title: Empowering smokers with a web-assisted tobacco intervention to use prescription smoking cessation medications: a feasibility trial.
abstract: BACKGROUND
  Varenicline and bupropion, efficacious smoking cessation medications, have had suboptimal impact due to barriers at the patient, practitioner and system level. This study explored the feasibility of a web-assisted tobacco intervention offering free prescription smoking cessation medication by mail if the smoker visited a physician for authorization.
  
  
  METHODS
  Adult Ontarians, smoking at least 10 cigarettes daily, intending to quit within 30 days, with no contraindications to bupropion or varenicline were eligible. After an online assessment, eligible participants received an electronic personalized printable prescription form for a 12-week course of varenicline or bupropion to bring to a physician within 3 weeks for authorization, if appropriate. The physician's office faxed prescriptions to an online pharmacy that couriered medication to the patient following medication counselling by telephone. Weekly motivational emails were sent during treatment. Participants were asked to complete follow-up questionnaires online at 7, 11, 15 and 41 weeks after enrollment.
  
  
  RESULTS
  In total, 1214 individuals submitted an online assessment from April to September 2010 and 73.6 % (95 % confidence interval (CI) = 71.1-76.1 %; n = 893) were eligible. At least 65.8 % (95 % CI = 62.7-68.9 %; n = 588) of eligible participants subsequently visited a physician and 58.7 % (95 % CI = 55.5-61.9 %; n = 524) received medication (50.6 % varenicline [n = 265] and 49.4 % bupropion [n = 259]). Reasons for not filling a prescription were failure to visit a physician (80.1 %; 95 % CI = 73.8-86.5 %; n = 121), physician not prescribing the medication (15.9 %; 95 % CI = 10.1-21.7 %; n = 24) or other reasons (4.0 %; 95 % CI = 0.9-7.1 %; n = 6). Follow-up response rate was 66.7 % (95 % CI = 63.7-69.8 %; n = 596). Minimal issues were encountered with printing the prescription or medication delivery.
  
  
  CONCLUSIONS
  This study establishes the feasibility of using the Internet and free medication to enable smokers to engage physicians to treat this addiction. Implementation of this intervention can be scaled up by leveraging existing healthcare systems to treat smokers on a population level. Further evaluation in a randomized controlled trial is necessary.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier NCT01023659.
authors.affiliation: Addictions Program, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, ON, M6J 1H4, Canada. peter.selby@camh.ca.|Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada. peter.selby@camh.ca.|Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada. peter.selby@camh.ca.|Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. peter.selby@camh.ca.|Ontario Tobacco Research Unit, 155 College Street, Toronto, ON, M5T 3M7, Canada. peter.selby@camh.ca.
authors.forename: Peter
authors.initials: P
authors.lastname: Selby
authors.affiliation: Addictions Program, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, ON, M6J 1H4, Canada. sarwar.hussain@camh.ca.
authors.forename: Sarwar
authors.initials: S
authors.lastname: Hussain
authors.affiliation: Addictions Program, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, ON, M6J 1H4, Canada. sabrina.voci@camh.ca.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Voci
authors.affiliation: Addictions Program, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, ON, M6J 1H4, Canada. laurie.zawertailo@camh.ca.|Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. laurie.zawertailo@camh.ca.
authors.forename: Laurie
authors.initials: L
authors.lastname: Zawertailo
mesh_terms: D000328:Adult; D016642:Bupropion / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009819:Office Visits; D009864:Ontario; D011177:Postal Service; D011209:Power, Psychological; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices; D000068580:Varenicline / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D016642:Bupropion; D000068580:Varenicline