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Randomized Controlled Trial
. 2015 Nov 2:10:154.
doi: 10.1186/s13012-015-0336-8.

Evaluating the QUIT-PRIMO clinical practice ePortal to increase smoker engagement with online cessation interventions: a national hybrid type 2 implementation study

Thomas K Houston  1   2   3 , Rajani S Sadasivam  4 , Jeroan J Allison  4 , Arlene S Ash  4 , Midge N Ray  5 , Thomas M English  4 , Timothy P Hogan  6   7   4 , Daniel E Ford  5
Affiliations
Randomized Controlled Trial

Evaluating the QUIT-PRIMO clinical practice ePortal to increase smoker engagement with online cessation interventions: a national hybrid type 2 implementation study

Thomas K Houston et al. Implement Sci. .

Abstract

Background: Effective web-assisted tobacco interventions (WATIs) have been underutilized by smokers; moreover, despite practice guideline recommendations, clinical teams do not routinely refer smokers to WATIs. Our goal was to test a clinical practice innovation, an ePortal designed to change practice and patient behavior. Our hypotheses were that the integrated system would result in increased smoker referrals, with an automated follow-up system resulting in more smoker registrations and finally augmentations of the WATI would result in more smokers quitting at 6 months.

Methods: Practice ePortal Implementation Trial: Practices (n = 174) were randomized to an online practice ePortal with an "e-referral tool" to the WATI (e-referred smokers received automated email reminders from the practice) and with practice feedback reports with patient tracking and practice-to-patient secure messaging versus comparison (a paper "referral prescription"). Implementation success was measured by the number of smokers referred and smokers registering. Clinical Effectiveness Trial: To estimate the effectiveness of the WATI components on 6-month smoking cessation, registered smokers were randomized into three groups: a state-of-the-art tailored WATI control [control], the WATI enhanced with proactive, pushed tailored email motivational messaging (messaging), and the WATI with messaging further enhanced with personal secure messaging with a tobacco treatment specialist and an online support group (personalized).

Results: Practice ePortal Trial results: A total of 4789 smokers were referred. The mean smokers referred per practice was not statistically different by group (ePortal 24.89 (SD 22.29) versus comparison 30.15 (SD 25.45), p = 0.15). The e-referral portal implementation program resulted in nearly triple the rate of smoker registration (31 % of all smokers referred registered online) versus comparison (11 %, p < 0.001). Clinical Effectiveness Trial results: Active smokers randomized to the personalized group had a 6-month cessation rate of 25.2 %, compared with the messaging group (26.7 %) and the control (17 %). Next, when using an inverse probability weighted selection model to account for attrition, those randomized to the two groups that received motivational messaging (messaging or personalized) were more likely to quit than those in the control (p = 0.04).

Conclusions: Among all smokers referred, the e-referral resulted in nearly threefold greater registrants (31 %) than paper (11 %). The practice ePortal smokers received multiple reminders (increasing registration opportunities), and the practices could track patient progress. The result was more smokers registering and, thus, more cessation opportunities. Combining the proactive referral and the WATI resulted in higher rates of smoking cessation.

Trial registration: Web-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628 .

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Figures

Fig. 1
Fig. 1
Practice ePortal (trial 1) and clinical effectiveness (trial 2) Randomization Flow
Fig. 2
Fig. 2
Trial 1: comparing paper-referral and ePortal practice implementation results (patient referrals to the web-assisted tobacco intervention and subsequent patient registration) among 174 practices. Mean number of referral Per practice (95 % confidence interval) and mean percentage referred smokers who registered (95 % confidence interval)
Fig. 3
Fig. 3
The number of smokers referred and registered by each practice
Fig. 4
Fig. 4
Trial 2: clinical effectiveness of the web-assisted tobacco intervention, consort Diagram
See this image and copyright information in PMC

References

    1. Stead LF, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev. 2012;10:CD008286. - PubMed
    1. Swan GE, McClure JB, Jack LM, Zbikowski SM, Javitz HS, Catz SL, et al. Behavioral counseling and varenicline treatment for smoking cessation. Am J Prev Med. 2010;38(5):482–90. doi: 10.1016/j.amepre.2010.01.024. - DOI - PMC - PubMed
    1. Coleman T. ABC of smoking cessation. Use of simple advice and behavioural support. BMJ (Clinical research ed) 2004;328(7436):397–9. doi: 10.1136/bmj.328.7436.397. - DOI - PMC - PubMed
    1. Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2008(2):CD000165. doi:10.1002/14651858.CD000165.pub3. - PubMed
    1. The Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel L, and Staff. A clinical practice guideline for treating tobacco use and dependence: 2008 update: A U.S. Public Health Service Report. Am J Prev Med. 2008; 35(2):158–176. http://dx.doi.org/10.1016/j.amepre.2008.04.009. - DOI - PMC - PubMed

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