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2015 HSR&D/QUERI National Conference Abstract

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3135 — Comparative Effectiveness of an Internet-Based Smoking Cessation Intervention versus Clinic-Based Specialty Care for Veterans

Calhoun PS, COIN - Durham; Olsen M, COIN - Durham; Smith VA, COIN - Durham; Moore SD, VISN-6 MIRECC; Hair LP, COIN - Durham; Datta S, COIN - Durham; Beckham JC, VISN-6 MIRECC; Bastian LA, VA Connecticut Healthcare System;

Objectives:
The primary objective of this project was to examine the effectiveness of an internet-based smoking cessation intervention combined with a tele-health medication clinic for nicotine replacement therapy (NRT) compared to referral to clinic based smoking cessation care.

Methods:
A total of 413 patients were proactively recruited from the Durham VA Medical Center and followed for 12 months. Patients were randomized to receive either a referral to VA specialty smoking cessation care (control) or to the internet intervention and tele-health medication clinic. Primary outcomes included (1) intervention reach, (2) self-reported 7-day point prevalence abstinence rates at 3 months and 12 months; and 3) relative cost-effectiveness. Reach of the internet intervention was defined as the proportion of veterans who registered and visited the internet site at least once.

Results:
Reach was significantly higher for the internet plus tele-health medication clinic intervention compared to usual care (50% vs. 19%; OR = 4.17; 95% CI 2.67-6.49, p < .0001) and patients randomized to the internet were significantly more likely to receive NRT (76% versus 20%; OR = 12.83; 95% CI 8.00-20.58, p < .0001). At 3 months-post randomization, however, differences in quit rates between the intervention arm (17%) and the control arm (12%) were not statistically significant. Similarly, there were no differences in quit rates at 12 months (15% vs. 17%). Costs were substantially higher for patients randomized to the internet arm due to increased penetration and intensity of NRT use, however, none of the cost effectiveness measures between the two groups achieved statistical significance. Among those who registered with the internet site (n = 102), total contact time with the site was related to long term abstinence (t = 2.11, p < .05), however, overall use of the internet site among registered users was relatively low (median = 35 minutes).

Implications:
While the internet plus tele-medicine clinic increased reach and use of NRT compared to referral to specialty based smoking cessation treatment, long term quit rates were equivocal.

Impacts:
There is a need to increase the reach of more intensive interventions in order to maximize quit rates among Veterans.