Interdisciplinary Approach to Developing Nicotine Dependence Treatment Order Set: An Innovative Pilot Implementation

Abstract

Tobacco use remains the leading cause of preventable diseases and mortality in the United States. State quitline is an evidence-based tobacco cessation intervention for people who smoke. However, patients’ referral to quitline has been low. To address this gap in practice, we collected stakeholder feedback and engaged in an interdisciplinary and collaborative effort to create a new nicotine dependence treatment referral system using our electronic health record-based order sets. The project was conducted in 3 phases: (1) development process, (2) dissemination and approval from practice leaders, and (3) dissemination to clinicians. With the stakeholder feedback, we updated the existing nicotine dependence order set (NDO) by including links to the state quitline and local community resources targeting the social determinants of health. We created a brief educational material on the new NDO for dissemination. We measured the intention to use, implementation outcomes, acceptance, appropriateness, and feasibility of the new NDO. In the prepresentation survey, although 81% of the participants from the leadership and 77% from the clinician groups reported using the order set in general, only 13% from the leadership and 10% from the clinician group used the existing NDO. In the postpresentation survey, nearly 100% of the leadership and clinician respondents intended to use the new NDO in their practices. Acceptance (leadership vs clinicians: 82% vs 100%), appropriateness (leadership vs clinicians: 82% vs 95%), and feasibility (leadership vs clinicians: 82% vs 100%) were high in the postpresentation survey. Despite the positive reception to the new NDO, future research is needed to test the adoption, sustainability, and effectiveness of the NDO in addressing smoking cessation outcomes.