A behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocol
Abstract Background People with a psychiatric diagnosis smoke at high rates, yet are rarely treated for tobacco use. Health care systems often use a “no treatment” default for tobacco, such that providers must actively choose (opt-in) to treat their patients who express interest in quitting. Default...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-020-00011-x |
| _version_ | 1819163814954795008 |
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| author | Erin S. Rogers Christina Wysota Judith J. Prochaska Craig Tenner Joanna Dognin Binhuan Wang Scott E. Sherman |
| author_facet | Erin S. Rogers Christina Wysota Judith J. Prochaska Craig Tenner Joanna Dognin Binhuan Wang Scott E. Sherman |
| author_sort | Erin S. Rogers |
| collection | DOAJ |
| description | Abstract Background People with a psychiatric diagnosis smoke at high rates, yet are rarely treated for tobacco use. Health care systems often use a “no treatment” default for tobacco, such that providers must actively choose (opt-in) to treat their patients who express interest in quitting. Default bias theory suggests that opt-in systems may reinforce the status quo to not treat tobacco use in psychiatry. We aim to conduct a pilot study testing an opt-out system for implementing a 3As (ask, advise, assist) tobacco treatment model in outpatient psychiatry. Methods We will use a mixed-methods, cluster-randomized study design. We will implement a tobacco use clinical reminder for outpatient psychiatrists at the VA New York Harbor Healthcare System. Psychiatrists (N = 20) will be randomized 1:1 to one of the two groups: (1) opt-in treatment approach—psychiatrists will receive a reminder that encourages them to offer cessation medications and referral to cessation counseling; (2) opt-out treatment approach—psychiatrists will receive a clinical reminder that includes a standing cessation medication order and a referral to cessation counseling that will automatically generate unless the provider cancels. Prior to implementation of the reminders, we will hold a 1-h training on tobacco treatment for psychiatrists in both arms. We will use VA administrative data to calculate the study’s primary outcomes: (1) the percent of smokers prescribed a cessation medication and (2) the percent of smokers referred to counseling. During the intervention period, we will also conduct post-visit surveys with a cluster sample of 400 patients (20 per psychiatrist) to assess psychiatrist fidelity to the 3As approach and patient perceptions of the opt-out system. At 6 months, we will survey the clustered patient sample again to evaluate the study’s secondary outcomes: (1) patient use of cessation treatment in the prior 6 months and (2) self-reported 7-day abstinence at 6 months. At the end of the intervention period, we will conduct semi-structured interviews with 12–14 psychiatrists asking about their perceptions of the opt-out approach. Discussion This study will produce important data on the potential of opt-out systems to overcome the barriers in implementing tobacco use treatment in outpatient psychiatry. Trial registration Clinicaltrials.gov NCT04071795 (registered on August 28, 2019) |
| first_indexed | 2024-12-22T17:50:07Z |
| format | Article |
| id | doaj.art-1b1698aefcb1484ab46a15d6abed7d14 |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-22T17:50:07Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-1b1698aefcb1484ab46a15d6abed7d142022-12-21T18:18:11ZengBMCImplementation Science Communications2662-22112020-02-011111010.1186/s43058-020-00011-xA behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocolErin S. Rogers0Christina Wysota1Judith J. Prochaska2Craig Tenner3Joanna Dognin4Binhuan Wang5Scott E. Sherman6Department of Population Health, NYU School of MedicineDepartment of Population Health, NYU School of MedicineDepartment of Medicine, Stanford Prevention Research Center, Stanford UniversityVA NY Harbor Healthcare SystemVA NY Harbor Healthcare SystemDepartment of Population Health, NYU School of MedicineDepartment of Population Health, NYU School of MedicineAbstract Background People with a psychiatric diagnosis smoke at high rates, yet are rarely treated for tobacco use. Health care systems often use a “no treatment” default for tobacco, such that providers must actively choose (opt-in) to treat their patients who express interest in quitting. Default bias theory suggests that opt-in systems may reinforce the status quo to not treat tobacco use in psychiatry. We aim to conduct a pilot study testing an opt-out system for implementing a 3As (ask, advise, assist) tobacco treatment model in outpatient psychiatry. Methods We will use a mixed-methods, cluster-randomized study design. We will implement a tobacco use clinical reminder for outpatient psychiatrists at the VA New York Harbor Healthcare System. Psychiatrists (N = 20) will be randomized 1:1 to one of the two groups: (1) opt-in treatment approach—psychiatrists will receive a reminder that encourages them to offer cessation medications and referral to cessation counseling; (2) opt-out treatment approach—psychiatrists will receive a clinical reminder that includes a standing cessation medication order and a referral to cessation counseling that will automatically generate unless the provider cancels. Prior to implementation of the reminders, we will hold a 1-h training on tobacco treatment for psychiatrists in both arms. We will use VA administrative data to calculate the study’s primary outcomes: (1) the percent of smokers prescribed a cessation medication and (2) the percent of smokers referred to counseling. During the intervention period, we will also conduct post-visit surveys with a cluster sample of 400 patients (20 per psychiatrist) to assess psychiatrist fidelity to the 3As approach and patient perceptions of the opt-out system. At 6 months, we will survey the clustered patient sample again to evaluate the study’s secondary outcomes: (1) patient use of cessation treatment in the prior 6 months and (2) self-reported 7-day abstinence at 6 months. At the end of the intervention period, we will conduct semi-structured interviews with 12–14 psychiatrists asking about their perceptions of the opt-out approach. Discussion This study will produce important data on the potential of opt-out systems to overcome the barriers in implementing tobacco use treatment in outpatient psychiatry. Trial registration Clinicaltrials.gov NCT04071795 (registered on August 28, 2019)https://doi.org/10.1186/s43058-020-00011-xTobacco use cessationPsychiatryElectronic medical record |
| spellingShingle | Erin S. Rogers Christina Wysota Judith J. Prochaska Craig Tenner Joanna Dognin Binhuan Wang Scott E. Sherman A behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocol Implementation Science Communications Tobacco use cessation Psychiatry Electronic medical record |
| title | A behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocol |
| title_full | A behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocol |
| title_fullStr | A behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocol |
| title_full_unstemmed | A behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocol |
| title_short | A behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocol |
| title_sort | behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines a provider randomized study protocol |
| topic | Tobacco use cessation Psychiatry Electronic medical record |
| url | https://doi.org/10.1186/s43058-020-00011-x |
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