J. Med. Internet Res. - Development of an interactive, Web-delivered system to increase provider-patient engagement in smoking cessation.

Tópicos

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Resumo

CKGROUND: Patient self-management interventions for smoking cessation are effective but underused. Health care providers do not routinely refer smokers to these interventions.OBJECTIVE: The objective of our study was to uncover barriers and facilitators to the use of an e-referral system that will be evaluated in a community-based randomized trial. The e-referral system will allow providers to refer smokers to an online smoking intervention during routine clinical care.METHODS: We devised a four-step development and pilot testing process: (1) system conceptualization using Delphi to identify key functionalities that would overcome barriers in provider referrals for smoking cessation, (2) Web system programming using agile software development and best programming practices with usability refinement using think-aloud testing, (3) implementation planning using the nominal group technique for the effective integration of the system into the workflow of practices, and (4) pilot testing to identify practice recruitment and system-use barriers in real-world settings.RESULTS: Our Delphi process (step 1) conceptualized three key e-referral functions: (1) Refer Your Smokers, allowing providers to e-refer patients at the point of care by entering their emails directly into the system, (2) practice reports, providing feedback regarding referrals and impact of smoking-cessation counseling, and (3) secure messaging, facilitating provider-patient communication. Usability testing (step 2) suggested the system was easy to use, but implementation planning (step 3) suggested several important approaches to encourage use (eg, proactive email cues to encourage practices to participate). Pilot testing (step 4) in 5 practices had limited success, with only 2 patients referred; we uncovered important recruitment and system-use barriers (eg, lack of study champion, training, and motivation, registration difficulties, and forgetting to refer).CONCLUSIONS: Implementing a system to be used in a clinical setting is complex, as several issues can affect system use. In our ongoing large randomized trial, preliminary analysis with the first 50 practices using the system for 3 months demonstrated that our rigorous preimplementation evaluation helped us successfully identify and overcome these barriers before the main trial.TRIAL: Clinicaltrials.gov NCT00797628; http://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/61feCfjCy).

Resumo Limpo

ckground patient selfmanag intervent smoke cessat effect underus health care provid routin refer smoker interventionsobject object studi uncov barrier facilit use ereferr system will evalu communitybas random trial ereferr system will allow provid refer smoker onlin smoke intervent routin clinic caremethod devis fourstep develop pilot test process system conceptu use delphi identifi key function overcom barrier provid referr smoke cessat web system program use agil softwar develop best program practic usabl refin use thinkaloud test implement plan use nomin group techniqu effect integr system workflow practic pilot test identifi practic recruit systemus barrier realworld settingsresult delphi process step conceptu three key ereferr function refer smoker allow provid eref patient point care enter email direct system practic report provid feedback regard referr impact smokingcess counsel secur messag facilit providerpati communic usabl test step suggest system easi use implement plan step suggest sever import approach encourag use eg proactiv email cue encourag practic particip pilot test step practic limit success patient refer uncov import recruit systemus barrier eg lack studi champion train motiv registr difficulti forget referconclus implement system use clinic set complex sever issu can affect system use ongo larg random trial preliminari analysi first practic use system month demonstr rigor preimplement evalu help us success identifi overcom barrier main trialtrial clinicaltrialsgov nct httpclinicaltrialsgovctshownct archiv webcit httpwwwwebcitationorgfecfjci

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