Clinical Reminder Changes to Increase Smoking Cessation Treatment in Outpatient Psychiatry

Study Overview
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Brief Summary
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This study will use a scientifically robust, mixed-methods, two-arm cluster-randomized study design. Investigators will implement a tobacco use clinical reminder for outpatient psychiatrists practicing at the VA New York Harbor Healthcare System (N = 20). Half of the psychiatrists will receive a reminder that encourages the psychiatrist to offer cessation medications and referral to cessation counseling to patients interested in quitting (Opt-In Reminder). The other half will receive a clinical reminder that includes a standing nicotine replacement therapy (NRT) order and a referral to cessation counseling that will automatically generate unless the provider actively opts-out (Opt-Out Reminder). Prior to implementation of the reminders, psychiatrists in both arms will receive a one-hour training on tobacco treatment and individual education outreach to demonstrate the clinical reminder and answer questions (academic detailing).

Official Title
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Clinical Reminder Changes to Increase Smoking Cessation Treatment in Outpatient Psychiatry

Conditions
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Smoking Cessation

Intervention / Treatment
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* Behavioral: Opt-Out Reminder
* Behavioral: Opt-In Reminder


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Psychiatrists Works in outpatient psychiatry at Manhattan or Brooklyn VA campus and has no plans to leave in the next 6 months Patient Post-Visit Survey Population Had a visit with a psychiatrist included in the study Current smoker Exclusion Criteria: Outpatient Psychiatrists: None Patient Post-Visit Survey Population: Non-English speaking

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: 2 arm cluster randomized study design
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Opt Out<br>Training and Academic Detailing | Behavioral: Opt-Out Reminder<br>* half will receive a clinical reminder that includes a standing NRT order and a referral to cessation counseling that will automatically generate unless the provider actively opts-out<br>|
| Experimental: Opt In<br>Training and Academic Detailing | Behavioral: Opt-In Reminder<br>* Half of the psychiatrists will receive a reminder that encourages the psychiatrist to offer cessation medications and referral to cessation counseling to patients interested in quitting<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patients Screened for Smoking | Number of patients with documented current smoking in the medical record who were screened for tobacco use during their psychiatry visit. Data derived from medial records. | Up to Month 6 | 
| Number of Smokers Prescribed a Cessation Medication | Number of people with documented current smoking in the medical record who were prescribed cessation medication. | Up to Month 6 | 
| Number of Smokers Referred to Counseling | Number of people with documented current smoking in the medical record for whom counseling referrals were ordered. | Up to Month 6 |