The QUIT-PRIMO provider-patient Internet-delivered smoking cessation referral intervention: a cluster-randomized comparative effectiveness trial: study protocol

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.

Implementing point of care “e-referrals” in 137 clinics to increase access to a quit smoking internet system: the Quit-Primo and National Dental PBRN HI-QUIT Studies

“…This study was conducted within the context of two larger randomized trials evaluating the effectiveness of the e-referral system [20]. This study was approved by the University of Alabama at Birmingham and University of Massachusetts Medical School Institutional Review Boards.…”

“…The translational clinical practice improvement: ReferASmoker.org e-referral The ReferASmoker.org e-referral system facilitated referrals to Decide2Quit.org, an evidence-based, web-delivered smoking cessation self-management system [20,25,26]. ReferASmoker.org included a web form where providers entered smokers' email addresses (Appendix 1).…”

“…Practices were recruited using nationwide mass mailing. These practices were recruited for two federally funded pragmatic trials evaluating Decide2Quit.org, a patient-centered web-assisted tobacco intervention [QUIT-PRIMO (Quality Improvement in Tobacco Provider Referrals & Internet-delivered Microsystem Optimization) is a study of our patient-centered, web-assisted tobacco intervention Decide2Quit.org in primary care medical practices [20]; the HI-QUIT (Hygienists to Internet Quality Improvement in Tobacco) study is a similar study of Decide2Quit.org in dental practices]. Recruitment continued until recruitment goals for evaluation of the patient-level intervention were met.…”

“…For these Internet systems, automated electronic referrals (e-referrals) could directly link patients to the intervention. In an e-referral system [20], healthcare providers, at the point of care, can advise patients to use an online behavioral intervention and, with patient agreement, provide the online behavioral system a contact identifier (e.g., the patient's email). The system can then proactively use this patient contact to send persuasive messages encouraging participation.…”

Formative Evaluation to Determine Facilitators and Barriers to Nurse-driven Implementation: Designing an Inpatient mHealth Intervention to Support Smoking Cessation

“…We developed these messages using current guidelines [15], and social cognitive theory [16], and evaluated them through a web-assisted tobacco intervention (R21-CA089011, 1R01CA129091-01) [17][18][19][20]. In the outpatient setting, the motivational messages resulted in increased engagement in the online smoking intervention and increased six-month smoking cessation outcomes (odds ratio 1.7) compared with controls.…”