Tubb Matthew R, Vonder Meulen Mary Beth, Pallerla Harini, Regan Saundra, Doarn Charles R
Family and Community Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
Mhealth. 2019 Jul 30;5:22. doi: 10.21037/mhealth.2019.06.03. eCollection 2019.
Smoking is the leading preventable cause of morbidity and mortality in the United States. Primary care providers (PCPs) have a unique opportunity to engage patients to quit smoking, but to be effective, clinicians must be able to personalize evidence-based interventions that are useful and appealing to patients in a time efficient manner. We pilot tested a novel iPad application (app), called e-Quit worRx™, designed to enhance patient-centered shared-decision making (SDM) about smoking cessation, with the primary goal of determining feasibility in primary care offices.
A total of 73 patients from three offices within a local diverse primary care network were enrolled in a pragmatic single crossover-controlled trial. The decision aid app was incorporated into current smokers' waiting time for their PCP in the exam room, and their PCP reviewed their personal responses and selections to finalize treatment choices. Mixed methods were used in the evaluation and the primary outcomes were app feasibility in primary care and enhanced SDM.
Our app was determined to be feasible for use in primary care for both patients and PCPs. It significantly increased time spent discussing smoking cessation with their PCP and the likelihood that a decision was made at the time of the visit. While not significant, mean differences were observed in other study measures including SDM, decisional conflict, quality of patient-provider communication, and stage of change progression at 12 weeks post-trial.
We created a usable and acceptable iPad app-based decision aid for use in primary care offices. The design process presented several challenges including integration into a clinical setting. Despite these challenges, we successfully ran a pragmatic pilot trial in three primary care offices using a technology novel to many of the users.
吸烟是美国可预防的发病和死亡的主要原因。初级保健提供者（PCP）有独特的机会促使患者戒烟，但要想取得成效，临床医生必须能够以高效的方式对基于证据的干预措施进行个性化定制，使其对患者有用且有吸引力。我们对一款名为e-Quit worRx™的新型iPad应用程序（应用）进行了试点测试，该应用旨在加强以患者为中心的关于戒烟的共同决策（SDM），主要目标是确定其在初级保健办公室的可行性。
在一个多元化的当地初级保健网络中的三个办公室，共有73名患者参加了一项实用的单交叉对照试验。决策辅助应用程序被纳入当前吸烟者在诊室等待看初级保健提供者的时间内，他们的初级保健提供者会查看他们的个人回答和选择以最终确定治疗方案。评估采用了混合方法，主要结果是该应用在初级保健中的可行性以及增强的共同决策。
我们的应用被确定对患者和初级保健提供者在初级保健中使用是可行的。它显著增加了与初级保健提供者讨论戒烟的时间以及就诊时做出决策的可能性。虽然不显著，但在其他研究指标中观察到了平均差异，包括共同决策、决策冲突、医患沟通质量以及试验后12周的行为改变阶段进展。
我们创建了一个可在初级保健办公室使用的、实用且可接受的基于iPad应用的决策辅助工具。设计过程面临了几个挑战，包括融入临床环境。尽管有这些挑战，我们还是成功地在三个初级保健办公室进行了一项实用的试点试验，该技术对许多用户来说是新颖的。
