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

NCT ID: NCT05172219

Last Updated: 2021-12-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-01-13

Study Completion Date

2020-12-31

Brief Summary

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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

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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.

Conditions

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Smoking, Tobacco

Keywords

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Smoking Quit Attempts Quality Improvement Asynchronous Care Electronic Messaging

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The model was a 2 (link to survey) × 2 (message source) experimental design; therefore, we had two factors that created four treatment conditions.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Participants: The patients were not informed of other portal messages. The portal message they received (if it had a link to asynchronous care or not and if it was sent by physician or system) was determined by random assignment.

Care Providers: After reviewing patients for exclusion criteria, the physicians were not informed which intervention group patients were assigned. They knew who was selected for the study and then those patients were randomly assigned to intervention groups by computerized randomization system.

Investigators: The data was extracted from the EHR and de-identified prior to sharing it with the investigators. Therefore, the investigators were blind to patients and patient assignment.

Outcomes Assessor: Outcomes were assessed only from de-identified data.

Study Groups

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Message Type PNSL: Physician sender, No Survey Link

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

Group Type ACTIVE_COMPARATOR

Physician Sent Outreach without Embedded Asynchronous Care in Portal Message

Intervention Type BEHAVIORAL

Physician sent a portal message encouraging a quit attempt without a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent.

Message Type PSL: Physician sender, Survey Link

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

Group Type ACTIVE_COMPARATOR

Physician Sent Outreach with Embedded Asynchronous Care in Portal Message

Intervention Type BEHAVIORAL

PCPs sent a portal message encouraging a quit attempt embedded a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent.

Message Type SNSL: System sender, No Survey Link

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

Group Type ACTIVE_COMPARATOR

System Sent Outreach without Embedded Asynchronous Care in Portal Message

Intervention Type BEHAVIORAL

Health System sent a portal message encouraging a quit attempt without a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent. Half of the messages came from the patient's PCP and the other half came from the health system to determine if communication from a patient's physician was associated with more quit attempts.

Message Type SSL: System sender, Survey Link

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

Group Type ACTIVE_COMPARATOR

System Sent Outreach with Embedded Asynchronous Care in Portal Message

Intervention Type BEHAVIORAL

Health System sent a portal message encouraging a quit attempt embedded a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent.

Interventions

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Physician Sent Outreach with Embedded Asynchronous Care in Portal Message

PCPs sent a portal message encouraging a quit attempt embedded a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent.

Intervention Type BEHAVIORAL

Physician Sent Outreach without Embedded Asynchronous Care in Portal Message

Physician sent a portal message encouraging a quit attempt without a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent.

Intervention Type BEHAVIORAL

System Sent Outreach with Embedded Asynchronous Care in Portal Message

Health System sent a portal message encouraging a quit attempt embedded a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent.

Intervention Type BEHAVIORAL

System Sent Outreach without Embedded Asynchronous Care in Portal Message

Health System sent a portal message encouraging a quit attempt without a link to asynchronous care within a portal message encouraging a quit attempt in order to compare EMR-documented, physician-assisted quit attempts to those who received messages without the link 30 days after messages were sent. Half of the messages came from the patient's PCP and the other half came from the health system to determine if communication from a patient's physician was associated with more quit attempts.

Intervention Type BEHAVIORAL

Other Intervention Names

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PSL PNSL SSL SNSL

Eligibility Criteria

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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.)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Oklahoma State University Center for Health Sciences

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marjorie A Erdmann, MS

Role: PRINCIPAL_INVESTIGATOR

Oklahoma State University

Locations

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Oklahoma State University Center for Health Sciences

Tulsa, Oklahoma, United States

Site Status

Countries

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United States

References

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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.

Reference Type DERIVED
PMID: 35226082 (View on PubMed)

Other Identifiers

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2020031

Identifier Type: -

Identifier Source: org_study_id