Division of General Internal Medicine, University of California San Francisco, San Francisco, California.
Division of General Internal Medicine, University of California San Francisco, San Francisco, California.
Am J Prev Med. 2018 Jul;55(1):35-43. doi: 10.1016/j.amepre.2018.04.009. Epub 2018 Jun 18.
Although evidence-based, the 5A's (Ask, Advise, Assess, Assist, and Arrange) for smoking cessation are often incompletely delivered by primary care providers. This study examines whether a computer tablet 5A's intervention improves primary care provider adherence to the 5A's.
Cluster RCT.
SETTING/PARTICIPANTS: All primary care providers in three urban, adult primary care clinics were randomized for participation. Any English- or Spanish-speaking patient with a primary care appointment who had smoked >100 lifetime cigarettes and at least one cigarette in the past week was eligible.
A cluster RCT comparing computer-facilitated 5A's with usual care assessed effects on provider adherence to each of the 5A's as determined by patient report. Intervention subjects used a computer tablet to complete the 5A's immediately before a primary care appointment. A tailored, patient handout and a structured, clinician guide were generated. Data were collected in 2014-2015 and analyzed in 2016-2017.
Provider adherence to the 5A's.
Providers (N=221) saw 961 patients (n=412 intervention, n=549 control) for a total of n=1,340 encounters with n=1,011 completed post-visit interviews (75.4% completion). Intervention providers had significantly higher odds of completing Assess (AOR=1.32, 95% CI=1.02, 1.73) and Assist (AOR=1.45, 95% CI=1.08, 1.94). When looking at first study visits only, intervention providers had higher odds for Arrange (AOR=1.72, 95% CI=1.23, 2.40) and all 5A's (AOR=2.04, 95% CI=1.35, 3.07) but study visit did not influence receipt of the other 5A's.
A computer-facilitated 5A's delivery model was effective in improving the fidelity of provider-delivered 5A's to diverse primary care patients. This relatively low-cost, time-saving intervention has great potential for smoking cessation and other health behaviors. Future studies should identify ways to promote and sustain technology implementation.
This study is registered at www.clinicaltrials.gov NCT02046408.
尽管有循证依据，但初级保健提供者经常不能完全实施 5A（询问、建议、评估、帮助和安排）戒烟方法。本研究旨在探讨平板电脑 5A 干预是否能提高初级保健提供者对 5A 的依从性。
整群随机对照试验。
设置/参与者：所有参与三个城市成人初级保健诊所的初级保健提供者均参与了随机分组。任何有初级保健预约、有吸烟史（>100 支香烟/≥1 支香烟/周）的英语或西班牙语患者都有资格参与。
采用比较计算机辅助 5A 与常规护理的整群随机对照试验，通过患者报告评估干预措施对提供者实施每个 5A 的依从性的影响。干预组的参与者在进行初级保健预约前使用计算机平板电脑完成 5A。生成了个性化的患者传单和结构化的临床医生指南。数据收集于 2014-2015 年，分析于 2016-2017 年。
提供者对 5A 的依从性。
提供者（N=221）共为 961 名患者（n=412 例干预组，n=549 例对照组）提供了服务，总共进行了 n=1,340 次就诊，n=1,011 次就诊完成了随访访谈（完成率为 75.4%）。干预组提供者完成评估（AOR=1.32，95%CI=1.02，1.73）和帮助（AOR=1.45，95%CI=1.08，1.94）的可能性显著更高。仅观察首次就诊时，干预组提供者更有可能安排（AOR=1.72，95%CI=1.23，2.40）和所有 5A（AOR=2.04，95%CI=1.35，3.07），但就诊次数并不影响其他 5A 的实施。
计算机辅助 5A 实施模式能有效提高初级保健患者 5A 实施的提供者可信度。这种相对低成本、节省时间的干预措施在戒烟和其他健康行为方面具有很大的潜力。未来的研究应确定促进和维持技术实施的方法。
本研究在 www.clinicaltrials.gov 上注册，编号为 NCT02046408。
