Combining alcohol interventions with tobacco addictions treatment in primary care-the COMBAT study: a pragmatic cluster randomized trial

Article

Minian, Nadia, Baliunas, Dolly, Zawertailo, Laurie, Noormohamed, Aliya, Giesbrecht, Norman, Hendershot, Christian S., Le Foll, Bernard, Rehm, Jürgen, Samokhvalov, Andriy and Selby, Peter L.. 2017. "Combining alcohol interventions with tobacco addictions treatment in primary care-the COMBAT study: a pragmatic cluster randomized trial." Implementation Science. 12 (1). https://doi.org/10.1186/s13012-017-0595-7
Article Title

Combining alcohol interventions with tobacco addictions treatment in primary care-the COMBAT study: a pragmatic cluster randomized trial

ERA Journal ID40412
Article CategoryArticle
AuthorsMinian, Nadia, Baliunas, Dolly, Zawertailo, Laurie, Noormohamed, Aliya, Giesbrecht, Norman, Hendershot, Christian S., Le Foll, Bernard, Rehm, Jürgen, Samokhvalov, Andriy and Selby, Peter L.
Journal TitleImplementation Science
Journal Citation12 (1)
Article Number65
Number of Pages8
Year2017
PublisherBioMed Central Ltd.
Place of PublicationUnited Kingdom
ISSN1748-5908
Digital Object Identifier (DOI)https://doi.org/10.1186/s13012-017-0595-7
Web Address (URL)https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0595-7
Abstract

Background
Tobacco and alcohol use present multiplicative risk for aerodigestive cancers. Reducing alcohol consumption improves smoking cessation outcomes and reduces cancer risk. Risky alcohol consumption and smoking are often treated separately despite concurrent treatment potentially leading to better outcomes for each. However, no rapidly scalable program exists for combined interventions in primary care clinics spread across wide geographic areas. This cluster randomized trial aims to report on the effects of a novel clinical decision support system (CDSS) on intervention rates by primary care practitioners addressing risky alcohol use in a smoking cessation program.

Methods/design
We will be implementing a clinical decision support system (CDSS) in 221 primary care sites participating in the Smoking Treatment for Ontario Patients (STOP) program across Ontario, Canada. Sites will be blindly allocated to one of two clinical decision support systems guiding practitioners to provide a risky alcohol use intervention to smokers attempting to quit using nicotine replacement therapy (NRT). Risky alcohol use is defined as drinking above the Canadian Cancer Society’s low-risk drinking guidelines. Primary analysis will measure the proportion of risky drinkers offered an alcohol intervention in each CDSS arm at baseline. Patients will be contacted by phone or email to track smoking cessation and alcohol consumption rates at 6- and 12-month follow-up.

Discussion
Upon completion of the trial, the effect of different clinical decision support systems on practitioner behaviour, and on client tobacco and alcohol use, will be discussed. If the CDSS successfully promotes SBIRT for risky alcohol use in a primary care setting and/or improves patient-level outcomes, including smoking cessation rates and alcohol use reduction, this tool can be used as a model for other web-based behaviour change interventions integrated into primary care practice.

KeywordsAlcohol; Clinical decision support system; Primary care; Health care practitioner; Cancer prevention; Tobacco
ANZSRC Field of Research 2020420319. Primary health care
Byline AffiliationsCentre for Addiction and Mental Health, Canada
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