A comprehensive electronic health record-enabled smoking treatment program: Evaluating reach and effectiveness in primary care in a multiple baseline design.

Effective treatments for smoking cessation exist but are underused. Proactive chronic care approaches may enhance the reach of cessation treatment and reduce the prevalence of smoking in healthcare systems. This pragmatic study evaluated a population-based Comprehensive Tobacco Intervention Program (CTIP) implemented in all (6) adult primary care clinics in a Madison, Wisconsin, USA healthcare cooperative, assessing treatment reach, reach equity, and effectiveness in promoting smoking cessation. CTIP launched in 3 waves of 2 clinics each in a multiple baseline design. Electronic health record (EHR) tools facilitated clinician-delivered pharmacotherapy and counseling; guiding tobacco care managers in phone outreach to all patients who smoke; and prompting multimethod bulk outreach to all patients on a smoking registry using an opt-out approach. EHR data were analyzed to assess CTIP reach and effectiveness among 6894 adult patients between January 2018 and February 2020. Cessation treatment reach increased significantly after CTIP launch in 5 of 6 clinics and was significantly higher when clinics were active vs. inactive in CTIP [Odds Ratio (OR) range = 2.0-3.0]. Rates of converting from current to former smoking status were also higher in active vs. inactive clinics (OR range = 2.2-10.5). Telephone treatment reach was particularly high in historically underserved groups, including African-American, Hispanic, and Medicaid-eligible patients. Implementation of a comprehensive, opt-out, chronic-care program aimed at all patients who smoke was associated with increases in the rates of pharmacotherapy and counseling delivery and quitting smoking. Proactive outreach may help reduce disparities in treatment access.
Competing Interests: Declaration of Competing Interest Danielle E. McCarthy, Michael C. Fiore, and Timothy B. Baker have all received grant funding from NCI, the institute that sponsors SmokefreeTXT. Michael C. Fiore serves as a consultant to the National Cancer Institute (NCI) on tobacco cessation policy issues. Timothy B. Baker has served as a paid consultant to ICF to evaluate the portfolio of Smokefree resources via monies supplied by NCI. His consulting activities involved suggesting new research directions for digital health interventions and providing feedback to ICF and NCI on research products on such interventions. The research reported in this report was not part of his consulting work with ICF/NCI. Timothy B. Baker is Principal Investigator on a project funded by NHLBI for which Pfizer provided free active and placebo varenicline. Pfizer played no role in the design, implementation, or analysis of the project described in the present manuscript. All other authors have no conflicts to report. The electronic health record tools described in this manuscript are marketed by Epic Systems Corporation.
(Copyright © 2022. Published by Elsevier Inc.)