Protocols
Find standardized, evidence-based protocols for use in your practice. When
embedded in electronic health records, treatment protocols can serve as clinical
decision support at the point of care so no opportunities are missed to achieve
control.
Tobacco Cessation Protocols
No level of smoking or tobacco use is safe. Tobacco addiction is a chronic condition, often requiring multiple quit attempts for a tobacco user to become tobacco free. There are effective, evidence-based, brief clinical interventions available to help patients who smoke. Tobacco cessation protocols can be integrated into the tobacco use identification and intervention clinical workflow.
Create Your Own Protocol
Create your own tobacco cessation protocol using our template and implementation guidance document, which includes insights from stakeholders in the tobacco cessation community.
Featured Evidence-Based Protocols*
Atrius Health and Harvard Vanguard Medical Associates Tobacco Intervention Workflow
This tobacco intervention workflow is included in a question-and-answer style case study that highlights an extensive health systems change effort that was undertaken by Atrius Health and Harvard Vanguard Medical Associates to improve tobacco dependence treatment in a health care system.
Louisiana State University Health System Tobacco Control Initiative Treatment Protocol
This treatment protocol is included in a question-and-answer style case study that provides an overview of Louisiana State University Health System Tobacco Control Initiative, which is focused on developing and implementing a systematic approach to treating tobacco use in one of the largest safety-net health delivery systems in the country.
Veterans Health Administration (VHA): Tobacco Use Cessation Treatment Guidance
This three-part treatment guidance includes two easy-to-use charts and a table detailing VHA medication options. Part 1 provides guidance on “The 5 A’s” (ask, advise, assess, assist, arrange) used to address tobacco use among current and former smokers. Part 2 provides a flowchart to assist providers in selecting VHA first-line therapies and what to do for those patients who relapse. Part 3 consists of a detailed table describing VHA smoking cessation medication regimens, including pros/cons, limitations, and dosing recommendations.
Tools and Resources
- American Academy of Family Physicians: Treating Tobacco Dependence Practice Manual [PDF-987K]
This practice manual provides solutions and suggestions for implementing a systems-change approach for evidence-based tobacco cessation treatment. - CDC Office on Smoking and Health: Tips From Former Smokers Campaign
This campaign provides resources for health care providers to get their patients to quit smoking. - National Cancer Institute: Smokefree.gov
The information and professional assistance available on this website can help to support your patients’ immediate and long-term needs as they become, and remain, nonsmokers. Smokefree.gov allows patients to choose the help that best fits their needs. - University of California, San Francisco: Rx for Change—Clinician-Assisted Tobacco Cessation
This comprehensive, turn-key, tobacco cessation training program equips health professional students and licensed clinicians with state-of-the-art knowledge and skills for assisting patients with quitting. - University of Wisconsin Center for Tobacco Research and Intervention: Videos for Health Care Providers
This resource includes videos about tobacco dependence treatment for health care providers. - New York City Department of Health and Mental Hygiene: Tobacco Quit Kit
The Tobacco Quit Kit contains clinical tools, resources for providers, and patient education materials, which promote evidence-based practices for tobacco cessation.
Learn More
- An Algorithm for Tailoring Pharmacotherapy for Smoking Cessation: Results from a Delphi Panel of International Experts
Tobacco Control, February 2009 - An Updated Algorithm for Choosing Among Smoking Cessation Treatments
Journal of Substance Abuse Treatment, August 2013
Hypertension Treatment Protocols
Use standardized treatment protocols to improve blood pressure control by clarifying titration intervals revealing new treatment options and expanding the types of staff that can assist in timely follow-up with patients.
Create Your Own Protocol
Create your own hypertension treatment protocol using our template, guidance document, interactive guide and insights from established stakeholder in the heart disease and stroke prevention and treatment community.
Featured Evidence-Based Protocols*
Veterans Affairs (VA)/Department of Defense (DoD)
The VA/DoD protocol focuses on the critical decision points in the management of hypertension in primary care.
Protocol
- Use of thiazide diuretics as first-line therapy
- Recommendations for prehypertension and treatment by stage of hypertension
- Target goals vary depending on patient’s co-morbidities (e.g., diabetes, chronic kidney disease)
- The evidence base for each step
- Recommended lab tests
Supplemental Guidance
- Recommendations for specific segments of patient populations
- Impact of lifestyle therapies on blood pressure in hypertensive adults
- Causes of inadequate response to therapy
- Strategies to improve patient adherence
Kaiser Permanente
The Kaiser Permanente protocol was developed for use by integrated health care delivery systems that care for adults.
Protocol
- Use of thiazide diuretic/ACE inhibitor combinations as first-line therapy; when feasible, single pill combination tablets are preferred
- Guidelines for women of child-bearing potential
- Recommended drugs and dosages
- Documentation of the number needed to treat to prevent one additional negative health outcome
Supplemental Guidance
- Systems-based approach that establishes a comprehensive hypertension control program with these elements:
- Treatment protocol elements listed previously
- Team-based care
- Convenient blood pressure checks
- Population registry
- Quality performance goals
- Quality performance tracking metrics
- Self-monitoring blood pressure
Institute for Clinical Systems Improvement (ICSI)
The ICSI protocol was developed for use by networks of medical groups.
Protocol
- Hyperlinks to more information on various topics
- Classification of blood pressure includes ambulatory home/24hr monitor
Supplemental Guidance
- Treatment of subpopulations (e.g., racial/ethnical minorities, patients with resistant hypertension)
- Quality improvement
- Extensive supporting references
New York City Health and Hospital Corporation (HHC)
The New York City HHC protocol was developed for use by large municipal health care delivery systems that also have clinics in communities.
Protocol
- Use of thiazide diuretics as first-line therapy
- Recommended lab tests
- Recommended drugs and dosages
- Tailored protocol for patients with hypertension and diabetes
- Healthy lifestyle advice
Supplemental Guidance
- Treatment of resistant hypertension and hypertension in people with diabetes
- List of drugs, supplements that may contribute to hypertension
- Description of the impact of lifestyle therapies on blood pressure in hypertensive adults
- Self-care tools/messages for patients
Learn More
- Protocol-Based Treatment of Hypertension: A Critical Step on the Pathway to Progress
JAMA, January 2014 - An Effective Approach to High Blood Pressure Control
Hypertension, April 2014 - An Effective Approach to High Blood Pressure Control
Journal of the American College of Cardiology, April 2014 - Better Blood Pressure Control: A National Priority
(Interview with CDC Director Tom Frieden)
Medscape, November 2013
*About Featured Protocols
The featured protocols are examples of a wide variety of available evidence-based protocols that practices and health care systems may consider for adoption and use. Linking to non-federal sites does not constitute an endorsement by the Department of Health and Human Services, the Centers for Disease Control and Prevention, or any of their employees of the sponsors or the information or products presented on the sites. Links to non-federal sites containing protocols serve only as a source of guidance. Health care professionals should always consider the individual clinical circumstances of each person. Links to the protocols are not intended to be a substitute for professional medical advice; individuals should seek advice from their health care professionals.
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