Best practice guidelines

Evidence-based guidelines, best practices and health promotion

Health care provider checking patients lymph nodesBest practices are preferred strategies and initiatives aimed at providing the optimal knowledge and skills necessary to address the growing needs of our health care system. This section provides educational resources on how to identify various health challenges and educate patients and providers in the best treatment methods.

 

Evidence-based guidelines

The CareOregon Quality Management Committee (QMC) approves guidelines that are evidence-based and reviewed at least biennially by a nationally recognized body of experts on the topic. Once approved, these are placed on the website. Paper copies are also available upon request.

For more information on the guideline selection and approval process, see Clinical Guidelines Policy.

CareOregon-approved guidelines

Topic

Additional resources SourceApproved by CareOregon QMC
Tobacco cessationSee below2008 AHRQJuly 2018
Childhood immunizationsSee below2018 CDCJanuary 2019
Adult immunizationsSee below2018 CDCJanuary 2019
Congestive heart failure (CHF)See below2016 ACC/AHA/HFSOctober 2018
Diabetes (diagnosis and management of Type 2 diabetes in adults)See below2018 ADAJuly 2018
Early childhood cavity preventionSee below 2014 AAP
June 2019
Oral health care in pregnancySee below2009 ACOG
June 2019
Attention Deficit Hyperactivity Disorder (ADHD) - AAFPSee below2016 AAFPMay 2018
Attention Deficit Hyperactivity Disorder (ADHD) - CDCSee below2017 CDCMay 2018
AsthmaSee below 2018 CDC/NHLBISeptember 2018
Adult preventive servicesSee below2017 USPSTFFebruary 2018
Child/adolescent preventive servicesSee below2017 USPSTFMay 2018
Substance abuse screeningSee below2016 SAMHSA
May 2018
Depression (ACP)See below2016 ACPSeptember 2018
Depression (VA/DoD)See below2016 VA/DoDSeptember 2018
Depression (USPSTF)See below2016 USPSTFSeptember 2018
Palliative care     2018 NCHPCOctober 2019

The Centers for Disease Control and Prevention (CDC) says that more deaths are caused each year by tobacco use than from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined. Research confirms that secondhand smoke causes disease and premature death in children and adults who do not smoke.

 

Tobacco use and dependence: CareOregon-approved guidelines

Tobacco Use Screening and Brief Intervention 

Additional tobacco cessation resources

 

Brief clinical strategies for patients willing to quit (five A's)

  • Ask about tobacco use. Identify and document tobacco use status for every patient at every visit.
  • Advise to quit. In a clear, strong and personalized manner, urge every tobacco user to quit.
  • Assess willingness to try to quit. Is the tobacco user willing to quit now?
  • Assist in quit attempt. For patients willing to make a quit attempt, use counseling and pharmacotherapy to help them quit.
  • Arrange follow-up. Schedule follow-up contact, preferably within the first week after the quit date.

 

Helping patients stay motivated to quit

  • Relevance. Encourage the patient to indicate why quitting is personally relevant, being as specific as possible. Motivational information has the greatest impact if it is relevant to a patient’s health status or risk.
  • Risks. Ask the patient to identify potential negative consequences of tobacco use.
    • Acute risks (e.g., shortness of breath, harm to pregnancy)
    • Long-term risks (e.g., heart attacks and strokes, cancers)
    • Environmental risks (e.g., increased risk of heart, lung and cancer disease among family members)
  • Rewards. Ask the patient to identify potential benefits of stopping tobacco use. Highlight benefits that are most relevant to the patient, such as:
    • Saving money
    • Improving health
    • Food will taste better
    • Setting a good example for children
    • Having healthier babies and children
  • Roadblocks. Ask patients to identify their barriers and concerns about quitting. Common barriers and concerns may include:
    • Weight gain
    • Withdrawal symptoms
    • Lack of support
    • Enjoyment of tobacco
  • Repetition. Repeat the motivational intervention every time an unmotivated patient visits the clinic. Remind patients that successful quitting often requires several attempts.

 

Supporting patients who have recently quit: Preventing relapse

The following interventions should be part of every visit with a patient who has recently quit:

  • Congratulate patients on any success and strongly encourage them to remain abstinent.
  • Use open-ended questions to encourage patients to problem-solve challenges.

Encourage the patient to talk about problems or anticipated threats to remaining abstinent.

 

CareOregon benefits

Pharmacotherapy

Pharmacotherapy is fully covered by CareOregon. CareOregon requires a physician’s prescription for all pharmacotherapy options. Nicotine replacement therapy (NRT) includes gum, patch, lozenges and inhalers. Bupropion SR (Zyban) and Chantix are covered. Chantix requires a written prescription and the member is encouraged to be enrolled in the Quit For Life® Tobacco Cessation Program.

Approved therapies are in the  CareOregon Formulary on our website. Ask Oregon Tobacco Quit Line staff about dosages and contraindications for these pharmaceuticals. The toll-free number is 800-QUIT-NOW (800-784-8669).

 

Pharmacotherapy during pregnancy

CareOregon supports the clinical practice guideline developed by the U.S. Department of Health and Human Services Public Health Service (Treating Tobacco Use and Dependence, June 2008) about using nicotine replacement therapy and Bupropion during pregnancy. Search for “Bupropion” in the formulary.

Use the five A’s — brief interventions — with a pregnant patient. Urge the patient to enroll in an intensive behavioral counseling service, such as the Quit For Life® Program.

Consider pharmacotherapy if a patient is a heavy tobacco user and is unable to quit with counseling only, and the potential benefits and likelihood of quitting outweigh potential risks.

Strong evidence supports proactive telephone counseling, group counseling and individual counseling in tobacco cessation. Nicotine replacement therapy is most effective when used with structured behavioral counseling.

 

Counseling

Tobacco cessation services are covered by CareOregon for both OHP and CareOregon Medicare Advantage members. No referral is required to provide tobacco cessation treatment and counseling. Providers are encouraged to follow the five A’s model for treating tobacco use and dependence.

The free Oregon Tobacco Quit Line (800-QUIT-NOW) is the first referral for providers without an in-house program. Providers may ask about recommended dosing levels and contraindications for NRT. The Quit For Life® Program is a covered benefit limited to twice in a 12-month period. It offers telephone counseling and support.

If your patient wants to set a quit date, fax a referral form to the Quit Line. A counselor will contact the patient. Registered callers may call the Quit Line for free cessation counseling as needed.

 

To contact the Oregon Tobacco Quit Line:

Fax: 800-483-3114
Call: 800-QUIT-NOW (800-784-8669) or TTY 711
Website: Oregon Tobacco Quit Line
Spanish-speaking counselors: 877-2NO-FUME (877-266-3863)

 

Patient information

Order patient information from the CareOregon Communications Department, 503-416-1741, or email materials@careoregon.org. To order a free copy of CareOregon’s stop smoking packet to be mailed to your patient, call Customer Service at 800-224-4840. Please provide the member’s name and mailing address (one per household).

 

Resources

Doctor and nurse giving a baby a shot

CareOregon shares data with the Oregon ALERT Immunization Registry and encourages providers to use this database to obtain immunization records for patients they are seeing. This is the best source for immunizations given by multiple providers and at multiple locations. This registry helps ensure up-to-date information and accurate and timely immunizations.

For more information, please visit the website.

 

Immunizations: CareOregon-approved guidelines

 

Additional immunization resources

 

Tools

CareOregon-approved guidelines

 

Additional resources for diabetes care

CareOregon-approved guidelines

 

Additional resources for asthma care

CareOregon-approved guidelines

 

Additional preventive services resources

CareOregon-approved guidelines

 

Additional resources for substance use disorders

CareOregon-approved guidelines

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