Clinical trial NCT05172219: Evaluation of Electronic Portal Messaging and Embedded Asynchronous Care on Physician-Assisted Smoking Quit Attempts
Official title: 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
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Smoking, Tobacco
Keywords: Smoking Quit Attempts
Quality Improvement
Asynchronous Care
Electronic Messaging
Lead sponsor: Oklahoma State University Center for Health Sciences
Sponsor class: OTHER
First posted: 2021-12-29
Enrollment: 200
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: The model was a 2 (link to survey) × 2 (message source) experimental design; therefore, we had two factors that created four treatment conditions.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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.

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.

Eligibility criteria: 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.)

Primary outcomes:
measure: Smoking Quit Attempt
timeFrame: 30 days after intervention
Secondary outcomes:
Other outcomes:
measure: Physician Perceptions of Electronic Outreach Intervention
timeFrame: 6 months after intervention
Locations:
city: Tulsa
country: United States
facility: Oklahoma State University Center for Health Sciences
state: Oklahoma
Study officials:
affiliation: Oklahoma State University
name: Marjorie A Erdmann, MS
role: PRINCIPAL_INVESTIGATOR
References:
citation: 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.