This study tests the use of handheld computer tablets to promote the integration of 5A's for smoking cessation in academic and community primary care clinics. Although most patients receive the ask and advise steps, only slightly more than half are assessed for readiness to change, less than half receive assistance in changing, and only 9% have an arranged follow-up. While the large majority of primary care providers support the 5A's model, negative attitudes and the lack of time, knowledge, and cessation skills are common obstacles. Alternate service delivery systems that address these obstacles and evidence-based strategies to promote their implementation are needed to improve provider adherence and 5A's fidelity. This proposal develops and tests a computer-facilitated 5A's (CF-5A's) model that administers the 5A's intervention to patients then prompts providers for reinforcing next steps. CF-5A's could efficiently and effectively promote smoking cessation while educating providers about cessation resources and appropriate follow-up. Based on the Technology Acceptance Model, clinically tailored strategies to promote CF-5A's implementation will be developed and tested to ensure the appropriate use and uptake of this new service delivery model. Although focused on 5A's for smoking cessation, this study examines the underlying implementation science of computer-aided service delivery models with important implications for the integration of other substance use or behavioral health interventions in primary care. A careful, mixed methods exploration and testing of key implementation factors is used to help build evidence-based strategies to improve the integration of behavioral health services in primary care settings. The goals of this implementation study will be achieved in 4 specific aims:
AIM 1 : Develop a computer facilitated 5A's (CF-5A's) service delivery model and implementation plan to promote smoking cessation in primary care.
AIM 2 : Evaluate the CF-5A's service delivery model by comparing randomized intervention and control providers in academic and community primary care clinics.
AIM 3 : Identify and evaluate individual, clinic, and systems level implementation outcomes and predictors of implementation success using a mixed methods design.
AIM 4 : Disseminate the CF-5A's and implementation interventions to a national sample of academic and community clinics.

Public Health Relevance

Through the specific aims of this proposal, a computer-facilitated 5A's for smoking cessation will be developed and implemented for both local and national primary care providers. Provider adherence to the evidence-based 5A's approach will be evaluated. Improved provider adherence and 5A's fidelity have the potential to improve smoking cessation rates and reduce public health burden.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZDA1)
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Wiley, Tisha R A
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Vijayaraghavan, Maya; Yuan, Patrick; Gregorich, Steven et al. (2017) Disparities in receipt of 5As for smoking cessation in diverse primary care and HIV clinics. Prev Med Rep 6:80-87
Kalkhoran, Sara; Alvarado, Nicholas; Vijayaraghavan, Maya et al. (2017) Patterns of and reasons for electronic cigarette use in primary care patients. J Gen Intern Med 32:1122-1129
Kalkhoran, Sara; Appelle, Nicole A; Napoles, Anna M et al. (2016) Beyond the Ask and Advise: Implementation of a Computer Tablet Intervention to Enhance Provider Adherence to the 5As for Smoking Cessation. J Subst Abuse Treat 60:91-100
Nápoles, Anna María; Appelle, Nicole; Kalkhoran, Sara et al. (2016) Perceptions of clinicians and staff about the use of digital technology in primary care: qualitative interviews prior to implementation of a computer-facilitated 5As intervention. BMC Med Inform Decis Mak 16:44