title: Expanding Cessation Pharmacotherapy Via Videoconference Educational Outreach to Prescribers.
abstract: BACKGROUND
  Smoking cessation pharmacotherapy is underutilized by people with mental illnesses, who smoke at high rates and die prematurely of smoking-related diseases. Educational outreach can improve prescribing, but distances impede widespread use of this practice. Little research has assessed whether videoconference can effectively deliver educational outreach. We conducted a randomized, controlled trial of in-person versus videoconference educational outreach for smoking cessation pharmacotherapy across a state mental health system.
  
  
  METHODS
  We randomly assigned clinics to receive in-person or videoconference educational outreach with audit and feedback for cessation pharmacotherapy. Prescribers completed brief questionnaires before and after the intervention. With segmented regression analysis of interrupted time series, we evaluated prescribing trends in Medicaid pharmacy claims for nicotine replacement therapy (NRT) and varenicline, with interaction terms for the effect of intervention type (in-person vs. videoconference).
  
  
  RESULTS
  With interaction terms in the model, filled NRT prescriptions increased after the intervention compared to before (p < .01). The pattern of fills after the intervention were different at centers receiving in-person compared to videoconference educational outreach (p < .02) without clearly favoring one over the other. Additionally, filled varenicline prescriptions increased after the intervention compared to before (p = .04), but type of intervention delivery did not influence varenicline fills. Prescriber satisfaction with the educational intervention was high and prescriber attitudes became more positive in both groups.
  
  
  CONCLUSIONS
  This study suggests that single session educational outreach with audit and feedback can increase cessation pharmacotherapy utilization, and that videoconference delivery could be an effective, scalable approach to improve workforce capacity in systems serving mentally ill smokers.
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH; Department of Health and Human Services, Bureau of Behavioral Health, Concord, NH Mary.f.brunette@dartmouth.edu.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Brunette
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH;
authors.forename: Nino
authors.initials: N
authors.lastname: Dzebisashvili
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH;
authors.forename: Haiyi
authors.initials: H
authors.lastname: Xie
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH;
authors.forename: Sarah
authors.initials: S
authors.lastname: Akerman
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH;
authors.forename: Joelle C
authors.initials: JC
authors.lastname: Ferron
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH;
authors.forename: Stephen
authors.initials: S
authors.lastname: Bartels
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000379:methods / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000639:trends; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D055656:Prescriptions; D011570:Psychiatry / Q000193:education* / Q000639:trends; D012907:Smoking / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D014481:United States; D000068580:Varenicline / Q000627:therapeutic use; D049269:Videoconferencing
chemical_list: D000068580:Varenicline