Patrick S Calhoun1, Santanu Datta2, Maren Olsen3, Valerie A Smith4, Scott D Moore5, Lauren P Hair6, Eric A Dedert5, Angela Kirby5, Michelle Dennis7, Jean C Beckham5, Lori A Bastian8. 1. Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA. Electronic address: Patrick.calhoun2@va.gov. 2. Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA; Department of General Internal Medicine, Duke University Medical Center, Durham, NC, 27705, USA. 3. Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, 27705, USA. 4. Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA; Department of General Internal Medicine, Duke University Medical Center, Durham, NC, 27705, USA. 5. Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA. 6. Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA. 7. Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA. 8. Department of Medicine, University of Connecticut Medical Center, Farmington, CT, 06030, USA; VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, 06516, USA.
Abstract
INTRODUCTION: The primary objective of this project was to examine the effectiveness of an Internet-based smoking cessation intervention combined with a tele-health medication clinic for nicotine replacement therapy (NRT) compared to referral to clinic-based smoking cessation care. METHODS:A total of 413 patients were proactively recruited from the Durham VA Medical Center and followed for 12 months. Patients were randomized to receive either a referral to VA specialty smoking cessation care (control) or to the Internet intervention and tele-health medication clinic. Primary outcomes included (1) intervention reach, (2) self-reported 7-day point prevalence abstinence rates at 3 months and 12 months, and 3) relative cost-effectiveness. RESULTS: Reach of the Internet intervention and use of smoking cessation aids were significantly greater compared to the control. At 3 months-post randomization, however, there were no significant differences in quit rates: 17% (95% CI: 12%–23%) in the Internet-based intervention compared to 12% (95% CI: 8%–17%) in the control arm. Similarly, there were no differences in quit rates at 12 months (13% vs. 16%). While costs associated with the Internet arm were higher due to increased penetration and intensity of NRT use, there were no statistically significant differences in the relative cost effectiveness (e.g., life years gained, quality adjusted life years) between the two arms. CONCLUSIONS: Current results suggest that using an electronic medical record to identify smokers and proactively offering smoking cessation services that are consistent with US Public Health Guidelines can significantly reduce smoking in veterans. Novel interventions that increase the reach of intensive treatment are needed to maximize quit rates in this population.
RCT Entities:
INTRODUCTION: The primary objective of this project was to examine the effectiveness of an Internet-based smoking cessation intervention combined with a tele-health medication clinic for nicotine replacement therapy (NRT) compared to referral to clinic-based smoking cessation care. METHODS: A total of 413 patients were proactively recruited from the Durham VA Medical Center and followed for 12 months. Patients were randomized to receive either a referral to VA specialty smoking cessation care (control) or to the Internet intervention and tele-health medication clinic. Primary outcomes included (1) intervention reach, (2) self-reported 7-day point prevalence abstinence rates at 3 months and 12 months, and 3) relative cost-effectiveness. RESULTS: Reach of the Internet intervention and use of smoking cessation aids were significantly greater compared to the control. At 3 months-post randomization, however, there were no significant differences in quit rates: 17% (95% CI: 12%–23%) in the Internet-based intervention compared to 12% (95% CI: 8%–17%) in the control arm. Similarly, there were no differences in quit rates at 12 months (13% vs. 16%). While costs associated with the Internet arm were higher due to increased penetration and intensity of NRT use, there were no statistically significant differences in the relative cost effectiveness (e.g., life years gained, quality adjusted life years) between the two arms. CONCLUSIONS: Current results suggest that using an electronic medical record to identify smokers and proactively offering smoking cessation services that are consistent with US Public Health Guidelines can significantly reduce smoking in veterans. Novel interventions that increase the reach of intensive treatment are needed to maximize quit rates in this population.
Entities:
Keywords:
Internet intervention; Smoking cessation; Tele-health; Veterans
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