291978
An integrated clinical-public health informatics system for smoking cessation: Pragmatic clinical trial in 174 practices
Tuesday, November 5, 2013
Rajani S. Sadasivam, PhD
,
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
Thomas K. Houston, MD, MPH
,
VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA
Midge N. Ray, RN, MSN
,
Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL
Thomas English, PhD
,
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
Arlene Ash, PhD
,
Department of Quantitative Health Sciences, UMass Medical School, Worcester, MA
Hua Feng, MS
,
Bedford VAMC, Bedford, MA, USA, Bedford, MA
Daniel Ford, MD
,
Departments of Epidemiology and Health Policy and Management, John Hopkins, BALTIMORE
Jeroan J. Allison, MD, MPH
,
Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
Background: Increasing evidence supports web-assisted tobacco interventions, but few smokers take advantage of these tools. Objective: We evaluated an integrated clinical-public health informatics system where primary care providers �e-referred� patients to Decide2Quit.org, a web-assisted tobacco intervention. Methods: Practices (Internal Medicine and Family Practice) were randomized to one of two referral methods: 1) a paper brochure or 2) a point-of-care e-referral completed by entering smoker's email into the ReferASmoker.org web-based e-referral system. Smokers from e-referral practices received automated email links to Decide2Quit.org. All smokers who registered with Decide2Quit.org received access to interactive quit smoking calculators and decision tools. Using a within-practice fractional factorial design, smokers were further randomized to three conditions: (A), receiving only the calculators and tools above, or (B) �A� plus motivational emails tailored to their readiness to quit, or (C) �B� plus asynchronous communication with tobacco treatment specialist. At the practice-level, we evaluated number of referrals and subsequent smoker registrations. At the smoker-level, we compared self-reported smoking cessation at six months. Results: The 174 practices referred 4380 smokers to Decide2Quit.org, with a per-practice mean of 26.7(95% CI=21.0-32.3) among �brochure� practices, compared with 21.9 (range: 17.1-26.6) per e-referral practice (p = 0.3). The e-referral practices had a higher mean number of smokers registrations 6.7 (4.8-8.5) compared with 2.7 (2.0-3.4) in �brochure� practices, yielding a statistically significant Incident Rate Ratio (IRR) of 2.5 (95% CI 1.8-3.5). At the smoker-level, the tools only (A) condition had a self-reported cessation rate of 17%, and the (B) condition was higher at 26%, as was the (C) condition 25%. Six-month cessation in the two groups that received motivational email messages (B and C) combined was significantly higher than the tools only (A) condition (Odds Ratio 1.6 (95% CI 1.02-2.8) p = 0.38). Conclusion: Clinical practices that used e-referrals had higher rates (more than double) of smokers using Decide2Quit.org, and augmented Decide2Quit.org tools increased patient quit rates.
Learning Areas:
Communication and informatics
Implementation of health education strategies, interventions and programs
Learning Objectives:
Demonstrate that electronic referrals by clinical practices double participation in a public health intervention than simply handing paper brochures.
Demonstrate that sending motivation tailored emails to smokers improves quit rates
Presenting author's disclosure statement:Qualified on the content I am responsible for because: A Computer Engineer, I have worked over the last 8 years with health services researchers to evaluate e-health systems for healthcare providers and patients, including the NCI funded Decide2Quit.org web-assisted tobacco intervention. I am currently the PI of an NCI R21 that is testing a suite of electronic chain referral approaches to test whether peer referrals will increase access to patient interventions
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
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