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Holliday R, Hong B, McColl E, Livingstone-Banks J, Preshaw PM. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database Syst Rev 2021; 2:CD005084. [PMID: 33605440 PMCID: PMC8095016 DOI: 10.1002/14651858.cd005084.pub4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dental professionals are well placed to help their patients stop using tobacco products. Large proportions of the population visit the dentist regularly. In addition, the adverse effects of tobacco use on oral health provide a context that dental professionals can use to motivate a quit attempt. OBJECTIVES To assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register up to February 2020. SELECTION CRITERIA We included randomised and quasi-randomised clinical trials assessing tobacco cessation interventions conducted by dental professionals in the dental practice or community setting, with at least six months of follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts for potential inclusion and extracted data from included trials. We resolved disagreements by consensus. The primary outcome was abstinence from all tobacco use (e.g. cigarettes, smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. Individual study effects and pooled effects were summarised as risk ratios (RR) and 95% confidence intervals (CI), using Mantel-Haenszel random-effects models to combine studies where appropriate. We assessed statistical heterogeneity with the I2 statistic. We summarised secondary outcomes narratively. MAIN RESULTS Twenty clinical trials involving 14,897 participants met the criteria for inclusion in this review. Sixteen studies assessed the effectiveness of interventions for tobacco-use cessation in dental clinics and four assessed this in community (school or college) settings. Five studies included only smokeless tobacco users, and the remaining studies included either smoked tobacco users only, or a combination of both smoked and smokeless tobacco users. All studies employed behavioural interventions, with four offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention. We judged three studies to be at low risk of bias, one to be at unclear risk of bias, and the remaining 16 studies to be at high risk of bias. Compared with usual care, brief advice, very brief advice, or less active treatment, we found very low-certainty evidence of benefit from behavioural support provided by dental professionals, comprising either one session (RR 1.86, 95% CI 1.01 to 3.41; I2 = 66%; four studies, n = 6328), or more than one session (RR 1.90, 95% CI 1.17 to 3.11; I2 = 61%; seven studies, n = 2639), on abstinence from tobacco use at least six months from baseline. We found moderate-certainty evidence of benefit from behavioural interventions provided by dental professionals combined with the provision of NRT or e-cigarettes, compared with no intervention, usual care, brief, or very brief advice only (RR 2.76, 95% CI 1.58 to 4.82; I2 = 0%; four studies, n = 1221). We did not detect a benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting (RR 1.51, 95% CI 0.86 to 2.65; I2 = 83%; three studies, n = 1020; very low-certainty evidence). Only one study reported adverse events or oral health outcomes, making it difficult to draw any conclusions. AUTHORS' CONCLUSIONS There is very low-certainty evidence that quit rates increase when dental professionals offer behavioural support to promote tobacco cessation. There is moderate-certainty evidence that tobacco abstinence rates increase in cigarette smokers if dental professionals offer behavioural support combined with pharmacotherapy. Further evidence is required to be certain of the size of the benefit and whether adding pharmacological interventions is more effective than behavioural support alone. Future studies should use biochemical validation of abstinence so as to preclude the risk of detection bias. There is insufficient evidence on whether these interventions lead to adverse effects, but no reasons to suspect that these effects would be specific to interventions delivered by dental professionals. There was insufficient evidence that interventions affected oral health.
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Affiliation(s)
- Richard Holliday
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Bosun Hong
- Oral Surgery Department, Birmingham Dental Hospital, Birmingham, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Philip M Preshaw
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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James TL. Improving Referrals to Diabetes Self-Management Education in Medically Underserved Adults. Diabetes Spectr 2021; 34:20-26. [PMID: 33627990 PMCID: PMC7887525 DOI: 10.2337/ds20-0001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Electronic health records (EHRs) and clinical decision-support algorithms improve diabetes care. This quality improvement (QI) project aimed to determine whether an electronic diabetes education referral protocol using the Diabetes Self-Management Education and Support for Adults With Type 2 Diabetes: Algorithm of Care (DSMES Algorithm) and protocol training would increase the proportion of adult patients with type 2 diabetes at a federally qualified health center electronically referred for diabetes self-management education and support (DSMES). DESIGN AND METHODS The EHR was modified to include the DSMES Algorithm and questions regarding prior participation in diabetes education. Protocol trainings were conducted. Data were obtained via retrospective chart review. A one-sample t test was used to evaluate the statistical difference between the electronic referral (e-referral) rates of the pre-intervention and intervention groups. RESULTS Completion of the DSMES Algorithm was positively associated with e-referrals to diabetes education (P <0.001). The intervention group had a higher rate of e-referral for DSMES than the pre-intervention group (31 vs. 0%, P <0.001). CONCLUSION E-referral protocols using the DSMES Algorithm and protocol training may aid in the identification and documentation of self-care needs of medically underserved patients with type 2 diabetes and improve e-referrals to DSMES. Of clinical importance, these findings translate into active patient engagement, team-based care, and information-sharing. Additional work is needed to determine whether the e-referral rate is sustained or increases over time. Further investigations should also be explored to evaluate the impact of e-referral protocols and algorithms on participation in DSMES.
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Affiliation(s)
- Tiffany L James
- University of Alabama at Birmingham, Birmingham, AL, and Valley Healthcare System, Columbus, GA
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3
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Riddle MW. HIV screening in dental settings: Challenges, opportunities, and a call to action. Oral Dis 2020; 26 Suppl 1:9-15. [PMID: 32862545 DOI: 10.1111/odi.13468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 01/03/2023]
Abstract
HIV is responsible for tremendous suffering and loss around the world, but many advances in HIV screening, diagnosis, treatment, and prevention provide hope for an end to the HIV epidemic. Global and national campaigns facilitate access to these HIV advances, but some individuals and communities still lack access, particularly in developing countries. To reach those who remain under-served, campaigns encourage greater integration of HIV services with non-HIV services. As members of the healthcare team with a clinical stake in HIV, dental care providers have a unique contribution to make. Much research on the role of dental care providers in HIV has focused on HIV screening in the dental setting, and researchers have identified possible ways forward but also daunting challenges. Approaches for screening, brief intervention, and referral to treatment used in primary care and dental care settings for other health risks may help overcome challenges related to provider scope of practice and need for training. Approaches to managing distress and uncertainty in other clinical contexts may help overcome challenges related to patient acceptability, equipping providers to manage sensitive topics and emotional aspects of HIV screening. While not panaceas, these approaches may be useful to dental care providers interested in answering the global "call to action" for contributing to ending the HIV epidemic.
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Affiliation(s)
- Melissa Wiseman Riddle
- Division of Extramural Research, Behavioral and Social Sciences Research Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
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4
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Herbst N, Wiener RS, Helm ED, O'Donnell C, Fitzgerald C, Wong C, Bulekova K, Waite M, Mishuris RG, Kathuria H. Effectiveness of an Opt-Out Electronic Heath Record-Based Tobacco Treatment Consult Service at an Urban Safety Net Hospital. Chest 2020; 158:1734-1741. [PMID: 32428510 DOI: 10.1016/j.chest.2020.04.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To address the burden of tobacco use in underserved populations, our safety net hospital developed a tobacco treatment intervention consisting of an "opt-out" electronic health record-based best practice alert + order set, which triggers consultation to an inpatient tobacco treatment consult (TTC) service for all hospitalized smokers. RESEARCH QUESTION We sought to understand if the intervention would increase patient-level outcomes (receipt of tobacco treatment during hospitalization and at discharge; 6-month smoking abstinence) and improve hospital-wide performance on tobacco treatment metrics. DESIGN AND METHODS We conducted two retrospective quasi-experimental analyses to examine effectiveness of the TTC service. Using a pragmatic design and multivariable logistic regression, we compared patient-level outcomes of receipt of nicotine replacement therapy and 6-month quit rates between smokers seen by the service (n = 505) and eligible smokers not seen because of time constraints (n = 680) between July 2016 and December 2016. In addition, we conducted an interrupted time series analysis to examine the effect of the TTC service on hospital-level performance measures, comparing reported Joint Commission measure rates for inpatient (Tob-2) and postdischarge (Tob-3) tobacco treatment preimplementation (January 2015-June 2016) vs postimplementation (July 2016-December 2017) of the intervention. RESULTS Compared with inpatient smokers not seen by the TTC service, smokers seen by the TTC service had higher odds of receiving nicotine replacement during hospitalization (260 of 505 [51.5%] vs 244 of 680 [35.9%]; adjusted ORs [AOR], 1.93 [95% CI, 1.5-2.45]) and at discharge (164 of 505 [32.5%] vs 84 of 680 [12.4%]; AOR, 3.41 [95% CI, 2.54-4.61]), as well as higher odds of 6-month smoking abstinence (75 of 505 [14.9%] vs 68 of 680 [10%]; AOR, 1.48 [95% CI, 1.03-2.12]). Hospital-wide, the intervention was associated with a change in slope trends for Tob-3 (P < .01), but not for Tob-2. INTERPRETATION The "opt-out" electronic health record-based TTC service at our large safety net hospital was effective at improving both patient-level outcomes and hospital-level performance metrics, and could be implemented at other safety net hospitals that care for hard-to-reach smokers.
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Affiliation(s)
- Nicole Herbst
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Renda Soylemez Wiener
- Pulmonary Center, Boston University School of Medicine, Boston, MA; Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, Bedford, MA
| | - Eric D Helm
- Pulmonary Center, Boston University School of Medicine, Boston, MA
| | | | | | - Carolina Wong
- Pulmonary Center, Boston University School of Medicine, Boston, MA
| | - Katia Bulekova
- Research Computing Services Group, Information Services and Technology, Boston University, Boston, MA
| | - Meg Waite
- Analytics and Public Reporting, Boston Medical Center, Boston, MA
| | - Rebecca G Mishuris
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA
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Sadasivam RS, Kamberi A, DeLaughter K, Phillips B, Williams JH, Cutrona SL, Ray MN, Gilbert GH, Houston TK. Secure Asynchronous Communication Between Smokers and Tobacco Treatment Specialists: Secondary Analysis of a Web-Assisted Tobacco Intervention in the QUIT-PRIMO and National Dental PBRN Networks. J Med Internet Res 2020; 22:e13289. [PMID: 32374266 PMCID: PMC7240437 DOI: 10.2196/13289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/24/2019] [Accepted: 01/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Within a web-assisted tobacco intervention, we provided a function for smokers to asynchronously communicate with a trained tobacco treatment specialist (TTS). Previous studies have not attempted to isolate the effect of asynchronous counseling on smoking cessation. OBJECTIVE This study aimed to conduct a semiquantitative analysis of TTS-smoker communication and evaluate its association with smoking cessation. METHODS We conducted a secondary analysis of data on secure asynchronous communication between trained TTSs and a cohort of smokers during a 6-month period. Smokers were able to select their preferred TTS and message them using a secure web-based form. To evaluate whether the TTS used evidence-based practices, we coded messages using the Motivational Interviewing Self-Evaluation Checklist and Smoking Cessation Counseling (SCC) Scale. We assessed the content of messages initiated by the smokers by creating topical content codes. At 6 months, we assessed the association between smoking cessation and the amount of TTS use and created a multivariable model adjusting for demographic characteristics and smoking characteristics at baseline. RESULTS Of the 725 smokers offered asynchronous counseling support, 33.8% (245/725) messaged the TTS at least once. A total of 1082 messages (TTSs: 565; smokers 517) were exchanged between the smokers and TTSs. The majority of motivational interviewing codes were those that supported client strengths (280/517, 54.1%) and promoted engagement (280/517, 54.1%). SCC code analysis showed that the TTS provided assistance to smokers if they were willing to quit (247/517, 47.8%) and helped smokers prepare to quit (206/517, 39.8%) and anticipate barriers (197/517, 38.1%). The majority of smokers' messages discussed motivations to quit (234/565, 41.4%) and current and past treatments (talking about their previous use of nicotine replacement therapy and medications; 201/565, 35.6%). The majority of TTS messages used behavioral strategies (233/517, 45.1%), offered advice on treatments (189/517, 36.5%), and highlighted motivations to quit (171/517, 33.1%). There was no association between the amount of TTS use and cessation. In the multivariable model, after adjusting for gender, age, race, education, readiness at baseline, number of cigarettes smoked per day at baseline, and the selected TTS, smokers messaging the TTS one or two times had a smoking cessation odds ratio (OR) of 0.8 (95% CI 0.4-1.4), and those that messaged the TTS more than two times had a smoking cessation OR of 1.0 (95% CI 0.4-2.3). CONCLUSIONS Our study demonstrated the feasibility of using asynchronous counseling to deliver evidence-based counseling. Low participant engagement or a lack of power could be potential explanations for the nonassociation with smoking cessation. Future trials should explore approaches to increase participant engagement and test asynchronous counseling in combination with other approaches for improving the rates of smoking cessation.
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Affiliation(s)
| | - Ariana Kamberi
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Kathryn DeLaughter
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Barrett Phillips
- Veterans Affairs Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | | | - Sarah L Cutrona
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Midge N Ray
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gregg H Gilbert
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Thomas K Houston
- University of Massachusetts Medical School, Worcester, MA, United States
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Ajiboye A, Gordon J, Fox C, Garcia R. Oral Health Effects of Tobacco Products: Science and Regulatory Policy. J Dent Res 2019; 98:1168-1172. [DOI: 10.1177/0022034519872946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- A.S. Ajiboye
- American Association for Dental Research, Alexandria, VA, USA
| | - J.S. Gordon
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - C.H. Fox
- American Association for Dental Research, Alexandria, VA, USA
| | - R.I. Garcia
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
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Bettano A, Land T, Byrd A, Svencer S, Nasuti L. Using Electronic Referrals to Address Health Disparities and Improve Blood Pressure Control. Prev Chronic Dis 2019; 16:E114. [PMID: 31441768 PMCID: PMC6716462 DOI: 10.5888/pcd16.180583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Massachusetts developed and used bidirectional electronic referrals to connect clinical patients across the state to interventions run by community organizations. The objective of our study was to determine whether the use of Massachusetts’s electronic referral system (MA e-Referral) reached racial/ethnic groups experiencing health disparities and whether it was associated with improved health outcomes. Methods We assembled encounter-level medical records from September 2013 through June 2017 for patients at Massachusetts clinics funded by the Clinical Community Partnerships for Prevention into 2 cohorts. First, all patients meeting program eligibility guidelines for an e-Referral (N = 21,701) were examined to assess the distribution of e-Referrals among populations facing health disparities; second, a subset of 3,817 people with hypertension were analyzed to detect changes in blood pressure after e-Referral to an evidence-based community intervention. Results Non-Hispanic black (OR, 1.4; 95% confidence interval [CI], 1.2–1.6) and Hispanic patients (OR, 1.3; 95% CI, 1.1–1.4) had higher odds than non-Hispanic white patients of being referred electronically. Patients completing their hypertension intervention had 74% (95% CI, 1.2–2.5) higher odds of having an in-control blood pressure reading than patients who were not electronically referred. Conclusion Clinical to community linkage to interventions through MA e-Referral reached non-Hispanic black, Hispanic, and Spanish-speaking populations and was associated with improved blood pressure control.
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Affiliation(s)
- Amy Bettano
- Massachusetts Department of Public Health, 250 Washington St, 6th floor, Boston, MA 02108.
| | - Thomas Land
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Alice Byrd
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Susan Svencer
- National Association of Chronic Disease Directors, Decatur, Georgia
| | - Laura Nasuti
- Massachusetts Department of Public Health, Boston, Massachusetts
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Hood-Medland EA, Stewart SL, Nguyen H, Avdalovic M, MacDonald S, Zhu SH, Mayoral A, Tong EK. Health System Implementation of a Tobacco Quitline eReferral. Appl Clin Inform 2019; 10:735-742. [PMID: 31578046 PMCID: PMC6774758 DOI: 10.1055/s-0039-1697593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/02/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Proactive referrals through electronic orders (eReferrals) can increase patient connection with tobacco quitlines. More information is needed on "real-world" implementation of electronic health record tools to promote tobacco cessation while minimizing provider burden. OBJECTIVES This paper examines the health system implementation of an eReferral to a tobacco quitline without best practice alerts in primary care, specialty, and hospital settings in an academic health system. METHODS This is a prospective implementation study of a health system tobacco eReferral to a state quitline that was completed with an approach to minimize provider cognitive burden. Data are drawn from electronic health record data at University of California, Davis Health Systems (March 2013-February 2016). RESULTS Over 3 years, 16,083 encounters with smokers resulted in 1,137 eReferral orders (7.1%). Treatment reach was 1.6% for quitline services and 2.3% for outpatient group classes. While the group classes were offered to outpatient smokers, the eReferral order was included in an outpatient order set and eventually an automated inpatient discharge order set; no provider alerts were implemented. Referrals were sustained and doubled after inpatient order set implementation. Among all first time eReferral patients, 12.2% had a 6 to 12 month follow-up visit at which they were documented as nonsmoking. CONCLUSION This study demonstrates a quitline eReferral order can be successfully implemented and sustained with minimal promotion, without provider alerts and in conjunction with group classes. Reach and effectiveness were similar to previously described literature.
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Affiliation(s)
- Eve Angeline Hood-Medland
- Department of Internal Medicine, University of California, Davis in Sacramento, California, United States
| | - Susan L. Stewart
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis in Sacramento, California, United States
| | - Hien Nguyen
- Department of Internal Medicine, University of California, Davis in Sacramento, California, United States
| | - Mark Avdalovic
- Department of Internal Medicine, University of California, Davis in Sacramento, California, United States
| | - Scott MacDonald
- Department of Clinical Informatics, University of California, Davis in Sacramento, California, United States
| | - Shu-Hong Zhu
- Department of Family Medicine, Moores Cancer Center, University of California, San Diego in San Diego, California, United States
| | - Antonio Mayoral
- Department of Family Medicine, Moores Cancer Center, University of California, San Diego in San Diego, California, United States
| | - Elisa K. Tong
- Department of Internal Medicine, University of California, Davis in Sacramento, California, United States
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Do HP, Tran BX, Le Pham Q, Nguyen LH, Tran TT, Latkin CA, Dunne MP, Baker PR. Which eHealth interventions are most effective for smoking cessation? A systematic review. Patient Prefer Adherence 2018; 12:2065-2084. [PMID: 30349201 PMCID: PMC6188156 DOI: 10.2147/ppa.s169397] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To synthesize evidence of the effects and potential effect modifiers of different electronic health (eHealth) interventions to help people quit smoking. METHODS Four databases (MEDLINE, PsycINFO, Embase, and The Cochrane Library) were searched in March 2017 using terms that included "smoking cessation", "eHealth/mHealth" and "electronic technology" to find relevant studies. Meta-analysis and meta-regression analyses were performed using Mantel-Haenszel test for fixed-effect risk ratio (RR) and restricted maximum-likelihood technique, respectively. Protocol Registration Number: CRD42017072560. RESULTS The review included 108 studies and 110,372 participants. Compared to nonactive control groups (eg, usual care), smoking cessation interventions using web-based and mobile health (mHealth) platform resulted in significantly greater smoking abstinence, RR 2.03 (95% CI 1.7-2.03), and RR 1.71 (95% CI 1.35-2.16), respectively. Similarly, smoking cessation trials using tailored text messages (RR 1.80, 95% CI 1.54-2.10) and web-based information and conjunctive nicotine replacement therapy (RR 1.29, 95% CI 1.17-1.43) may also increase cessation. In contrast, little or no benefit for smoking abstinence was found for computer-assisted interventions (RR 1.31, 95% CI 1.11-1.53). The magnitude of effect sizes from mHealth smoking cessation interventions was likely to be greater if the trial was conducted in the USA or Europe and when the intervention included individually tailored text messages. In contrast, high frequency of texts (daily) was less effective than weekly texts. CONCLUSIONS There was consistent evidence that web-based and mHealth smoking cessation interventions may increase abstinence moderately. Methodologic quality of trials and the intervention characteristics (tailored vs untailored) are critical effect modifiers among eHealth smoking cessation interventions, especially for web-based and text messaging trials. Future smoking cessation intervention should take advantages of web-based and mHealth engagement to improve prolonged abstinence.
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Affiliation(s)
- Huyen Phuc Do
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia,
- Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam,
| | - Bach Xuan Tran
- Department of Health, Behaviours and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Quyen Le Pham
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Long Hoang Nguyen
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Tung Thanh Tran
- Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam,
| | - Carl A Latkin
- Department of Health, Behaviours and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael P Dunne
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia,
- Institute for Community Health Research, Hue University, Hue, Vietnam
| | - Philip Ra Baker
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia,
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Williams JH, DeLaughter K, Volkman JE, Sadasivam RS, Ray MN, Gilbert GH, Houston TK. Exploring Online Asynchronous Counseling With Tobacco Treatment Specialists in the QUIT-PRIMO and National Dental PBRN HI-QUIT Studies: Who Uses It and What Do They Say? Am J Health Promot 2018; 32:1170-1177. [PMID: 29848011 PMCID: PMC5986085 DOI: 10.1177/0890117116670972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the content of messages sent by smokers through asynchronous counseling within a Web-based smoking cessation intervention. DESIGN Qualitative. SETTING National community-based setting of patients who had been engaged by the medical or dental practices at which they attended or via Google advertisements. PARTICIPANTS Adults older than 19 years who were current smokers and interested in quitting. Participants throughout the United States referred to a Web-based cessation intervention by their medical or dental provider or by clicking on a Google advertisement. METHODS We conducted a qualitative review of 742 asynchronous counseling messages sent by 270 Web site users. Messages were reviewed, analyzed, and organized into qualitative themes by the investigative team. RESULTS The asynchronous counseling feature of the intervention was used most frequently by smokers who were white (87%), female (67%), aged 45 to 54 (32%), and who had at least some college-level education (70%). Qualitative analysis yielded 7 basic themes-Talk about the Process of Quitting, Barriers to Quitting, Reasons to Quit, Quit History, Support and Strategies for Quitting, Quitting with Medication, and Quit Progress. The most common theme was Support and Strategies for Quitting with 255 references among all messages. CONCLUSION We found rich communication across the spectrum of the quit process, from persons preparing to quit to those who had successfully quit. Asynchronous smoking cessation counseling provides a promising means of social support for smokers during the quit process.
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Affiliation(s)
- Jessica H Williams
- 1 Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn DeLaughter
- 2 VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA, USA
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
- 4 VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford and Boston, MA, USA
| | - Julie E Volkman
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
- 5 Department of Communication, Bryant University, Smithfield, RI, USA
| | - Rajani S Sadasivam
- 2 VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA, USA
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - Midge N Ray
- 1 Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregg H Gilbert
- 6 Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas K Houston
- 2 VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA, USA
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
- 4 VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford and Boston, MA, USA
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Graham AL, Burke MV, Jacobs MA, Cha S, Croghan IT, Schroeder DR, Moriarty JP, Borah BJ, Rasmussen DF, Brookover MJ, Suesse DB, Midthun DE, Hays JT. An integrated digital/clinical approach to smoking cessation in lung cancer screening: study protocol for a randomized controlled trial. Trials 2017; 18:568. [PMID: 29179734 PMCID: PMC5704639 DOI: 10.1186/s13063-017-2312-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/01/2017] [Indexed: 01/06/2023] Open
Abstract
Background Delivering effective tobacco dependence treatment that is feasible within lung cancer screening (LCS) programs is crucial for realizing the health benefits and cost savings of screening. Large-scale trials and systematic reviews have demonstrated that digital cessation interventions (i.e. web-based and text message) are effective, sustainable over the long-term, scalable, and cost-efficient. Use of digital technologies is commonplace among older adults, making this a feasible approach within LCS programs. Use of cessation treatment has been improved with models that proactively connect smokers to treatment rather than passive referrals. Proactive referral to cessation treatment has been advanced through healthcare systems changes such as modifying the electronic health record to automatically link smokers to treatment. Methods This study evaluates the impact of a proactive enrollment strategy that links LCS-eligible smokers with an evidence-based intervention comprised of a web-based (WEB) program and integrated text messaging (TXT) in a three-arm randomized trial with repeated measures at one, three, six, and 12 months post randomization. The primary outcome is biochemically confirmed abstinence at 12 months post randomization. We will randomize 1650 smokers who present for a clinical LCS to: (1) a usual care control condition (UC) which consists of Ask–Advise–Refer; (2) a digital (WEB + TXT) cessation intervention; or (3) a digital cessation intervention combined with tobacco treatment specialist (TTS) counseling (WEB + TXT + TTS). Discussion The scalability and sustainability of a digital intervention may represent the most cost-effective and feasible approach for LCS programs to proactively engage large numbers of smokers in effective cessation treatment. We will also evaluate the impact and cost-effectiveness of adding proven clinical intervention provided by a TTS. We expect that a combined digital/clinical intervention will yield higher quit rates than digital alone, but that it may not be as cost-effective or feasible for LCS programs to implement. This study is innovative in its use of interoperable, digital technologies to deliver a sustainable, scalable, high-impact cessation intervention and to facilitate its integration within clinical practice. It will add to the growing knowledge base about the overall effectiveness of digital interventions and their role in the healthcare delivery system. Trial registration ClinicalTrials.gov, NCT03084835. Registered on 9 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2312-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA. .,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - Michael V Burke
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - Megan A Jacobs
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Ivana T Croghan
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James P Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bijan J Borah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Donna F Rasmussen
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - M Jody Brookover
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Dale B Suesse
- Division of Research and Education Systems Support, Mayo Clinic, Rochester, MN, USA
| | - David E Midthun
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - J Taylor Hays
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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12
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Sadasivam RS, Cutrona SL, Luger TM, Volz E, Kinney R, Rao SR, Allison JJ, Houston TK. Share2Quit: Online Social Network Peer Marketing of Tobacco Cessation Systems. Nicotine Tob Res 2017; 19:314-323. [PMID: 27613918 DOI: 10.1093/ntr/ntw187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/18/2016] [Indexed: 11/13/2022]
Abstract
Introduction Although technology-assisted tobacco interventions (TATIs) are effective, they are underused due to recruitment challenges. We tested whether we could successfully recruit smokers to a TATI using peer marketing through a social network (Facebook). Methods We recruited smokers on Facebook using online advertisements. These recruited smokers (seeds) and subsequent waves of smokers (peer recruits) were provided the Share2Quit peer recruitment Facebook app and other tools. Smokers were incentivized for up to seven successful peer recruitments and had 30 days to recruit from date of registration. Successful peer recruitment was defined as a peer recruited smoker completing the registration on the TATI following a referral. Our primary questions were (1) whether smokers would recruit other smokers and (2) whether peer recruitment would extend the reach of the intervention to harder-to-reach groups, including those not ready to quit and minority smokers. Results Overall, 759 smokers were recruited (seeds: 190; peer recruits: 569). Fifteen percent (n = 117) of smokers successfully recruited their peers (seeds: 24.7%; peer recruits: 7.7%) leading to four recruitment waves. Compared to seeds, peer recruits were less likely to be ready to quit (peer recruits 74.2% vs. seeds 95.1%), more likely to be male (67.1% vs. 32.9%), and more likely to be African American (23.8% vs. 10.8%) (p < .01 for all comparisons). Conclusions Peer marketing quadrupled our engaged smokers and enriched the sample with not-ready-to-quit and African American smokers. Peer recruitment is promising, and our study uncovered several important challenges for future research. Implications This study demonstrates the successful recruitment of smokers to a TATI using a Facebook-based peer marketing strategy. Smokers on Facebook were willing and able to recruit other smokers to a TATI, yielding a large and diverse population of smokers.
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Affiliation(s)
- Rajani S Sadasivam
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Sarah L Cutrona
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA.,Meyers Primary Care Institute, Worcester, MA
| | - Tana M Luger
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Bedford, MA
| | | | - Rebecca Kinney
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Sowmya R Rao
- Department of Surgery, Boston University, Boston, MA
| | - Jeroan J Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Thomas K Houston
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Bedford, MA
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13
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Taylor GMJ, Dalili MN, Semwal M, Civljak M, Sheikh A, Car J. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev 2017; 9:CD007078. [PMID: 28869775 PMCID: PMC6703145 DOI: 10.1002/14651858.cd007078.pub5] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tobacco use is estimated to kill 7 million people a year. Nicotine is highly addictive, but surveys indicate that almost 70% of US and UK smokers would like to stop smoking. Although many smokers attempt to give up on their own, advice from a health professional increases the chances of quitting. As of 2016 there were 3.5 billion Internet users worldwide, making the Internet a potential platform to help people quit smoking. OBJECTIVES To determine the effectiveness of Internet-based interventions for smoking cessation, whether intervention effectiveness is altered by tailoring or interactive features, and if there is a difference in effectiveness between adolescents, young adults, and adults. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, which included searches of MEDLINE, Embase and PsycINFO (through OVID). There were no restrictions placed on language, publication status or publication date. The most recent search was conducted in August 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs). Participants were people who smoked, with no exclusions based on age, gender, ethnicity, language or health status. Any type of Internet intervention was eligible. The comparison condition could be a no-intervention control, a different Internet intervention, or a non-Internet intervention. To be included, studies must have measured smoking cessation at four weeks or longer. DATA COLLECTION AND ANALYSIS Two review authors independently assessed and extracted data. We extracted and, where appropriate, pooled smoking cessation outcomes of six-month follow-up or more, reporting short-term outcomes narratively where longer-term outcomes were not available. We reported study effects as a risk ratio (RR) with a 95% confidence interval (CI).We grouped studies according to whether they (1) compared an Internet intervention with a non-active control arm (e.g. printed self-help guides), (2) compared an Internet intervention with an active control arm (e.g. face-to-face counselling), (3) evaluated the addition of behavioural support to an Internet programme, or (4) compared one Internet intervention with another. Where appropriate we grouped studies by age. MAIN RESULTS We identified 67 RCTs, including data from over 110,000 participants. We pooled data from 35,969 participants.There were only four RCTs conducted in adolescence or young adults that were eligible for meta-analysis.Results for trials in adults: Eight trials compared a tailored and interactive Internet intervention to a non-active control. Pooled results demonstrated an effect in favour of the intervention (RR 1.15, 95% CI 1.01 to 1.30, n = 6786). However, statistical heterogeneity was high (I2 = 58%) and was unexplained, and the overall quality of evidence was low according to GRADE. Five trials compared an Internet intervention to an active control. The pooled effect estimate favoured the control group, but crossed the null (RR 0.92, 95% CI 0.78 to 1.09, n = 3806, I2 = 0%); GRADE quality rating was moderate. Five studies evaluated an Internet programme plus behavioural support compared to a non-active control (n = 2334). Pooled, these studies indicated a positive effect of the intervention (RR 1.69, 95% CI 1.30 to 2.18). Although statistical heterogeneity was substantial (I2 = 60%) and was unexplained, the GRADE rating was moderate. Four studies evaluated the Internet plus behavioural support compared to active control. None of the studies detected a difference between trial arms (RR 1.00, 95% CI 0.84 to 1.18, n = 2769, I2 = 0%); GRADE rating was moderate. Seven studies compared an interactive or tailored Internet intervention, or both, to an Internet intervention that was not tailored/interactive. Pooled results favoured the interactive or tailored programme, but the estimate crossed the null (RR 1.10, 95% CI 0.99 to 1.22, n = 14,623, I2 = 0%); GRADE rating was moderate. Three studies compared tailored with non-tailored Internet-based messages, compared to non-tailored messages. The tailored messages produced higher cessation rates compared to control, but the estimate was not precise (RR 1.17, 95% CI 0.97 to 1.41, n = 4040), and there was evidence of unexplained substantial statistical heterogeneity (I2 = 57%); GRADE rating was low.Results should be interpreted with caution as we judged some of the included studies to be at high risk of bias. AUTHORS' CONCLUSIONS The evidence from trials in adults suggests that interactive and tailored Internet-based interventions with or without additional behavioural support are moderately more effective than non-active controls at six months or longer, but there was no evidence that these interventions were better than other active smoking treatments. However some of the studies were at high risk of bias, and there was evidence of substantial statistical heterogeneity. Treatment effectiveness in younger people is unknown.
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Affiliation(s)
- Gemma M. J. Taylor
- University of BristolMRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology12a Priory RoadBristolUKBS8 1TU
| | | | - Monika Semwal
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)SingaporeSingapore
| | | | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of EdinburghAllergy & Respiratory Research Group and Asthma UK Centre for Applied ResearchTeviot PlaceEdinburghUKEH8 9AG
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)SingaporeSingapore
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
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14
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Ramseier CA, Suvan JE. Behaviour change counselling for tobacco use cessation and promotion of healthy lifestyles: a systematic review. J Clin Periodontol 2016; 42 Suppl 16:S47-58. [PMID: 25496370 DOI: 10.1111/jcpe.12351] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2014] [Indexed: 11/27/2022]
Abstract
AIM To systematically assess the efficacy of oral health behaviour change counselling for tobacco use cessation (TUC) and the promotion of healthy lifestyles. MATERIALS AND METHODS Systematic Reviews, Randomized (RCTs), and Controlled Clinical Trials (CCTs) were identified through an electronic search of four databases complemented by manual search. Identification, screening, eligibility and inclusion of studies were performed independently by two reviewers. Quality assessment of the included publications was performed according to the AMSTAR tool for the assessment of the methodological quality of systematic reviews. RESULTS A total of seven systematic reviews were included. With the exception of inadequate oral hygiene, the following unhealthy lifestyles related with periodontal diseases were investigated: tobacco use, unhealthy diets, harmful use of alcohol, physical inactivity, and stress. Brief interventions for TUC were shown to be effective when applied in the dental practice setting while evidence for dietary counselling and the promotion of other healthy lifestyles was limited or non-existent. CONCLUSIONS While aiming to improve periodontal treatment outcomes and the maintenance of periodontal health current evidence suggests that tobacco use brief interventions conducted in the dental practice setting were effective thus underlining the rational for behavioural support.
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Affiliation(s)
- Christoph A Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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15
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Houston TK, Sadasivam RS, Allison JJ, Ash AS, Ray MN, English TM, Hogan TP, Ford DE. Evaluating the QUIT-PRIMO clinical practice ePortal to increase smoker engagement with online cessation interventions: a national hybrid type 2 implementation study. Implement Sci 2015; 10:154. [PMID: 26525410 PMCID: PMC4630887 DOI: 10.1186/s13012-015-0336-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022] Open
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. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0336-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas K Houston
- VA eHealth Quality Enhancement Research Initiative and Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA. .,Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, MA, USA. .,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rajani S Sadasivam
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeroan J Allison
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Arlene S Ash
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Midge N Ray
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Thomas M English
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy P Hogan
- VA eHealth Quality Enhancement Research Initiative and Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.,Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, MA, USA.,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel E Ford
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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16
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Persistence of smoking-cessation decision support use in a dental practice. Am J Prev Med 2015; 48:722-8. [PMID: 25736977 DOI: 10.1016/j.amepre.2014.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/22/2014] [Accepted: 12/24/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION A computer-assisted tobacco decision support tool increased dental practitioners' (dentists and dental hygienists) advice to quit smoking and referral to a quitline during a group randomized trial. The purpose of this study is to document the extent to which use persisted after the trial. METHODS Electronic dental record (EDR) data from 2010 to 2013 were analyzed in 2014 for use of computer-assisted tobacco intervention tool advice scripts and referral to a quitline during four periods: during the trial and post-trial when only intervention clinic dental practitioners had access to the tool, and during full deployment, both before and after an EDR modification. RESULTS Intervention clinic dental practitioners (18.5 dentist full-time equivalents [FTEs] and 27.8 dental hygienist FTEs practicing in seven clinics) referred 19.0% of 1,368 smokers to a quitline during the trial and referred 15.4% of 4,011 smokers post-trial. After full tool deployment but pre-EDR change, these dental practitioners referred 15.6% of 2,214 intervention clinic smokers, whereas 18.3 dentist FTEs and 29.7 dental hygienist FTEs practicing in eight clinics referred 8.5% of 2,113 smokers. Post-EDR change, dental practitioners referred 12.2% of 2,214 intervention clinic smokers and 8.1% of 2,399 control clinic smokers to a quitline. In the last three quarters of observation, clinic script use ranged from 15.4% to 65.8% and referral to a quitline ranged from 2.0% to 18.7% of visits. CONCLUSIONS Although EDR design affected rates of referral, dental practitioners persisted in using a computer-assisted tobacco intervention tool to refer smokers to a quitline.
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