TY - JOUR
T1 - Evaluating the QUIT-PRIMO clinical practice ePortal to increase smoker engagement with online cessation interventions
T2 - A national hybrid type 2 implementation study
AU - Houston, Thomas K.
AU - Sadasivam, Rajani S.
AU - Allison, Jeroan J.
AU - Ash, Arlene S.
AU - Ray, Midge N.
AU - English, Thomas M.
AU - Hogan, Timothy P.
AU - Ford, Daniel E.
N1 - Funding Information:
This research was supported by the National Cancer Institute at the National Institutes of Health (R01-CA-129091) and the National Center for Advancing Translational Sciences of the National Institutes of Health [Award Number UL1TR000161]. Dr. Houston directs the eHealth Quality Enhancement Research Initiative (grant number eHQ-10-190) and receives support from this national Veterans’ Affairs implementation center, and Dr. Sadasivam’s effort was also supported by a National Cancer Institute Career Development Award (K07CA172677). No funding source had a role in the writing of the manuscript or decision to submit for publication. No contributor has been paid to write this article by a pharmaceutical company or other agency. The authors would like to acknowledge the Tobacco Treatment Specialists, Jessica Hillman-Williams, Heather Coley, and Kathryn DeLaughter for their contribution to the study in providing expertise in smoking cessation online. The authors would also like to acknowledge Anne Hubbell and Ariana Kamberi for their work as study coordinators, Jonathan Guerard and Mary Beth Dziewietin for their diligence in data collection and organization, and Kavitha Balakrishnan for her contribution to the D2Q system.
Publisher Copyright:
© 2015 Houston et al.
PY - 2015/11/2
Y1 - 2015/11/2
N2 - 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.
AB - 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.
KW - E-referrals
KW - Implementation science
KW - Medical practice
KW - Public health informatics
KW - Smoking cessation
KW - Web-assisted tobacco intervention
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UR - http://www.scopus.com/inward/citedby.url?scp=84959174150&partnerID=8YFLogxK
U2 - 10.1186/s13012-015-0336-8
DO - 10.1186/s13012-015-0336-8
M3 - Article
C2 - 26525410
AN - SCOPUS:84959174150
SN - 1748-5908
VL - 10
JO - Implementation Science
JF - Implementation Science
IS - 1
M1 - 154
ER -