Systems Strategies for Treating Tobacco Dependence
The role of health systems in tobacco cessation is to promote, provide coverage for, and support delivery of treatment, quit attempts, and successful quitting. There is evidence that institutional or systems support facilitate provider treatment of tobacco dependence. According to the Treating Tobacco Use and Dependence: Clinical Practice Guideline, 2008 Update, health care systems should therefore institute the following institutional policies:
- “Implement a tobacco user identification system in every clinic;
- Provide adequate training, resources and feedback to ensure that providers consistently deliver effective treatments;
- Dedicate staff to provide tobacco dependence treatment and assess the delivery of this treatment in staff performance evaluations;
- Promote hospital policies that support and provide tobacco dependence services; and
- Include effective tobacco dependence treatments as paid or covered services for all subscribers or members of health insurance packages.”
In addition to the Guidelines, performance and quality-based measures have been expanded to more thoroughly address tobacco cessation. These include the:
The Joint Commission has updated its tobacco measures, which no longer target a specific diagnosis and are now broadly applicable to all hospitalized in patients 18 years of age and older. The new measures address:
- Assessment – all adult patients will be assessed for tobacco use.
- Treatment – tobacco users will be offered evidence-based counseling to help them quit and FDA-approved quitting aids during their hospital stay, unless contraindicated.
- Treatment at discharge – current tobacco users will be referred to evidence-based outpatient counseling and offered a prescription for quitting aids upon discharge.
- Treatment follow-up – current tobacco users will receive a follow-up call within two weeks after hospital discharge to ascertain their tobacco use status.