Abstract
BackgroundTobacco and alcohol use present multiplicative risk for aerodigestive cancers. Reducing alcohol consumption improves smoking cessation outcomes and reduces cancer risk. Risky alcohol consumption and smoking are often treated separately despite concurrent treatment potentially leading to better outcomes for each. However, no rapidly scalable program exists for combined interventions in primary care clinics spread across wide geographic areas. This cluster randomized trial aims to report on the effects of a novel clinical decision support system (CDSS) on intervention rates by primary care practitioners addressing risky alcohol use in a smoking cessation program.Methods/designWe will be implementing a clinical decision support system (CDSS) in 221 primary care sites participating in the Smoking Treatment for Ontario Patients (STOP) program across Ontario, Canada. Sites will be blindly allocated to one of two clinical decision support systems guiding practitioners to provide a risky alcohol use intervention to smokers attempting to quit using nicotine replacement therapy (NRT). Risky alcohol use is defined as drinking above the Canadian Cancer Society’s low-risk drinking guidelines. Primary analysis will measure the proportion of risky drinkers offered an alcohol intervention in each CDSS arm at baseline. Patients will be contacted by phone or email to track smoking cessation and alcohol consumption rates at 6- and 12-month follow-up.DiscussionUpon completion of the trial, the effect of different clinical decision support systems on practitioner behaviour, and on client tobacco and alcohol use, will be discussed. If the CDSS successfully promotes SBIRT for risky alcohol use in a primary care setting and/or improves patient-level outcomes, including smoking cessation rates and alcohol use reduction, this tool can be used as a model for other web-based behaviour change interventions integrated into primary care practice.Trial registrationClinicalTrials.gov NCT03108144
Highlights
Tobacco and alcohol use present multiplicative risk for aerodigestive cancers
If the clinical decision support system (CDSS) successfully promotes SBIRT for risky alcohol use in a primary care setting and/or improves patient-level outcomes, including smoking cessation rates and alcohol use reduction, this tool can be used as a model for other web-based behaviour change interventions integrated into primary care practice
We describe the protocol for a cluster randomized trial named “Personalized patient alerts and care pathways to prompt prevention interventions for combined alcohol and tobacco users in primary care” or COMBAT
Summary
This novel web-based platform for prevention interventions could shift the current practice of addressing alcohol and tobacco separately in the same patient to one where it is feasible for practitioners to provide a combined intervention for both behaviours using an evidence-informed computer-guided intervention This program may overcome the barrier of low implementation rates of brief interventions for alcohol use in primary care by automating best practices for cancer prevention. In the field of health systems research, findings from this study can inform future planning and integration of other behavioural interventions—such as physical activity and mood management—into primary care settings. This program can be scaled out beyond primary care to Addiction Agencies and Public Health Units.
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