/filled by the provider or the TC trained
Pharmacist at the pharmacy window. Patients may receive a 2 week supply plus 6 refills.
TCC staff, upon receiving a consult along with the NHGL TCF, will contact an eligible
provider to prescribe requested medications.

13. Subsequent Patient Contacts. Follow the TC Tx Decision Tree for follow-up timeframes.
Follow-up contacts will be documented on the TCF and should include information about
medications, withdrawal/craving concerns, current tobacco use status, and patient questions.
6-month follow-up is mandatory for all Cessation patients and will be conducted by TCC staff.
This contact should be documented on the bottom of page 2 of the NHGL TCF. Contact
should be made 6 months after the patient’s quit date. Required information: did patient use
any tobacco in the last 7 days?

14. Data Collection. All 6-month follow-ups will be conducted by TCC staff. 7-day point
prevalence will be recorded on page 2 of the patient’s TCF.

15. Quality Feedback. Once per month, TCC patients will be contacted by phone and asked
what their impressions are regarding TCC services. Is the system user-friendly? Are TCC
services easily accessible? Which level of treatment did they choose? How helpful was the
treatment they received in the success of their quit attempt?

16. Coding.
305.1 Tobacco Use Disorder as a diagnosis. The CPT codes are:
96150 – Health and Behavioral Assessment, each 15 minutes
96152 – Health and Behavioral Intervention (for following the patients), each 15 minutes
96152 – Re-assessment

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