Computer-Assisted Tobacco Interventions in Dental Offices - Full Text View

Purpose

Electronic dental records (EDR) are a potentially powerful tool to incorporate current scientific evidence into clinical practice by providing key information at the point of patient care. The investigators know that disseminating evidence-based guidelines is not sufficient to change clinical practice so innovative approaches need to be tested in dentistry. The composite expertise of the investigators and consultants on this project and a large group practice with multiple clinics utilizing one EDR are essential to address the aims of this study. This project will examine whether dentists and hygienists will assess interest in quitting and deliver a tobacco intervention more frequently when provided with computer assisted guidance compared to a control group. Specifically the investigators will measure the delivery of questions assessing willingness to change and appropriate interventions based on willingness to change by measuring the recording of these activities in the EDR and patient receipt of these recommendations through a phone survey. In addition, the study will do a qualitative assessment of the patient perceived value of the provider-patient encounter to further inform us about patient perception of this interaction. The investigators want to know if dental providers will utilize these tools during the dental encounter. If they are used, the investigators would propose further studies examining smoking cessation rates. The investigators were not able to measure cessation rates due to the short two year timeline of this funding mechanism. This tool has potential application for other clinical topics, which makes this approach very innovative when considering the translation of evidence into the unique clinical practice of dentistry.

Condition	Intervention
Smoking	Behavioral: CATI Tool

Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Health Services Research
Official Title:	Computer-Assisted Guidance for Tobacco Dependence Interventions in Dental Offices

Resource links provided by NLM:

MedlinePlus related topics: Smoking

U.S. FDA Resources

Further study details as provided by HealthPartners Institute for Education and Research:

Primary Outcome Measures:

Patient report [ Time Frame: Within 3 days of the dental encounter ] [ Designated as safety issue: No ]
Patient report of dental providers delivery of:
1. Screening for tobacco
2. Discussion of specific strategies toassistthe patienwith quitingsmoking
3. Referal to a Quitline (toll free numberfor comprehensive toabccocessation support)

Enrollment:	548
Study Start Date:	October 2009
Estimated Study Completion Date:	July 2012
Primary Completion Date:	April 2011 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
No Intervention: Control (Usual care) Return patients seen within the data collection window in HealthPartners Dental Clinics (new patient exams were excluded) who were documented as using tobacco, specifically cigarettes, at their last dental encounter. Randomization was at the clinic level.
Experimental: Tobacco Cessation Provider Tool Using Screening for drug use, Brief Intervention, Referral to Treatment (SBIRT) as a model, a tool was designed for the Electronic Dental Record which required assessment of 4 variables for patients reporting cigarettes use: 1) number of cigarettes daily, 2) how soon upon waking the first cigarette was smoked, 3) interest in quitting, and 4) previous quit attempts. Level of dependency was calculated and displayed in the health history using the Heavy Smoking Index. Pop-up provider scripts were generated using rule-based algorithms. Links to printable patient education materials on the quit line and on medications to help quit smoking were embedded in the scripts window. The tool automatically recorded tobacco-cessation details.	Behavioral: CATI Tool Using Screening for drug use, Brief Intervention, Referral to Treatment (SBIRT) as a model, a tool was designed for the Electronic Dental Record which required assessment of 4 variables for patients reporting cigarettes use: 1) number of cigarettes daily, 2) how soon upon waking the first cigarette was smoked, 3) interest in quitting, and 4) previous quit attempts. Level of dependency was calculated and displayed in the health history using the Heavy Smoking Index. Pop-up provider scripts were generated using rule-based algorithms. Links to printable patient education materials on the quit line and on medications to help quit smoking were embedded in the scripts window. The tool automatically recorded tobacco-cessation details.

Arms

Assigned Interventions

No Intervention: Control (Usual care)

Return patients seen within the data collection window in HealthPartners Dental Clinics (new patient exams were excluded) who were documented as using tobacco, specifically cigarettes, at their last dental encounter. Randomization was at the clinic level.

Experimental: Tobacco Cessation Provider Tool

Using Screening for drug use, Brief Intervention, Referral to Treatment (SBIRT) as a model, a tool was designed for the Electronic Dental Record which required assessment of 4 variables for patients reporting cigarettes use: 1) number of cigarettes daily, 2) how soon upon waking the first cigarette was smoked, 3) interest in quitting, and 4) previous quit attempts. Level of dependency was calculated and displayed in the health history using the Heavy Smoking Index. Pop-up provider scripts were generated using rule-based algorithms. Links to printable patient education materials on the quit line and on medications to help quit smoking were embedded in the scripts window. The tool automatically recorded tobacco-cessation details.

Behavioral: CATI Tool

Using Screening for drug use, Brief Intervention, Referral to Treatment (SBIRT) as a model, a tool was designed for the Electronic Dental Record which required assessment of 4 variables for patients reporting cigarettes use: 1) number of cigarettes daily, 2) how soon upon waking the first cigarette was smoked, 3) interest in quitting, and 4) previous quit attempts. Level of dependency was calculated and displayed in the health history using the Heavy Smoking Index. Pop-up provider scripts were generated using rule-based algorithms. Links to printable patient education materials on the quit line and on medications to help quit smoking were embedded in the scripts window. The tool automatically recorded tobacco-cessation details.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

Adult dental patient presenting for an exam visit whose most recent history reports the patient is a smoker. Patients had to agree to the phone survey.

Exclusion Criteria:

Research opt out list
Patients who discontinued the survey prior to completion(considered withdrawals)

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01584882

Locations

United States, Minnesota
HealthPartners Research Foundation
Bloomington, Minnesota, United States, 55445

Sponsors and Collaborators

HealthPartners Institute for Education and Research

Investigators

Principal Investigator:

D. Brad Rindal, DDS

HealthPartners Researc Foundation

More Information

Additional Information:

HealthPartners Research Foundation This link exits the ClinicalTrials.gov site

No publications provided by HealthPartners Institute for Education and Research

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Rindal DB, Rush WA, Schleyer TK, Kirshner M, Boyle RG, Thoele MJ, Asche SE, Thyvalikakath T, Spallek H, Durand EC, Enstad CJ, Huntley CL. Computer-assisted guidance for dental office tobacco-cessation counseling: a randomized controlled trial. Am J Prev Med. 2013 Mar;44(3):260-4. doi: 10.1016/j.amepre.2012.10.023.

Responsible Party:	HealthPartners Institute for Education and Research
ClinicalTrials.gov Identifier:	NCT01584882 History of Changes
Other Study ID Numbers:	09-062
Study First Received:	April 23, 2012
Last Updated:	April 24, 2012
Health Authority:	United States: Federal Government

Keywords provided by HealthPartners Institute for Education and Research:

Clinical decision support (CDS)
Tobacco
Behavioral
Dental hygienist

Dentist
Smoking
Electronic health record

Additional relevant MeSH terms:

Smoking
Habits

ClinicalTrials.gov processed this record on June 18, 2013

Computer-Assisted Tobacco Interventions in Dental Offices (CATI)