Design and participant characteristics of a randomized-controlled trial of telemedicine for smoking cessation among rural smokers.
BACKGROUND
In rural America cigarette smoking is prevalent, few cessation services are available, and healthcare providers lack the time and resources to help smokers quit. This paper describes the design and participant characteristics of Connect2Quit (C2Q), a randomized control trial (RCT) that tests the effectiveness and cost-effectiveness of integrated telemedicine counseling delivered by 2-way webcams mounted on desktop computers in participant's physician office examining rooms (ITM) versus quitline counseling delivered by telephone in participant's homes (Phone) for helping rural smokers quit.


METHODS
C2Q was implemented in twenty primary care and safety net clinics. Integrated telemedicine consisted of real-time video counseling, delivered to patients in their primary care physician's (PCP) office. Phone counseling, was delivered to patients in their homes. All participants received educational materials and guidance in selecting cessation medications.


RESULTS
The 566 participants were predominantly Caucasian (92%); 9% were Latino. Most (65%) earned <200% of Federal Poverty Level. One out of three lacked home internet access, 40% were not comfortable using computers, and only 4% had been seen by a doctor via telemedicine in the past. Hypertension, chronic lung disease, and diabetes were highly prevalent. Participants smoked nearly a pack a day and were highly motivated to quit.


CONCLUSIONS
C2Q is reaching a rural low-income population, with comorbid chronic diseases, that would benefit greatly from quitting smoking. ITM is a good delivery model, which integrates care by holding counseling sessions in the patient's PCP office and keeps the primary care team updated on patients' progress.


BACKGROUND



BACKGROUND
NCT00843505.
(a)Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States. Electronic address: lmussulman@kumc.edu.
Laura
L
Mussulman
(a)Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States. Electronic address: eellerbe@kumc.edu.
Edward F
EF
Ellerbeck
(a)Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States. Electronic address: acupertino@kumc.edu.
A Paula
AP
Cupertino
(c)Peabody College of Education & Human Development, University of Vanderbilt, 230 Appleton Place, Nashville, TN 37203, United States. Electronic address: kris.preacher@vanderbilt.edu.
Kristopher J
KJ
Preacher
(b)Center for Telemedicine & Telehealth, University of Kansas Medical Center, 4330 Shawnee Mission Parkway, Fairway, KS 66205, United States. Electronic address: rspaulding@kumc.edu.
Ryan
R
Spaulding
(d)Department of Psychology, University of Missouri-Kansas City, 5100 Rockhill Road, Kansas City, MO 64110, United States. Electronic address: catleyd@umkc.edu.
Delwyn
D
Catley
(a)Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States. Electronic address: lcox@kumc.edu.
Lisa Sanderson
LS
Cox
(a)Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States. Electronic address: llambart@kumc.edu.
Leah
L
Lambart
(e)Department of Nursing, University of Missouri-Kansas City, 5100 Rockhill Road, Kansas City, MO 64110, United States. Electronic address: jhunt2@kumc.edu.
Jamie J
JJ
Hunt
(a)Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States. Electronic address: nnazir@kumc.edu.
Niaman
N
Nazir
(a)Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States. Electronic address: tshireman@kumc.edu.
Theresa
T
Shireman
(b)Center for Telemedicine & Telehealth, University of Kansas Medical Center, 4330 Shawnee Mission Parkway, Fairway, KS 66205, United States. Electronic address: krichter@kumc.edu.
Kimber P
KP
Richter
D000328:Adult; D000367:Age Factors; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003367:Cotinine / Q000032:analysis; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010353:Patient Education as Topic / Q000458:organization & administration; D017060:Patient Satisfaction; D012107:Research Design; D012424:Rural Population; D012737:Sex Factors; D016540:Smoking Cessation / Q000379:methods*; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000628:therapy*
D003367:Cotinine
Primary care; RCT; Rural; Smoking cessation; Telemedicine