CF-5A's training for clinic staff

The intent of this training is to enable proactive roles of clinic staff with the CF-5A’s Intervention that support the patient-provider intervention process.
Objectives (2 - 4 can be integrated with mock run-throughs):
  1. Understand the basic overview of 5A’s delivery.
  2. Learn to introduce and support a patient to complete the CF-5A’s intervention assessment.
  3. Learn about the 3-pages of PDF/printouts and how to use them.
  4. Understand how to assist providers in arranging follow-up.
Objective 1) Staff are to watch the UC QUITS webinar, every smoker, every encounter The 5A’s of Tobacco Cessation -15.02 minutes. The video reviews the components of the 5A's; including learning about the first 4A's that the patient responds to on the PhreesiaPad, asking if they smoke, advising them to quit, assess their quitting readiness and begins to assist them at their readiness level. More videos on 5A’s and delivery can be found at cessation resources.
Objective 2)  Staff are to introduce the CF-5A's intervention to a patient after the patient checks in. Patients should have 5-6 minutes of time to fill out intervention assessment before their appointment.  The intervention assessment “begins the conversation” about tobacco use in the waiting area on the PhreesiaPad. 
Once patient checks in, a staff will introduce the intervention assessment to them by saying something like “Would you mind answering a series of questions on the tablet regarding smoking? It takes about 5 minutes." If patient agrees they will be directed by staff to the  “smoking cessation” indicator on the PhreesiaPad and complete the CF-5A’s Intervention assessment. Patients will answer questions about their smoking habits, history, and level of readiness to quit. Patients should be asked to let staff know when they are finished.
Patients needing staff assistance
  • If patient has general questions about the assessment refer to FAQs.
  • If patient experiences difficulty understanding or reading the questions asked, we recommend that staff help read through and clarify as needed.
  • If patient experiences technology challenges using the PhreesiaPad to answer intervention questions it is encouraged that a staff member assist by showing them how to use the tablet stylus to tap on their responses- or a staff can enter patient's responses for them, walking them through as needed.
​Thank patients who decline to take the CF-5A’s intervention assessment and let them know they can take it next time if they want. 

Objective 3) Once a patient completes the CF-5A's Intervention assessment on the PhreesiaPad and has indicated a level of readiness to quit their responses will generate 3-pages: a one pager for their personal use and two-pages to help guide provider. See 3-page examples below. These three pages are to be distributed to patient and provider before or at the beginning of the appointment.  Depending on CF-5A’s set up with Phreesia, a staff will access the three pages by either printed hard copies, or accessing a PDF file through the Phreesia dashboard -by clicking on patient's name, or through the patient's electronic medical record (EMR). See printouts and PDFs section for more on how to access these documents.

The first and second (of three) pages, Smoking Cessation Guide and Provider Reference Guide, are for the provider. They are designed to help guide the intervention conversation with the patient.
  • If PDF files or EMR integration are the clinic’s set-up preference the provider is to be notified by staff that the documents are available on the exam room monitor so that s/he can use during the appointment.
  • If hard copies are the clinic’s set-up preference, printouts will be generated (page 3 is to be given to the patient, NOT the provider) and are to be handed to provider or placed in patient's chart at the beginning of the appointment.
The provider's Smoking Cessation Guide (Page 1 of 3):
1. Serves as a conversation guide for the provider during the appointment.
2. If provider does not sign off for follow-up at the bottom, it will be up to staff, by provider's request, to arrange patient follow-up and provide information about resources.
3. Can be used as a billing supplement for tobacco counseling and can be filed as a patient medical record. See billing and e-records.
The provider's Reference Guide (Page 2 of 3):
1. Gives common scenario suggestions based on patient's responses for providers to use with them during the appointment encounter.
2. Shows Nicotine Replacement and other therapy options to help provider in prescribing appropriate therapies. Hard copy of page 2 can be discarded once appointment is finished.
The Smoking Health Assessment, (Page 3 of 3) is the patient’s personal responses based on their CF-5A’s Intervention assessment answers on the PhreesiaPad.
1. Patient is to receive a hard copy print out or PDF e-file by email.
2. If PDF or EMR  is the clinic's set up prefeence, provider will be notified that patient's responses are available and will access the PDF or EMR file to share with patient on the exam room monitor.
3. If hard copies are the clinic’s set-up preference, this page will be printed out (along with providers 2 pages) and given to the patient.
Objective 4) Once the CF-5A's intervention appointment ends, the provider may ask staff to help arrange a follow-up appointment and provide the patient with additional resources. In response, staff will:
  1. Arrange a follow-up appointment for the patient, ideally within 3 weeks if a quit plan has been established. Add follow-up date and time at the bottom of patient’s Smoking Health Assessment printout.
  2. Patient is to receive resources appropriate to their smoking cessation readiness. Whether they have a quit date or are just thinking about quitting there are resources available, in English and Spanish. Links for patient can be downloaded and printed or emailed.
  3. Assure patient is emailed a PDF copy of their Smoking Health Assessment if they do not receive a printout. 
After a few practice runs, these training steps will help staff build confidence to work with the provider to successfully deliver the CF-5A’s intervention.