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

Study Overview
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Brief Summary
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This study tests the use of handheld computer tablets to promote the integration of 5A's (Ask, Advise, Assess, Assist, Arrange) for smoking cessation in academic and community primary care clinics. 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.

Detailed Description
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This project develops and tests a computer-facilitated 5A's (CF-5A's) model that administers the 5A's intervention to patients 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. Development of the model, materials, and strategies will occur in years 1 and 2. Baseline data collection occurs in year 2, followed by a randomized trial of CF- 5A's where the provider is the unit of randomization. Provider use of the 5A's will primarily be assessed with a brief phone call to the patient after the primary care visit has occurred. 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 other substance use or behavioral health interventions in primary care. Implementation factors will be assessed using qualitative interviews and brief pre-post surveys.

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

Conditions
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Nicotine Addiction, Smoking Cessation

Intervention / Treatment
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* Other: Computer Tablet


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All primary care providers and clinic staff are eligible to participate. Patients must have a primary care appointment smoked a cigarette in past 7 days smoked at least 100 cigarettes in lifetime speak English or Spanish be cognitively able to use computer tablet Exclusion Criteria: Moderate to severe cognitive impairment Does not speak English or Spanish acute intoxication on alcohol or illicit drugs

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Tablet Intervention<br>Primary care providers will be randomized into intervention or control conditions. The patients of intervention providers will be given a computer tablet that provides 5A's for smoking cessation counseling. Patients of control providers will not receive a tablet intervention. | Other: Computer Tablet<br> <br> |
| No Intervention: Control<br>Primary care providers will be randomized into intervention or control conditions. The patients of intervention providers will be given a computer tablet that provides 5A's for smoking cessation counseling. Patients of control providers will not receive a tablet intervention. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 5A's Fidelity | Baseline and post-tablet intervention assessments of primary care provider adherence to 5A's protocol for smoking cessation. Patients are called after their primary care appointment and asked a series of questions to determine if (and which of) the 5A's were used during that visit. | Baseline assessment 2013-14; Intervention 2014-2015 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Tablet Usage | Intervention includes system strategies to improve usage of computer tablets in primary care waiting rooms. Outcome = tablet saturation or proportion of patients given a tablet. | 7/2014-7/2015 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Smoking, 5A's for smoking cessation, tailored health messages, Patient-facing information technology, Mobile health, behavioral health