Evaluation of Electronic Portal Messaging and Embedded Asynchronous Care on Physician-Assisted Smoking Quit Attempts

Oklahoma State University Center for Health Sciences

Status: Completed

Conditions: Smoking, Tobacco

Treatments: Behavioral: System Sent Outreach with Embedded Asynchronous Care in Portal Message; Behavioral: Physician Sent Outreach with Embedded Asynchronous Care in Portal Message; Behavioral: Physician Sent Outreach without Embedded Asynchronous Care in Portal Message; Behavioral: System Sent Outreach without Embedded Asynchronous Care in Portal Message

Study type: Interventional

Funder types: Other

Identifiers

NCT05172219

2020031

Details and patient eligibility

About

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.

Full 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.

Enrollment: 200 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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.)

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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200 participants in 4 patient groups

Message Type PNSL: Physician sender, No Survey Link

Active Comparator group

Description:

In this arm, the Physician is message sender and the message does not include a link to a survey that initiates asynchronous care.

Treatment:

Behavioral: Physician Sent Outreach without Embedded Asynchronous Care in Portal Message

Message Type PSL: Physician sender, Survey Link

Active Comparator group

Description:

In this arm, the Physician is message sender and the message does include a link to a survey that initiates asynchronous care.

Treatment:

Behavioral: Physician Sent Outreach with Embedded Asynchronous Care in Portal Message

Message Type SNSL: System sender, No Survey Link

Active Comparator group

Description:

In this arm, the Health System is message sender and the message does not include a link to a survey that initiates asynchronous care.

Treatment:

Behavioral: System Sent Outreach without Embedded Asynchronous Care in Portal Message

Message Type SSL: System sender, Survey Link

Active Comparator group

Description:

In this arm, the Health System is message sender and the message does include a link to a survey that initiates asynchronous care.

Treatment:

Behavioral: System Sent Outreach with Embedded Asynchronous Care in Portal Message