A minority of the 25 million US smokers who receive primary care each year receive evidence-based treatment to quit smoking. Healthcare systems have enormous potential to connect smokers with high quality, evidence-based care. Diverse strategies have been used to increase treatment use, but treatment reach remains stubbornly low. BREATHE 2 will be the first rigorous factorial experiment to optimize a package of centralized healthcare interventions to enhance the reach of quit-smoking interventions.
The factorial experiment will include 1,664 patients who smoke daily from eight primary care clinics. These patient-focused interventions include:
Invitations to participate sent electronically to patients identified as smokers in the electronic medical records.
Monetary incentives for treatment initiation.
Proactive telephone care management.
Reminders of access to intensive treatment to quit smoking.
All four experimental intervention components will be implemented for two years to permit analysis of their cumulative impact on treatment reach and smoking abstinence among primary care patients who are not initially willing to make a quit attempt. Analyses after a year of follow up will identify an especially effective (optimized) reach-intervention package to be evaluated in BREATHE 2 Project 3: Optimization.
BREATHE 2 Project 2 will strive to identify:
A highly effective intervention package that promotes usual and intensive treatment use (reach) and downstream abstinence from smoking at low cost.
The mediating pathways for these effects.
Sub-populations of patients who particularly benefit from these intervention components (reach representativeness).