Abstract
BackgroundAlthough 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).MethodsThe 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.DiscussionOur 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).Trial RegistrationWeb-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628.
Highlights
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
We describe the protocol for the QUITPRIMO-quality improvement in tobacco-provider referrals and Internet-delivered microsystem optimizationprovider-to-patient informatics system
To evaluate the impact of the provider and patient intervention, we have proposed the following three hypotheses: Hypothesis 1 (Refer): More patients will be Referred to the Decide2Quit self-management resource website in the QUIT-PRIMO e-referral practices compared with information prescription practices
Summary
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. 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). Brief clinical interventions, based on tobacco use screening and brief, structured cessation advice from a provider, have been documented to improve patient cessation rates [15,16,17,18]. The current US Department of Health and Human Services clinical practice guideline entitled “Treating Tobacco Use and Dependence” provides a summary of evidence-based recommendations [5]. The current guideline includes a framework for structured, brief clinical interventions using the “5 As” of counseling: 1. Ask: Identify and document tobacco use status for every patient at every visit
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