Evaluation of Electronic Portal Messaging and Embedded Asynchronous Care on Physician-Assisted Smoking Quit Attempts

A Quality Improvement Randomized Clinical Trial to Evaluate Electronic Portal Messaging, Embedded Asynchronous Care and Physician Versus System as Message Sender on Physician-Assisted Smoking Quit Attempts of Primary Care, Adult Patients

Among 10 PCPs, 200 adult smokers with an active patient portal who had been seen by a PCP within 12 months were randomly selected and randomly assigned to one of four conditions to compare the quit attempts of patients sent electronic outreach with and without asynchronous care link and to compare the quit attempts of patients who recieved the portal message from PCP or the health system.

Study Overview

• Status: Completed
• Conditions: Smoking, Tobacco
• Intervention / Treatment: Behavioral: Physician Sent Outreach without Embedded Asynchronous Care in Portal Message; Behavioral: Physician Sent Outreach with Embedded Asynchronous Care in Portal Message; Behavioral: System Sent Outreach without Embedded Asynchronous Care in Portal Message; Behavioral: System Sent Outreach with Embedded Asynchronous Care in Portal Message

Detailed Description

The investigators compared the effects of four technology-based smoking cessation messaging strategies on quit attempts by smokers identified in the health system. Specifically, investigators used a fully crossed between-subjects 2 (link to survey on smoking cessation guide: yes/no) × 2 (message source: PCP-generated vs. health system-generated) experimental design to which participants were randomly assigned to one of four intervention groups using a computerized random number generator:

• Group 1 was sent the message from their physician without a link to a survey;
• Group 2 was sent the message from their physician with the link to the survey (which constitutes the asynchronous care);
• Group 3 was sent the message from the health system without a link to the survey; and
• Group 4 was sent the message from the health system with the link to the survey (which constitutes the asynchronous care).

Electronic outreach was a message sent to patients via the patient portal. It encouraged a quit attempt; offered physician assistance; advised the patient on medication use to control cravings; and offered counseling support in the form of a Quitline. Patients in Groups 1 and 3 were invited to schedule an in-person appointment with their PCP if they wanted help. Patients in Groups 2 and 4 received the message with an embedded link to Tobacco Cessation Survey to receive PCP assistance asynchronously. If patients clicked through to access the survey, they answered 17 questions, confirming smoking status, reporting safety information for medication selection, describing prior quit attempts and sharing treatment preferences. The intervention was "asynchronous" because it did not involve direct, simultaneous interaction (e.g., face-to-face, chat, video conference) between the physician and the patient. After patient responses were submitted, they were stored and forwarded to their PCP. Physicians communicated the care plan and instructed patients via the portal message. If the plan included medication, a prescription was sent to the patient's EHR-documented preferred pharmacy without an in-person visit.

• Study Type: Interventional
• Enrollment (Actual): 200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Oklahoma
    • Tulsa, Oklahoma, United States, 74107
      • Oklahoma State University Center for Health Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Adults aged 18 years and older who were designated as a smoker in the EHR who had at least one face-to-face visit with their PCP in the prior 12 months and had a patient portal account
• To ensure equal representation across the 10 physicians, we randomly selected 20 patients under each physician to serve in the sample.

Exclusion Criteria:

• Patients were excluded if they no longer see the PCP, had a diagnosis for which the outreach program would be insensitive (e.g., lung cancer), previously expressed not wanting smoking cessation counseling, or were no longer a smoker.
• (Patients were post-hoc excluded if EHR indicated that they had received smoking cessation treatment 60 days prior to portal message intervention.)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Message Type PNSL: Physician sender, No Survey Link; In this arm, the Physician is message sender and the message does not include a link to a survey that initiates asynchronous care.	Behavioral: Physician Sent Outreach without Embedded Asynchronous Care in Portal Message; Physician sent a portal message encouraging a quit attempt without a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent.; Other Names: PNSL
Active Comparator: Message Type PSL: Physician sender, Survey Link; In this arm, the Physician is message sender and the message does include a link to a survey that initiates asynchronous care.	Behavioral: Physician Sent Outreach with Embedded Asynchronous Care in Portal Message; PCPs sent a portal message encouraging a quit attempt embedded a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent.; Other Names: PSL
Active Comparator: Message Type SNSL: System sender, No Survey Link; In this arm, the Health System is message sender and the message does not include a link to a survey that initiates asynchronous care.	Behavioral: System Sent Outreach without Embedded Asynchronous Care in Portal Message; Health System sent a portal message encouraging a quit attempt without a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent. Half of the messages came from the patient's PCP and the other half came from the health system to determine if communication from a patient's physician was associated with more quit attempts.; Other Names: SNSL
Active Comparator: Message Type SSL: System sender, Survey Link; In this arm, the Health System is message sender and the message does include a link to a survey that initiates asynchronous care.	Behavioral: System Sent Outreach with Embedded Asynchronous Care in Portal Message; Health System sent a portal message encouraging a quit attempt embedded a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent.; Other Names: SSL

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Smoking Quit Attempt	Smoking Quit Attempt documented in the EMR	30 days after intervention

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Physician Perceptions of Electronic Outreach Intervention	Physician perceptions of the electronic outreach intervention were measured using a 5-point scale to assess perceptions of workload, comfort of providing medication from survey information, and further interest in the program.	6 months after intervention

Collaborators and Investigators

• Sponsor: Oklahoma State University Center for Health Sciences
• Investigators: Principal Investigator: Marjorie A Erdmann, MS, Oklahoma State University

Publications and helpful links

General Publications

• Erdmann M, Edwards B, Adewumi MT. Effect of Electronic Portal Messaging With Embedded Asynchronous Care on Physician-Assisted Smoking Cessation Attempts: A Randomized Clinical Trial. JAMA Netw Open. 2022 Feb 1;5(2):e220348. doi: 10.1001/jamanetworkopen.2022.0348.

Study record dates

Study Major Dates

• Study Start (Actual): January 13, 2020
• Primary Completion (Actual): February 24, 2020
• Study Completion (Actual): December 31, 2020

Study Registration Dates

• First Submitted: November 30, 2021
• First Submitted That Met QC Criteria: December 28, 2021
• First Posted (Actual): December 29, 2021

Study Record Updates

• Last Update Posted (Actual): December 29, 2021
• Last Update Submitted That Met QC Criteria: December 28, 2021
• Last Verified: December 1, 2021

More Information

Terms related to this study

• Keywords: Quality Improvement; Electronic Messaging; Smoking Quit Attempts; Asynchronous Care
• Other Study ID Numbers: 2020031

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No