TEAM-UP: Tobacco treatment navigators uniting with primary care

Oregon Health & Science University, Portland OR

Investigators

Abstract

PROJECT SUMMARY Tobacco use disorder is the deadliest substance use disorder accounting for nearly half a million premature deaths in the United States each year. Primary care clinics have the potential to reach the majority of the population with tobacco cessation assistance in the context of ongoing care, but uptake of evidence-based strategies is poor. Team-based and electronic health record-supported approaches to promote tobacco assessment and referral to cessation services (e.g. Quitlines) have been successful, but were significantly disrupted by the sequelae of COVID-19. Population outreach approaches using navigators and technologies such as patient portals have been effective in facilitating patient access to and engagement with care services and can improve health outcomes. Important gaps in understanding which outreach approaches effectively reach and engage low-income primary care patients with tobacco cessation support remain. We propose that using an outreach strategy focused on patients who were not assisted during a recent primary care visit will greatly improve the delivery of tobacco cessation support to patients. We examine two outreach strategies: a predominately person-based outreach navigator (ON) vs. a technology-based interactive patient portal (IPP). Patients that are not offered assistance during a primary care visit will be randomized into 3 groups: ON vs. IPP vs. usual care / no outreach group (NOC). Both implementation strategies will use an evidence-based approach to communicate the importance of cessation counseling and tobacco cessation medications for an effective quit strategy, offer patient choice among options, and facilitate referrals to tobacco cessation counseling and orders for medications using EHR tools. This study aims to: 1. Implement a tobacco treatment outreach intervention with ON vs. IPP vs. NOC to compare rates and correlates of receipt of cessation counseling and tobacco cessation medication orders. 2. Evaluate the effectiveness of ON vs. IPP vs. NOC on tobacco quit status. 3. Estimate and compare the costs and cost-effectiveness of ON vs. IPP. These aims will be accomplished with a three-arm randomized trial with 6000 patients (randomization ratio of 1:1:1) from 10 community-based clinics. EHR data and patient surveys will be used to assess the effect of the ON vs. IPP vs. NOC on patient reach and effectiveness outcomes and whether the approaches work equitably across important subgroups of patients. We will also assess the cost to implement and conduct each outreach approach and conduct cost-effectiveness analyses. For each Aim, qualitative methods will complement the hypothesis testing analyses to better inform observed differences in outcomes of the approaches. This study is well aligned with NIDA priorities and fills a critical knowledge gap of identifying effective and scalable strategies to improve tobacco cessation assistance among low-income primary care patients.