Implementing Smoking Cessation Telehealth Technologies Within the VHA: Lessons Learned.

Background: Health care systems need to reach patients who are smokers and connect them to evidence-based resources that can help them quit. Telehealth, such as an interactive voice response (IVR) system, may be one solution, but there is no roadmap to develop or implement an IVR system within the US Department of Veterans Affairs (VA). Observations: We describe the development and implemention of IVR at the VA Portland Health Care System in Oregon to proactively reach veterans who use tobacco and connect them with cessation resources. We coordinated with local departments to verify the necessary processes and strategies that are important. We recommend several questions to ask the IVR vendor and be prepared to answer before contract finalization. The Patient Engagement, Tracking, and Long-term Support (PETALS) initiative may be an excellent place to start for VA IVR-related questions and can be used for IVR initiation within the VA, but other vendors will be needed for nonresearch purposes. Finally, we describe the process timeline and steps to help potential users. Conclusions: IVR systems, once they are developed and implemented, can be efficient, low-cost, resource-nonintensive solutions that can effectively connect patients with needed health care services. Developing an IVR system within the VA was challenging for our research team. We experienced a large learning curve during implementation and hope that our experience and lessons will help VA personnel in the future.

Study design for a proactive teachable moment tobacco treatment intervention among patients with pulmonary nodules.

INTRODUCTION: We developed Teachable Moment to Opt-Out of Tobacco (TeaM OUT) as a tobacco treatment intervention based on a foundation of a theoretical model of teachable moments, "naturally occurring life transitions or health events thought to motivate individuals to spontaneously adopt risk-reducing health behaviors". The TeaM OUT intervention combines a teachable moment for patients with newly detected incidental pulmonary nodules with a proactive interactive voice response (IVR) system to increase connections to evidence-based tobacco treatment interventions. METHODS: We will perform a convergent, nested observational mixed-methods study utilizing both randomized trial and observational methods to test the effectiveness and generalizability of the TeaM OUT intervention through three aims. AIM 1: Among patients recently diagnosed with a pulmonary nodule, we will utilize a pragmatic, stepped wedge randomized controlled design to evaluate the effectiveness of a proactive, teachable moment-based, tobacco treatment outreach intervention (TeaM OUT) on increasing engagement with tobacco treatment resources compared to Enhanced Usual Care. AIM 2: Using a longitudinal observational design, we will evaluate the association of receipt of the TeaM OUT intervention with seven-day point abstinence prevalence and quit motivation compared to Enhanced Usual Care. AIM 3: Qualitatively elicit perspectives from key stakeholders to inform acceptability and utility, implementation barriers and facilitators, and scalability of the TeaM OUT intervention. DISCUSSION: We are hopeful that implementation of TeaM OUT will increase the number of patients who quit using cigarettes with subsequent improvements in their health.