The following is a summary of “Rationale, design, and protocol for a hybrid type 1 effectiveness-implementation trial of a proactive smoking cessation electronic visit for scalable delivery via primary care: the E-STOP trial,” published in the November 2023 issue of Primary Care by Fahey, et al.

Despite being the leading cause of preventable disease and death in the United States, cigarette smoking persists as a significant public health challenge. Primary care settings offer an opportune environment to engage and assist adults in smoking cessation. However, barriers to implementing evidence-based cessation treatments exist. For a study, researchers sought to outline the design and protocol of a five-year Hybrid Type I effectiveness-implementation trial, aiming to evaluate both the effectiveness and implementation potential of a proactive electronic visit (e-visit) intervention delivered via the Electronic Health Record patient portal.

Recruiting adults across 18 primary care clinics, the clinic-randomized clinical trial compared the e-visit intervention to treatment as usual (TAU). Stratifying clinics based on their primary care providers, the study employs a 2:1 randomization to e-visit or TAU. The e-visit involved an initial baseline assessment gathering smoking history and motivation to quit, utilizing a clinical decision support algorithm for tailored cessation treatment recommendations. Patient providers reviewed the recommendations, and a one-month follow-up e-visit assesses cessation progress. Primary outcomes included cessation treatment utilization, reduction in cigarettes per day, and biochemically verified 7-day point prevalence abstinence at six months. The hypothesis posits superior cessation outcomes for the e-visit group compared to TAU.

The innovative asynchronous e-visit intervention could significantly enhance smoking cessation outcomes in primary care. The study also included a comprehensive evaluation of the implementation potential, examining factors at the patient, provider, and organizational levels. Successful outcomes from the trial could pave the way for widespread improvements in delivering evidence-based smoking cessation treatment.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02205-3