Smoking-Cessation e-Referrals (original) (raw)
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Internet Delivered Support for Tobacco Control in Dental Practice: Randomized Controlled Trial
Journal of Medical Internet Research, 2008
Background: The dental visit is a unique opportunity for tobacco control. Despite evidence of effectiveness in dental settings, brief provider-delivered cessation advice is underutilized. Objective: To evaluate an Internet-delivered intervention designed to increase implementation of brief provider advice for tobacco cessation in dental practice settings. Methods: 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. Results: 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. Conclusion: This low-intensity, easily disseminated intervention was successful in improving provider performance on advice to quit.
Computer-Assisted Guidance for Dental Office Tobacco-Cessation Counseling
American Journal of Preventive Medicine, 2013
Background: Decreases in smoking prevalence from recent decades have slowed, and national goals to reduce tobacco use remain unmet. Healthcare providers, including those in physician and dental teams, have access to evidence-based guidelines to help patients quit smoking. Translation of those guidelines into practice, however, remains low. Approaches that involve screening for drug use, brief intervention, and referral to treatment (SBIRT) are a promising, practical solution. Purpose: This study examined whether dentists and dental hygienists would assess interest in quitting, deliver a brief tobacco intervention, and refer to a tobacco quitline more frequently as reported by patients if given computer-assisted guidance in an electronic patient record versus a control group providing usual care. Design: A blocked, group-randomized trial was conducted from November 2010 to April 2011. Randomization was conducted at the clinic level. Patients nested within clinics represented the lowest-level unit of observation. Setting/participants: Participants were patients in HealthPartners dental clinics. Intervention: Intervention clinics were given a computer-assisted tool that suggested scripts for patient discussions. Usual care clinics provided care without the tool. Main outcome measures: Primary outcomes were post-appointment patient reports of the provider assessing interest in quitting, delivering a brief intervention, and referring them to a quitline. Results: Patient telephone surveys (72% response rate) indicated that providers assessed interest in quitting (control 70% vs intervention 87%, pϭ0.0006); discussed specifıc strategies for quitting (control 26% vs intervention 47%, pϭ0.003); and referred the patient to a tobacco quitline (control 17% vs intervention 37%, pϭ0.007) more frequently with the support of a computer-assisted tool integrated into the electronic health record. Conclusions: Clinical decision support embedded in electronic health records can effectively help providers deliver tobacco interventions. These results build on evidence in medical settings supporting this approach to improve provider-delivered tobacco cessation.
Implementing a Tobacco Assisted Referral Program in Dental Practices
Journal of Public Health Dentistry, 2009
Objectives: The objectives of this study are to design and implement a system-level tobacco-control intervention in a large prepaid dental group practice and assess effects on staff performance measures and patient satisfaction. Methods: We matched 14 dental facilities on size, socioeconomic status, smoking rate, and periodontal status, and then randomly assigned them to intervention or usual-care control. We trained intervention staff in an “Assisted Referral” team approach for assessing tobacco use, providing tailored advice and brief counseling, and encouraging smokers to talk by telephone with a specially trained tobacco counselor. Patients could call from the office or ask that the counselor call them later. Telephone counselors helped patients explore motivations and barriers for quitting; review available cessation-support strategies, programs, and medications; and identify next steps. Results: During the 14-month study period, 66,516 members had annual- or new-patient examinations. Both intervention and control sites had high rates of tobacco assessment (97 percent) and advice (93 percent). Intervention patients were more likely than controls (69 percent versus 3 percent, P < 0.01) to receive additional chair-side tobacco counseling and assistance, and 11 percent agreed to receive additional telephone counseling. Intervention patients were more satisfied than controls with the dental team's tobacco-control efforts (P < 0.03). Referral rates varied substantially for different staff. Conclusions: The Assisted Referral approach was successfully integrated into routine dental care, was well received by patients, and resulted in increased patient satisfaction. Because free telephone-based tobacco counseling is now available nationwide, the approach may be a practical strategy for most dental-care settings.
Implementation Science, 2010
Background: 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). Methods: 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.
Refer2Quit: Impact of Web-based skills training on tobacco interventions and quitline referrals
Journal of Continuing Education in the Health Professions, 2012
Introduction: Tobacco quitlines (QLs) provide effective evidence-based tobacco cessation counseling, yet they remain underutilized. Barriers to utilization include the lack of referrals by health care providers who typically have little knowledge about QLs and low self-efficacy for providing tobacco interventions. In order to educate providers about QLs, referral methods and tobacco interventions, a case-based online CME/CE program, Refer2Quit (R2Q), was developed. R2Q includes QL education and intervention and referral skills training tailored to provider type (eg, physician, nurse, dental provider, pharmacist) and work setting (eg, emergency, outpatient, inpatient). A module teaching motivational enhancement strategies was also included.
Preventing chronic disease, 2006
Tobacco is a significant risk factor for oral diseases. Dental care providers have the opportunity to inform patients about the risks associated with tobacco use and refer them to tobacco cessation resources. Although dental teams usually ask their patients about their tobacco use, most do not provide tobacco cessation counseling. This project involved four staff-model dental clinics and four contracted network dental clinics. Project goals were to 1) describe current practice patterns of tobacco cessation intervention, 2) increase the use of steps for treatment, known as the 5 As, recommended by the U.S. Public Health Service, 3) increase referrals to a tobacco helpline, and 4) increase use of pharmacotherapy for tobacco dependence treatment. The project included training and program support (e.g., sharing of project data, weekly newsletters, discussion at clinic meetings). Results indicate that this approach to addressing tobacco dependence in a dental clinic setting can effective...
Improving Adherence to Smoking Cessation Treatment: Smoking Outcomes in a Web-based Randomized Trial
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2018
Partial adherence in Internet smoking cessation interventions presents treatment and evaluation challenges. Increasing adherence may improve outcomes. To present smoking outcomes from an Internet randomized trial of two strategies to encourage adherence to tobacco dependence treatment components: (i) a social network (SN) strategy to integrate smokers into an online community and (ii) free nicotine replacement therapy (NRT). In addition to intent-to-treat analyses, we used novel statistical methods to distinguish the impact of treatment assignment from treatment utilization. A total of 5,290 current smokers on a cessation website (WEB) were randomized to WEB, WEB + SN, WEB + NRT, or WEB + SN + NRT. The main outcome was 30-day point prevalence abstinence at 3 and 9 months post-randomization. Adherence measures included self-reported medication use (meds), and website metrics of skills training (sk) and community use (comm). Inverse Probability of Retention Weighting and Inverse Proba...
Journal of general internal medicine, 2007
Objective The primary care visit represents an important venue for intervening with a large population of smokers. However, physician adherence to the Smoking Cessation Clinical Guideline (5As) remains low. We evaluated the effectiveness of a computer-tailored intervention designed to increase smoking cessation counseling by primary care physicians. Methods Physicians and their patients were randomized to either intervention or control conditions. In addition to brief smoking cessation training, intervention physicians and patients received a one-page report that characterized the patients’ smoking habit and history and offered tailored recommendations. Physician performance of the 5As was assessed via patient exit interviews. Quit rates and smoking behaviors were assessed 6 months postintervention via patient phone interviews. Intervention effects were tested in a sample of 70 physicians and 518 of their patients. Results were analyzed via generalized and mixed linear modeling controlling for clustering. Measurements and Main Results Intervention physicians exceeded controls on “Assess” (OR 5.06; 95% CI 3.22, 7.95), “Advise” (OR 2.79; 95% CI 1.70, 4.59), “Assist–set goals” (OR 4.31; 95% CI 2.59, 7.16), “Assist–provide written materials” (OR 5.14; 95% CI 2.60, 10.14), “Assist–provide referral” (OR 6.48; 95% CI 3.11, 13.49), “Assist–discuss medication” (OR 4.72;95% CI 2.90, 7.68), and “Arrange” (OR 8.14; 95% CI 3.98, 16.68), all p values being < 0.0001. Intervention patients were 1.77 (CI 0.94, 3.34,p = 0.078) times more likely than controls to be abstinent (12 versus 8%), a difference that approached, but did not reach statistical significance, and surpassed controls on number of days quit (18.4 versus 12.2, p < .05) but not on number of quit attempts. Conclusions The use of a brief computer-tailored report improved physicians’ implementation of the 5As and had a modest effect on patients’ smoking behaviors 6 months postintervention.