Limits...
Internet delivered support for tobacco control in dental practice: randomized controlled trial.

Houston TK, Richman JS, Ray MN, Allison JJ, Gilbert GH, Shewchuk RM, Kohler CL, Kiefe CI, DPBRN Collaborative Gro - J. Med. Internet Res. (2008)

Bottom Line: Control practices improved by 3% on ASK (Adj.OR 1.18 [95% CI 1.07-1.29]) and did not significantly improve in ADVISE.A significant group-by-time interaction effect indicated that intervention practices improved more over the study period than control practices for ADVISE (P = 0.042) but not for ASK.

View Article: PubMed Central - HTML - PubMed

Affiliation: Surgical and Medical Acute care and Advanced illness Research and Transition sciences (SMAART) Center, VA HSR&D REAP, Birmingham VA Medical Center, Birmingham, AL, USA. thouston@uab.edu

ABSTRACT

Background: The dental visit is a unique opportunity for tobacco control. Despite evidence of effectiveness in dental settings, brief provider-delivered cessation advice is underutilized.

Objective: To evaluate an Internet-delivered intervention designed to increase implementation of brief provider advice for tobacco cessation in dental practice settings.

Methods: Dental practices (N = 190) were randomized to the intervention website or wait-list control. Pre-intervention and after 8 months of follow-up, each practice distributed exit cards (brief patient surveys assessing provider performance, completed immediately after the dental visit) to 100 patients. Based on these exit cards, we assessed: whether patients were asked about tobacco use (ASK) and, among tobacco users, whether they were advised to quit tobacco (ADVISE). All intervention practices with follow-up exit card data were analyzed as randomized regardless of whether they participated in the Internet-delivered intervention.

Results: Of the 190 practices randomized, 143 (75%) dental practices provided follow-up data. Intervention practices' mean performance improved post-intervention by 4% on ASK (29% baseline, adjusted odds ratio = 1.29 [95% CI 1.17-1.42]), and by 11% on ADVISE (44% baseline, OR = 1.55 [95% CI 1.28-1.87]). Control practices improved by 3% on ASK (Adj. OR 1.18 [95% CI 1.07-1.29]) and did not significantly improve in ADVISE. A significant group-by-time interaction effect indicated that intervention practices improved more over the study period than control practices for ADVISE (P = 0.042) but not for ASK.

Conclusion: This low-intensity, easily disseminated intervention was successful in improving provider performance on advice to quit.

Trial registration: clinicaltrials.gov NCT00627185, http://www.webcitation.org/5c5Kugvzj.

Show MeSH
Number of unique providers visiting the website per week over 8 months
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC2630831&req=5

figure2: Number of unique providers visiting the website per week over 8 months

Mentions: Of the 70 intervention practices that participated in follow-up, 56 (80%) had at least 1 provider who actually participated in the intervention. In the 56 participating practices, 53 of the 56 dentists (95%) and 38 of the 56 hygienists (68%) logged on to the intervention website. The mean number of tracked pages per practice was 50 (SD 40), and these ranged from 1 to 157. The mean number of visits to the intervention per practice that logged on was 5.8 (SD 4.6), and the mean number of unique participants was 1.9 (SD 1.2), ranging as high as 6 participants (dentists and hygienists) in a single practice. Figure 2 displays the number of unique providers visiting the website per week of intervention time. The spikes in activity centered at weeks 12 and 18 correspond to the initial release of additional interactive cases. Other smaller spikes represent response to headlines and questions-of-the-week updates. For the 3 cases, 75% (42/56) of practices had at least 1 provider complete Case 1, 55% (31/56) had at least 1 provider complete Case 2, and 21% (12/56) completed Case 3.


Internet delivered support for tobacco control in dental practice: randomized controlled trial.

Houston TK, Richman JS, Ray MN, Allison JJ, Gilbert GH, Shewchuk RM, Kohler CL, Kiefe CI, DPBRN Collaborative Gro - J. Med. Internet Res. (2008)

Number of unique providers visiting the website per week over 8 months
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2630831&req=5

figure2: Number of unique providers visiting the website per week over 8 months
Mentions: Of the 70 intervention practices that participated in follow-up, 56 (80%) had at least 1 provider who actually participated in the intervention. In the 56 participating practices, 53 of the 56 dentists (95%) and 38 of the 56 hygienists (68%) logged on to the intervention website. The mean number of tracked pages per practice was 50 (SD 40), and these ranged from 1 to 157. The mean number of visits to the intervention per practice that logged on was 5.8 (SD 4.6), and the mean number of unique participants was 1.9 (SD 1.2), ranging as high as 6 participants (dentists and hygienists) in a single practice. Figure 2 displays the number of unique providers visiting the website per week of intervention time. The spikes in activity centered at weeks 12 and 18 correspond to the initial release of additional interactive cases. Other smaller spikes represent response to headlines and questions-of-the-week updates. For the 3 cases, 75% (42/56) of practices had at least 1 provider complete Case 1, 55% (31/56) had at least 1 provider complete Case 2, and 21% (12/56) completed Case 3.

Bottom Line: Control practices improved by 3% on ASK (Adj.OR 1.18 [95% CI 1.07-1.29]) and did not significantly improve in ADVISE.A significant group-by-time interaction effect indicated that intervention practices improved more over the study period than control practices for ADVISE (P = 0.042) but not for ASK.

View Article: PubMed Central - HTML - PubMed

Affiliation: Surgical and Medical Acute care and Advanced illness Research and Transition sciences (SMAART) Center, VA HSR&D REAP, Birmingham VA Medical Center, Birmingham, AL, USA. thouston@uab.edu

ABSTRACT

Background: The dental visit is a unique opportunity for tobacco control. Despite evidence of effectiveness in dental settings, brief provider-delivered cessation advice is underutilized.

Objective: To evaluate an Internet-delivered intervention designed to increase implementation of brief provider advice for tobacco cessation in dental practice settings.

Methods: Dental practices (N = 190) were randomized to the intervention website or wait-list control. Pre-intervention and after 8 months of follow-up, each practice distributed exit cards (brief patient surveys assessing provider performance, completed immediately after the dental visit) to 100 patients. Based on these exit cards, we assessed: whether patients were asked about tobacco use (ASK) and, among tobacco users, whether they were advised to quit tobacco (ADVISE). All intervention practices with follow-up exit card data were analyzed as randomized regardless of whether they participated in the Internet-delivered intervention.

Results: Of the 190 practices randomized, 143 (75%) dental practices provided follow-up data. Intervention practices' mean performance improved post-intervention by 4% on ASK (29% baseline, adjusted odds ratio = 1.29 [95% CI 1.17-1.42]), and by 11% on ADVISE (44% baseline, OR = 1.55 [95% CI 1.28-1.87]). Control practices improved by 3% on ASK (Adj. OR 1.18 [95% CI 1.07-1.29]) and did not significantly improve in ADVISE. A significant group-by-time interaction effect indicated that intervention practices improved more over the study period than control practices for ADVISE (P = 0.042) but not for ASK.

Conclusion: This low-intensity, easily disseminated intervention was successful in improving provider performance on advice to quit.

Trial registration: clinicaltrials.gov NCT00627185, http://www.webcitation.org/5c5Kugvzj.

Show MeSH