Computer-Facilitated 5A's for Smoking Cessation in Primary Care
This study tests the use of handheld computer tablets to promote the integration of 5A's (Ask, Advise, Assess, Assist, Arrange) for smoking cessation in academic and community primary care clinics. Although most patients receive the "ask" and "advise" steps, only slightly more than half are "assessed" for readiness to change, less than half receive "assistance" in changing, and only 9% have an "arranged" follow-up. While the large majority of primary care providers support the 5A's model, negative attitudes and the lack of time, knowledge, and cessation skills are common obstacles. Alternate service delivery systems that address these obstacles and evidence-based strategies to promote their implementation are needed to improve provider adherence and 5A's fidelity.
|Study Design:||Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Single Blind (Caregiver)
Primary Purpose: Health Services Research
|Official Title:||Computer-Facilitated 5A's for Smoking Cessation in Primary Care|
- 5A's Fidelity [ Time Frame: Baseline assessment 2013-14; Intervention 2014-2015 ] [ Designated as safety issue: No ]Baseline and post-tablet intervention assessments of primary care provider adherence to 5A's protocol for smoking cessation. Patients are called after their primary care appointment and asked a series of questions to determine if (and which of) the 5A's were used during that visit.
- Tablet Usage [ Time Frame: 7/2014-7/2015 ] [ Designated as safety issue: No ]Intervention includes system strategies to improve usage of computer tablets in primary care waiting rooms. Outcome = tablet saturation or proportion of patients given a tablet.
- Implementation Factors [ Time Frame: July 2013-2015 ] [ Designated as safety issue: No ]Qualitative interview data to assess the utility of the "Technology Acceptance Model" in explaining tablet and 5A's usage. Variables assessed include perceived usefulness, social norms and influence, and facilitating conditions.
|Study Start Date:||July 2012|
|Estimated Study Completion Date:||July 2017|
|Estimated Primary Completion Date:||September 2015 (Final data collection date for primary outcome measure)|
No Intervention: Tablet Intervention
Primary care providers will be randomized into intervention or control conditions. The patients of intervention providers will be given a computer tablet that provides 5A's for smoking cessation counseling. Patients of control providers will not receive a tablet intervention.
|Other: Computer Tablet|
This project develops and tests a computer-facilitated 5A's (CF-5A's) model that administers the 5A's intervention to patients then prompts providers for reinforcing next steps. CF-5A's could efficiently and effectively promote smoking cessation while educating providers about cessation resources and appropriate follow-up. Based on the Technology Acceptance Model, clinically tailored strategies to promote CF-5A's implementation will be developed and tested to ensure the appropriate use and uptake of this new service delivery model. Development of the model, materials, and strategies will occur in years 1 and 2.
Baseline data collection occurs in year 2, followed by a randomized trial of CF- 5A's where the provider is the unit of randomization. Provider use of the 5A's will primarily be assessed with a brief phone call to the patient after the primary care visit has occurred.
Although focused on 5A's for smoking cessation, this study examines the underlying implementation science of computer-aided service delivery models with important implications for the integration of other substance use or behavioral health interventions in primary care. Implementation factors will be assessed using qualitative interviews and brief pre-post surveys.
Please refer to this study by its ClinicalTrials.gov identifier: NCT02046408
|Contact: Jason Satterfield, PhD||415-353-2104|
|United States, California|
|San Francisco General Hospital||Recruiting|
|San Francisco, California, United States, 94110|
|Contact: Soraya Azari, MD 415-206-2372 firstname.lastname@example.org|
|Contact: Paula Lum, MD 415-476-4082 ext 411 email@example.com|
|UCSF Adult Primary Care Mt. Zion Clinic||Recruiting|
|San Francisco, California, United States, 94115|
|Contact: Jason Satterfield, PhD 415-353-2104 firstname.lastname@example.org|
|Sub-Investigator: Ralph Gonzales, MD|
|Principal Investigator:||Jason M Satterfield, PhD||University of California|