Standardizing a transitions of care pharmacist workflow for tobacco cessation efforts

Abstract

Background: Smoking is the leading cause of preventable disease, disability, and death. Pharmacists can aid in smoking cessation through pharmacotherapy recommendations, patient counseling, and follow-up.

Objective: Describe a standardized transitions of care (TOC) pharmacist workflow for patients' tobacco cessation efforts at hospital discharge and to secondarily evaluate patient participation, impact on cessation outcomes, and pharmacist effort to provide the service.

Practice description: TOC pharmacists provide medication optimization and education to patients admitted to and discharged from Norton Healthcare hospitals. Medication optimization for tobacco cessation occurs through a provider recommendation or by utilizing the Kentucky Board of Pharmacy-authorized protocol.

Practice innovation: A standardized workflow was created for TOC pharmacists to identify patients who use tobacco, assess patients' current tobacco use and willingness to quit, select appropriate pharmacotherapy, document, and follow up after discharge.

Evaluation methods: A retrospective descriptive study was performed for adult patients assessed by TOC pharmacists for tobacco cessation between November 2021 and April 2022, with follow-up visits completed through December 2022.

Results: The pharmacists assessed 357 patients and 252 (70.6%) stated they were interested in tobacco cessation. Of those interested, 117 patients (46.4%) indicated they were interested in receiving follow-up from TOC pharmacists and refills from a Norton pharmacy. Of the 117 patients interested in follow-up, 73 patients (62.4%) completed at least 1 follow-up visit with the TOC pharmacist. At the last completed follow-up visit, 26 patients (35.6%) reported complete tobacco cessation. Of the 47 patients who did not have complete cessation, they reported using 39% less tobacco on average compared with their initial assessment at hospital discharge. The mean time spent by TOC pharmacists using this workflow was 13.5 minutes per follow-up visit.

Conclusions: This project formalized a standardized and sustainable TOC pharmacist workflow that demonstrated a positive impact on tobacco cessation efforts for participating patients.