CF-5A's training for providers

PROVIDERS’ TRAINING ( ~35 minutes). 

Objectives (2-4 can be integrated with mock run-throughs) : 
  1. Learn the 5A’s and how the 4th and 5th A for the CF-5A's are delivered.
  2. Learn how the 3-page PDF/printouts work.
  3. Understand the different smoking cessation treatment options available.
  4. Implement strategies to arrange for patient follow-up.

Objective 1) To learn the steps of delivering the 4th A to "assist" patient in quitting smoking and the 5th A to "arrange" a follow-up and resources, the provider can view the following videos. These videos demonstrate delivery of all 5A’s. In the CF-5A's, providers are responsible for delivering the 4th and 5th A's (the first 3 A's are delivered by the PhreesiaPad, so providers can focus on learning how to effectively "assist" their patients and "arrange" follow-ups during their patient encounters. After a few attempts at 5A's delivery, the provider will likely build confidence in these skills. More videos, including those below, can be found in the Cessation resources section, or by entering "YouTube training for 5A’s smoking cessation" into a search engine.

Objective 2) The 3 PDF pages below are examples of what the PhreesiaPad will generate after patient completes the CF-5A’s Intervention assessment, and what the patient and provider are to do with them. The first two pages are to be reviewed by the provider so that s/he may use them to guide the discussion during the encounter. The third page is for the patient as their personal record. 

The provider’s Smoking Cessation Guide, (page 1 of 3), is a summary of patient responses to the first 3A's, (as well as starting the 4th A of assistance wanted by the patient). This summary sheet can be used as a conversation tool and checklist with the patient during the encounter. This Smoking Cessation Guide is intended to help the provider continue the conversation by assisting the patient in their quitting or preparation to quit, and for arranging their follow-up appointment based on their readiness. The Guide gives provider discussion points regarding:
  • Action items to be discussed with patient based on their responses.
  • The patient’s confidence, quitting readiness and smoking history.
  • Reviewing and signing/endorsing the patient’s printout.
  • Assisting patient with therapies and combinations.
  • Arranging a follow-up and resources: bottom section to be filled in.
As each item in the left “Patient data” column is discussed with patient, each related box is to be checked off. The bottom section is to be filled in by provider or staff once a follow-up is arranged.
This page can be used as a supplementary billing document for reimbursement as well as a medical record for patients’ personal files. See billing and e-health records.
Provider Reference Guide, page 2 of 3. The top half gives common scenario suggestions for providers to engage with and motivate patient, (See resources for motivational interviewing videos). Providers should review and learn motivational prompts for an effective discussion and intervention, including:
  • Discussion scripts to assist patient based on their quitting readiness, and
  • Rationale for provider regarding prompt script’s use.
Objective 3) The bottom half of page 2 provides a smoking cessation treatment guide for providers. Provider can learn about therapy options available for the patient, and decide on the most suitable fit and dose based on patient preferences and medical conditions. Combining therapies are known to maximize quitting success rates. Provider is to become familiar with NRTs, medications and combinations, and will have this reference guide while delivering the intervention. See Optimizing Therapies for details. The bottom half page indicates:
  • NRT and medication options for patient.
  • Forms and doses of NRTs and medications available and instructions for their use.
  • NRT and medication cautions and costs.
Combining behavioral therapies, (i.e. support groups, quit lines, smartphone apps, etc.) with NRT and medication therapies, will maximize a patient's quitting success and a provider's delivery efforts. Patient's health insurance may help determine therapies as well. Click cessation resources for general behavioral therapies. Or locally find the smoking cessation web-site by entering "smoking cessation help in your city/region here" into a search engine.   

Page 3 of 3, is the Smoking Health Assessment, patient’s personal response record. Patient will receive this printout before their appointment, after taking the CF-5A’s Intervention assessment on the PhreesiaPad. Or they are to be emailed a PDF of this record if in-person printouts are not an option. To enhance patient-provider discussion and agreement(s) this document is to be reviewed with patient during the appointment encounter and signed off at the bottom by provider .

Objective 4.) With the first three A’s addressed by patient on the PhreesiaPad, provider’s time can focus on the 4th and 5th A's by continuing to assist the patient in quitting and arranging for a follow-up based on patient’s readiness and printout guides. The 4th and 5th A are commonly where the provider fails to deliver, which decreases patient’s odds of quitting.  Based on the patient responses indicated on Smoking Cessation Guide (1 of 3) providers' will learn what stage patient is in their quitting readiness and what support they are interested in receiving. Provider is to review this document with the patient, possibly in tandem with their personal Smoking Health Assessment record. The conversation prompts and listed therapies in page 2 of 3 will guide provider in the conversation and adherence to intervention aims of assisting the patient, (using motivational interviewing approaches from video), as well as to arrange a follow-up and resources.
At the conclusion of the appointment, if a quitting date has been established, the provider will:
  • Arrange for a follow-up, ideally in 3 to 4 weeks.
  • Prescribe therapies and resources as needed.
  • Counsel the patient to call the QUIT-NOW phone line for further quitting assistance.
  • Sign off for follow-up at bottom of patient’s Smoking Health Assessment.
Alternatively, with provider's guidance patient follow-up appointments and resources can be arranged by clinic support staff.
After a few practice runs, these training steps will assist the primary care provider in building confidence to effectively deliver the CF-5A’s intervention. 
Local, national, web based, and smart phone apps for patients are available, in English and Spanish.
Click more resources to help build provider's CF-5A’s delivery confidence.