Encouraging physicians to counsel their smoking patients to quit is a national health priority. Physicians note several barriers to counseling smokers, including a lack of time, expertise, and organizational support. Using computers for collecting data to assist physicians in counseling patients is a way of improving the utilization of current computer technologies and behavioral models. Despite the efficacy of computer systems that enhance prevention, many barriers remain to the incorporation of such programs outside of research settings. Such a health communications system can assist a busy physician as it can query smokers about their habit, organize and present the information to provide """"""""best practice"""""""" guidance for intervention and follow-up.
The specific aim of this study is to determine, through systematic formative research, how to best integrate an innovative computer """"""""expert system"""""""" into everyday used in primary care offices. In this formative (NCI-phase II) pilot study we propose to carry out focus group discussions with all parties directly involved in primary care practices (patients, physicians, staff) to understand how best to integrate the system into everyday practice. We will integrate the computer expert system in the practices of five primary care physicians. Our primary hypothesis is that the system will be able to be integrated into primary care practice and be used by more than 50% of smokers before their physician visit. Our secondary hypothesis is that the computer system will increase the number of smoking cessation counseling activities undertaken by physicians (e.g., set a quit date), measured by patient exit interviews. Armed with the data from the pilot study, our future aim will be to: a) further refine the computer expert system into an optimal package for integration into practice and b) to conduct a randomized clinical trial (NCI phase III) of the system in a more representative sample of physicians with sufficient power to evaluate the initial efficacy of the intervention using verified 7 day point prevalence and continuous abstinence as the primary outcomes.
