Evaluation of a Proactive Smoking Cessation Electronic Visit to Extend the Reach of Evidence-Based Cessation Treatment via Primary Care

Abstract

Background:Best practice guidelines for smoking cessation treatment through primary care advise the 5As model. However, compliance with these guidelines is poor, leaving many smokers untreated. The purpose of this study was to develop and preliminarily evaluate an asynchronous smoking cessation electronic visit (e-visit) that could be delivered proactively through the electronic health record (EHR) to adult smokers treated within primary care. The goal of the e-visit is to automate 5As delivery to ensure that all smokers receive evidence-based cessation treatment. As such, the aims of this study were twofold: (1) to examine acceptability, feasibility, and treatment metrics associated with e-visit utilization and (2) to preliminarily examine efficacy relative to treatment as usual (TAU) within primary care.Methods:Participants (n = 51) were recruited from primary care practices between November 2018 and October 2019 and randomized 2:1 to receive either the smoking cessation e-visit or TAU. Participants completed assessments of cessation outcomes 1-month and 3-months postenrollment and e-visit analytics data were gathered from the EHR.Results:Self-report feedback from e-visit participants indicated satisfaction with the intervention and interest in using e-visits again in the future. Nearly all e-visits resulted in prescription of a U.S. Food and Drug Administration (FDA)-approved smoking cessation medication. In general, smoking cessation outcomes favored the e-visit condition at both 1 (odds ratios [ORs]: 2.10-5.39) and 3 months (ORs: 1.31-4.67).Conclusions:These results preliminarily indicate the feasibility, acceptability, and efficacy of this smoking cessation e-visit within primary care. Future studies should focus on larger scale examination of effectiveness and implementation across settings. The clinicaltrials.gov registration number for this trial is NCT04316260.

Keywords: behavioral health; electronic health records; m-Health; telehealth; telemedicine.

Conflict of interest statement

J.D. is co-owner of Behavioral Activation Tech LLC, a small business that develops and evaluates mobile application-based treatments for depression and co-occurring disorders. M.J.C. has received consulting honoraria from Pfizer and from Frutarom, Inc.

Figures

Fig. 1.

E-visit feedback. Feedback regarding the baseline e-visit was collected during the 1-month research follow-up. Respondents include n = 28 participants randomized to the e-visit condition who completed the 1-month research follow-up. e-visit, electronic visit.

Fig. 2.

Cessation outcomes as a function of treatment group. *p < 0.05. CPD, cigarettes per day; PPA, point prevalence abstinence; QA, quit attempt.