A controlled cluster randomized pilot study of the effect of a new smoking cessation management module on rates of initiation and continuation of smoking counselling in Ontario primary care practices using P-PROMPT Chronic Disease Management System (CDMS)

Abstract

<p>Multi-faceted interventions that include some form of a clinical information system have been shown to improve primary care physicians' management of chronic diseases. The objective of this pilot study was to assess the feasibility of a cluster randomized controlled trial of a multi-faceted intervention, which includes a clinical information system, to improve the management of the chronic disease of tobacco use by physicians. Feasibility was assessed with respect to the use of a measurement tool (Smoking Status Identification Card) and use of a new smoking cessation management module in the clinical information system.</p> <p>Letters of invitation were sent out to the 65 primary care physicians (in 38 primary care practices) who were subscribed to the web-based clinical information system (P-PROMPT CDMS). Five physicians from 5 primary care practices agree.d to participate, who were stratified and then randomized to the intervention (2 primary care practices) or control group (3 primary care practices).</p> <p>Following the 12-week study period, SSIC completion reached the 90% threshold success criterion in 2 of the 5 primary care practices (one each from the intervention and control group). The intervention group demonstrated basic use of the new smoking cessation management module that reached 21.9% and 19.0% in each of the respective practices, which was below the 30% threshold success criterion. A preliminary evaluation of physician delivery of smoking cessation counselling demonstrated a trend to a higher percentage of Ministry of Health and Long-Term Care (MOHLTC) physician service billing codes submitted among the physicians in the intervention group, which may be indicative of greater smoking cessation counselling.</p> <p>It is concluded that a randomized controlled trial to test a multi-faceted intervention is not feasible with the current study design. Significant modifications to the current study design are required that can potentially be tested prior to progression to a larger trial.</p>