Internet Delivered Support for Tobacco Control in Dental Practice: Randomized Controlled Trial
ABSTRACT The dental visit is a unique opportunity for tobacco control. Despite evidence of effectiveness in dental settings, brief provider-delivered cessation advice is underutilized.
To evaluate an Internet-delivered intervention designed to increase implementation of brief provider advice for tobacco cessation in dental practice settings.
Dental practices (N = 190) were randomized to the intervention website or wait-list control. Pre-intervention and after 8 months of follow-up, each practice distributed exit cards (brief patient surveys assessing provider performance, completed immediately after the dental visit) to 100 patients. Based on these exit cards, we assessed: whether patients were asked about tobacco use (ASK) and, among tobacco users, whether they were advised to quit tobacco (ADVISE). All intervention practices with follow-up exit card data were analyzed as randomized regardless of whether they participated in the Internet-delivered intervention.
Of the 190 practices randomized, 143 (75%) dental practices provided follow-up data. Intervention practices' mean performance improved post-intervention by 4% on ASK (29% baseline, adjusted odds ratio = 1.29 [95% CI 1.17-1.42]), and by 11% on ADVISE (44% baseline, OR = 1.55 [95% CI 1.28-1.87]). Control practices improved by 3% on ASK (Adj. OR 1.18 [95% CI 1.07-1.29]) and did not significantly improve in ADVISE. A significant group-by-time interaction effect indicated that intervention practices improved more over the study period than control practices for ADVISE (P = 0.042) but not for ASK.
This low-intensity, easily disseminated intervention was successful in improving provider performance on advice to quit.
clinicaltrials.gov NCT00627185, http://www.webcitation.org/5c5Kugvzj.
- SourceAvailable from: Catarina Kiefe
[Show abstract] [Hide abstract]
- "Most GRTs do not report a response rate as they have a target number of "groups" or practices to recruit for the purposes of statistical power  and do not identify, or at least report, a sampling denominator. Our facility and clinic response rates were much higher than the 27% of nursing homes in a GRT study of osteoporosis fracture prevention  or the 33% of practices in a managed-care organization's study to increase chlamydia screening . "
ABSTRACT: The Veterans Health Administration (VHA) oversees the largest integrated healthcare system in the United States. The feasibility of a large-scale, nationwide, group-randomized implementation trial of VHA outpatient practices has not been reported. We describe the recruitment and enrollment of such a trial testing a clinician-directed, Internet-delivered intervention for improving the care of postmyocardial infarction patients with multiple comorbidities. With a recruitment goal of 200 eligible community-based outpatient clinics, parent VHA facilities (medical centers) were recruited because they oversee their affiliated clinics and the research conducted there. Eligible facilities had at least four VHA-owned and -operated primary care clinics, an affiliated Institutional Review Board (IRB), and no ongoing, potentially overlapping, quality-improvement study. Between December 2003 and December 2005, in two consecutive phases, we used initial and then intensified recruitment strategies. Overall, 48 of 66 (73%) eligible facilities were recruited. Of the 219 clinics and 957 clinicians associated with the 48 facilities, 168 (78%) clinics and 401 (42%) clinicians participated. The median time from initial facility contact to clinic enrollment was 222 days, which decreased by over one-third from the first to the second recruitment phase (medians: 323 and 195 days, respectively; p < .001), when more structured recruitment with physician recruiters was implemented and a dedicated IRB manager was added to the coordinating center staff. Large group-randomized trials benefit from having dedicated physician investigators and IRB personnel involved in recruitment. A large-scale, nationally representative, group-randomized trial of community-based clinics is feasible within the VHA or a similar national healthcare system.Implementation Science 09/2011; 6:105. DOI:10.1186/1748-5908-6-105 · 3.47 Impact Factor
[Show abstract] [Hide abstract]
- "We will randomize 160 primary care clinical microsystems to the intervention or comparison group. For both the intervention and comparison groups, we will adapt protocols used in prior successful Internet-delivered provider interventions to recruit practices and implement the system in practices [31,32]. Because our trial targets both practices and patients, patients within practices undergo a second level of randomization, as described below. "
ABSTRACT: Although screening for tobacco use is increasing with electronic health records and standard protocols, other tobacco-control activities, such as referral of patients to cessation resources, is quite low. In the QUIT-PRIMO study, an online referral portal will allow providers to enter smokers' email addresses into the system. Upon returning home, the smokers will receive automated emails providing education about tobacco cessation and encouragement to use the patient smoking cessation website (with interactive tools, educational resources, motivational email messages, secure messaging with a tobacco treatment specialist, and online support group). The informatics system will be evaluated in a comparative effectiveness trial of 160 community-based primary care practices, cluster-randomized at the practice level. In the QUIT-PRIMO intervention, patients will be provided a paper information-prescription referral and then "e-referred" to the system. In the comparison group, patients will receive only the paper-based information-prescription referral with the website address. Once patients go to the website, they are subsequently randomized within practices to either a standard patient smoking cessation website or an augmented version with access to a tobacco treatment specialist online, motivational emails, and an online support group. We will compare intervention and control practice participation (referral rates) and patient participation (proportion referred who go to the website). We will then compare the effectiveness of the standard and augmented patient websites. Our goal is to evaluate an integrated informatics solution to increase access to web-delivered smoking cessation support. We will analyze the impact of this integrated system in terms of process (provider e-referral and patient login) and patient outcomes (six-month smoking cessation). Web-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628.Implementation Science 11/2010; 5:87. DOI:10.1186/1748-5908-5-87 · 3.47 Impact Factor
[Show abstract] [Hide abstract]
- "Intervention strategies that deliver smoking cessation interventions via nonphysician health professionals have shown success (Gordon, Andrews, Lichtenstein, & Severson, 2005; Houston et al., 2008; Severson, Andrews, Lichtenstein, Gordon, & Barckley, 1998). Community pharmacies are ideally positioned to promote smoking cessation because pharmacy patients typically interact with pharmacists on a regular basis and have high regard for pharmacists in general (Gallup Poll, 2007). "
ABSTRACT: Pharmacists are uniquely positioned within the community to provide smoking cessation counseling to their patients. However, pharmacists experience significant barriers to providing counseling, including limited time, reimbursement, and training in counseling techniques. We tested a computer-driven software system, "Exper_Quit" (EQ), that provided individually tailored interventions to patients who smoke and matching tailored reports for pharmacists to help guide cessation counseling. A two-phase design was used to recruit an observation-only group (OBS; n = 100), followed by participants (n = 200) randomly assigned to receive either EQ-assisted pharmacist counseling or EQ plus 8 weeks of nicotine transdermal patch (EQ+). Both treatment groups were scheduled to receive two follow-up counseling calls from pharmacists. Most participants in the EQ and EQ+ groups reported receiving counseling from a pharmacist, including follow-up calls, while none of the OBS participants reported speaking with the pharmacist about cessation. At 6 months, fewer OBS participants reported a quit attempt (42%) compared with EQ (76%) or EQ+ (65%) participants (p < .02). At 6 months, 7-day point-prevalence abstinence was 28% and 15% among the EQ+ and EQ groups, respectively, compared with 8% among OBS participants (p < .01), and EQ+ participants were twice as likely to be quit than were EQ participants (p < .01). A tailored software system can facilitate the delivery of smoking cessation counseling to pharmacy patients. Results suggest that EQ was successful in increasing (a) the delivery of cessation counseling, (b) quit attempts, and (c) quit rates. Pharmacists can play an important role in the effective delivery of smoking cessation counseling.Nicotine & Tobacco Research 03/2010; 12(3):217-25. DOI:10.1093/ntr/ntp197 · 2.81 Impact Factor