Evidence-based guidelines, best practices and health promotion
Best 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.
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.
|Additional resources||Source||Approved by CareOregon QMC|
|Tobacco cessation||See below||2008 AHRQ||July 2018|
|Childhood immunizations||See below||2018 CDC||January 2019|
|Adult immunizations||See below||2018 CDC||January 2019|
|Congestive heart failure (CHF)||See below||2016 ACC/AHA/HFS||October 2018|
|Diabetes (diagnosis and management of Type 2 diabetes in adults)||See below||2018 ADA||July 2018|
|Early childhood cavity prevention||See below||2014 AAP||June 2019|
|Oral health care in pregnancy||See below||2009 ACOG||June 2019|
|Attention Deficit Hyperactivity Disorder (ADHD) - AAFP||See below||2016 AAFP||May 2018|
|Attention Deficit Hyperactivity Disorder (ADHD) - CDC||See below||2017 CDC||May 2018|
|Asthma||See below||2018 CDC/NHLBI||September 2018|
|Adult preventive services||See below||2017 USPSTF||February 2018|
|Child/adolescent preventive services||See below||2017 USPSTF||May 2018|
|Substance abuse screening||See below||2016 SAMHSA||May 2018|
|Depression (ACP)||See below||2016 ACP||September 2018|
|Depression (VA/DoD)||See below||2016 VA/DoD||September 2018|
|Depression (USPSTF)||See below||2016 USPSTF||September 2018|
|Palliative care||2018 NCHPC||October 2019|
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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
Additional tobacco cessation resources
- Treating Tobacco Use and Dependence
- Quick Reference Guide for Clinicians: Treating Tobacco Use and Dependence
- Oregon Statewide Tobacco Control Plan 2005-2010: Taking Action for a Tobacco-Free Oregon
- Treating Tobacco Use and Dependence
- Smoking and Tobacco Use
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.
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.
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:
Call: 800-QUIT-NOW (800-784-8669) or TTY 711
Website: Oregon Tobacco Quit Line
Spanish-speaking counselors: 877-2NO-FUME (877-266-3863)
Order patient information from the CareOregon Communications Department, 503-416-1741, or email email@example.com. 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).
- Help for Smokers and Other Users
- You Can Quit Smoking 5-Day Countdown to Your Quit Date (English)
- You Can Quit Smoking 5-Day Countdown to Your Quit Date (Spanish)
- Good Information for Smokers
- Need Help Putting Out That Cigarette? (24-page booklet for pregnant women)
- Oregon Tobacco Quit Line. (Spanish-speaking counselors available)
- Quit For Life® Program (PDF): call toll-free 866-784-8454
- How Health Care Professionals Can Help Pregnant Smokers Quit (PDF)
- Smoke-Free Families
- Treating Tobacco Use and Dependence: Clinical Practice Guideline (U. S. Department of Health and Human Services)
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
- CDC: Recommendations and Guidelines: Vaccine Storage and Handling
- Immunization Action Coalition: Immunization VIS, Administration and Safety Information
- MCHD: Management Guide to: Pediatric Immunizations (at 24 months) Toolkit
- DHS training videos are available here.
Additional chronic heart failure resources
Additional resources for diabetes care
- Diabetes Medication Pearls
- The National Diabetes Education Program (NDEP) website offers best practices information as well as member educational materials
- Diabetes Treatment Pathway 2022
- Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
- Diagnosis and Evaluation of ADHD based on the AAP Guideline
Additional resources for ADHD care
Additional resources for asthma care
- Guidelines for the Diagnosis and Management of Asthma
- Clinical Evidence Review: Best Practices Asthma: Permanente Journal
- Improving Asthma Care for Children Toolkit: Best Practices in Medicaid Managed Care
- Preventive Services for Adults
- Preventive Services for Children and Adolescents (Please note: Because our Medicaid population includes many children, CareOregon covers blood lead screenings as a Level I preventive service, not a Level III preventive service as listed in this document)
Additional preventive services resources