SBIR-STTR Award

Public health experts have identified smoking cessation as the most cost-effective tobacco control strategy. Pharmacy clients typically see a pharmacist on a regular basis and regard pharmacists as highly valued caregivers. (McAneny L. 1999). Pharmacists are in a good position to help smokers quit and can provide important counseling supports as well as guidance in using nicotine replacement products. However, pharmacists often do not have the time or other resources to provide these important supports. Computer software programs (expert systems) have been used successfully to assist healthcare workers in providing smoking cessation counseling and supports (Prochaska et al., 1993; Strecher et al., 1994; Velicer et al., 1994). These systems provide standardized assessments and counseling feedback to smokers while reducing the burden to healthcare workers and clinical staff (Bock & Bock, 2001; Bock et al., 1999). The goal of this proposal is to develop a practical, inexpensive, easily delivered, evidence-based intervention to assist pharmacists in providing smoking cessation help to under-served adult smokers. The intervention will utilize an expert system software program customized for delivery through community health care pharmacies. It will provide individual assessment and tailored, real-time feedback reports to participants and pharmacist reports, which outline key areas for patient improvement and counseling suggestions for the pharmacist. This program will provide assessment of smokers' readiness to quit smoking (motivation), nicotine dependence, potential triggers, perceived benefits and barriers to quitting. Feedback reports to the patient will identify areas needing improvement, provide positive reinforcement of the patient's strengths, and highlight areas that need improvement and provide counseling suggestions for quitting smoking. All reports will be available in both English and Spanish. System logic is derived from evidence-based behavioral models that hold promise for helping individuals quit smoking (Hudmon et al., 1995; Prochaska et al., 1992). In Phase I, we will develop the software program and evaluate system acceptability using a pre-post design in a single group of subjects (N=50).

Thesaurus Terms:
allied health personnel, automated health care system, computer program /software, computer system design /evaluation, counseling, health administration, health care service planning, pharmacy administration, smoking cessation adult human (21+), cognitive behavior therapy, medically underserved population, social support network behavioral /social science research tag, clinical research, health services research tag, human subject

Public health experts have identified smoking cessation as the most cost-effective tobacco control strategy. Smoking cessation support delivered by health care professionals can be a highly effective means of reaching out proactively to smokers and helping them quit. Pharmacists are in an ideal position to advise and influence smokers regarding nicotine related therapy and to counsel smokers. Yet, pharmacists experience significant barriers to providing consistent, high-quality supports to smokers, including; time limitations, lack of training in effective counseling techniques and lack of reimbursement for counseling smokers (Ossip-Klein et al., 2000). This software system will provide basic training in pharmacy based smoking cessation counseling, save pharmacist time by conducting relevant assessments and provide high quality feedback to the smoker. The goal of this Phase II application is to finalize development and test the efficacy of the computer-based expert system ("Exper_Quit") developed in our Phase I project. Specifically, our goals are: 1) to increase the frequency with which pharmacists address smoking cessation in their interaction with customers, and 2) to increase the number of smokers who will be successful when making a quit attempt. The first six months of the project will be devoted to finalizing programming, coding, testing and writing content for the additional assessment and feedback components. Efficacy of the system will be tested at a HMO-based pharmacy. Exit interview data will be collected from smokers to assess the extent of pharmacist counseling for smoking with no intervention (observation only: OBS). Pharmacists will then be trained in providing smoking cessation counseling. Two additional groups of smokers will recruited by pharmacists and randomly assigned to either the TEST or CONTROL conditions. TEST participants will complete assessments, receive personalized feedback and a matching pharmacist report and be counseled by the pharmacist. These subjects will return in 1 month for a follow-up Exper_Quit assessment and to receive feedback on their progress. CONTROL participants will complete the baseline assessment but will not receive feedback and no pharmacist report will be printed. Exit interviews will document the extent of pharmacist counseling. All subjects will complete 2 and 6 month follow up assessments. Cessation (7 day point-prevalence abstinence) will be verified by saliva cotinine at month 6