Computer-Facilitated 5A's for Smoking Cessation in Primary Care

Background: The 5A’s for smoking cessation (Ask, Advise, Assess, Assist, Arrange) is a well-established, evidence-based standard of practice to help primary care patients with nicotine dependence. Unfortunately, although most patients receive the “ask” and “advise” steps, only slightly more than half are “assessed” for readiness to change, less than half receive “assistance” in changing, and only 9% have an “arranged” follow-up. While the large majority of primary care providers support the 5A’s model, negative attitudes and the lack of time, knowledge, and cessation skills are common obstacles. Alternate service delivery systems that address these obstacles and evidence-based strategies to promote their implementation are needed to improve provider adherence and 5A’s fidelity. Objective: This project develops and tests a computer-facilitated 5A’s (CF-5A’s) model that administers the 5A’s intervention to patients with a computer tablet then prompts providers for reinforcing next steps. CF-5A’s could efficiently and effectively promote smoking cessation while educating providers about cessation resources and appropriate follow-up. Based on the Technology Acceptance Model, clinically tailored strategies to promote CF-5A’s implementation will be developed and tested to ensure the appropriate use and uptake of this new service delivery model. Methods: A computer-tablet application that delivers the 5A’s for smoking cessation was developed and tested at 3 diverse, urban primary care clinics. All English and Spanish speaking patients receive a tablet upon check-in for their appointment and are guided through a series of health related questions to determine eligibility and consent. Randomization occurred on the level of provider and determines if the enrolled patient will be placed in the control group (treatment as usual) or intervention group (5A’s intervention that generates a tailored health handout for the patient and a set of instructions for the provider). Patients are interviewed after their primary care visit to determine provider fidelity to the 5A’s model. Clinic staff, providers, and patients are interviewed and surveyed to better understand the role of technology in medical clinics and how to best support sustainability for tablet usage in primary care. Results: This is a work in progress. To date, n=464 patients have been enrolled and assessed to determine a 5A’s baseline before the computer tablets were introduced into the clinics. N=26 beliefs elicitation interviews of staff were completed and analyzed to create 3 contextualized surveys testing the utility of the Technology Acceptance Model. Surveys and interviews regarding beliefs about technology in health care are currently being completed. Patients (smokers) are currently being enrolled in each of the 3 study clinics. Preliminary analyses will be available in Fall 2014 but data collection will continue until Spring 2015 – primarily to continue testing and revising technology implementation strategies. Conclusions: Although focused on 5A’s for smoking cessation, this study examines the underlying implementation science of computer-aided service delivery models with important implications for the integration of behavioral health interventions in primary care. A careful, mixed methods exploration of key implementation factors is used to help build evidence-based strategies to improve the integration of behavioral health services in primary care. []