Trans-disciplinary Care: A New Approach to Improving the Effectiveness of Tobacco Use Interventions

Tobacco use disorders devastate lives and financial well-being, and constitute one of the largest public health problems the world faces today. A main cause of avoidable illness and death, tobacco-related mortality rates lead to more than 435,000 deaths per year, in the United States alone^1–3 with millions more affected by tobacco-related illnesses. Annually, nearly 96 billion dollars are lost to medical costs directly related to smoking.⁴ While smoking is the most prevalent form of tobacco use, all forms of tobacco use pose dangers to health. The well-being of entire communities, particularly underserved communities, is affected, making tobacco use one of the largest public challenges facing the health care system today.

Tobacco use, like any addiction, is complex, affecting individuals, families, and communities in many ways. It is critical that tobacco use disorders be addressed in both micro (individual) interventions and macro (community-wide) initiatives with the challenges of working with underserved populations considered. Evidence suggests interventions which have been proven effective with the general population will work with underserved populations, if those interventions are made available. The key components of evidence-based tobacco use interventions center on dynamic system changes incorporating policy support and performance feedback mechanisms. Incorporating current developments in national standards surrounding the creation of medical homes and meaningful use of electronic health records, and reinforced with a trans-disciplinary approach, evidence-based smoking cessation practices can have an effect on tobacco use in underserved communities.

One of the new ways to increase the effectiveness of tobacco interventions being explored is the utilization of trans-disciplinary teams, now being developed in health care organizations around the country. An evolution from inter-disciplinary care, trans-disciplinary care is a multi-disciplinary team in which all members have expanded knowledge and training in the disciplines of other team members. In a trans-disciplinary team model, all members of the team address tobacco use and reinforce goals, regardless of the main purpose of the visit. This shared reinforcement, along with the transmission of information by disciplines with varying approaches, allows not only for consistent information to be given to the patient, but for information on tobacco use to be tied into all areas of primary care, mental health, nutrition, and oral health. This approach provides the patient with information on the effect of tobacco use in all areas of their lives and health. Combining evidence-based practices with a trans-disciplinary team approach maximizes the effect of messages being delivered in tobacco cessation campaigns, especially in underserved communities where there may be challenges with language and literacy in the provision of tobacco cessation interventions.

In an effort to promote evidence-based tobacco interventions, public and private organizations have developed best practices using evidence-based interventions to provide comprehensive treatment of tobacco use disorders. During the past 15 years, private and public organizations have been studying the efficacy of tobacco use interventions.^5–7 During this time, many state tobacco control programs have been independently evaluated, proving that when evidence-based approaches are used, decreases in smoking rates ensue.⁸ The Public Health Service Guideline on Treating Tobacco Use and Dependence represents a consolidation of the evidence base and identifies key components of effective tobacco use interventions. Counseling and medication are generally recommended as crucial elements of tobacco dependence treatments. Interventions may be brief or intense, should be motivationally geared, and follow a dose-response pattern. Motivational counseling should include practical problem-solving skills and social support. Psycho-social support should also include Quitline assistance when possible. Finally, in light of the clinical and cost-saving effect of evidence-based tobacco treatments, coverage for these treatments by insurers should be supported whenever possible. This summary must be used in conjunction with expert guidance in administrating a system-wide, trans-disciplinary tobacco treatment protocol within an organization in order to achieve maximum effect. Tobacco treatment protocols delivered by a trans-disciplinary team effectively address tobacco use in communities, particularly underserved communities.

Despite declines in tobacco-use...