title: Comparative Effectiveness of an Internet-Based Smoking Cessation Intervention Versus Clinic-Based Specialty Care for Veterans.
abstract: The primary objective of this project was to examine the effectiveness of an Internet-based smoking cessation intervention combined with a tele-health medication clinic for nicotine replacement therapy (NRT) compared to referral to clinic-based smoking cessation care.
  
  
  
  A total of 413 patients were proactively recruited from the Durham VA Medical Center and followed for 12 months. Patients were randomized to receive either a referral to VA specialty smoking cessation care (control) or to the Internet intervention and tele-health medication clinic. Primary outcomes included (1) intervention reach, (2) self-reported 7-day point prevalence abstinence rates at 3 months and 12 months, and 3) relative cost-effectiveness.
  
  
  
  Reach of the Internet intervention and use of smoking cessation aids were significantly greater compared to the control. At 3 months-post randomization, however, there were no significant differences in quit rates: 17% (95% CI: 12%–23%) in the Internet-based intervention compared to 12% (95% CI: 8%–17%) in the control arm. Similarly, there were no differences in quit rates at 12 months (13% vs. 16%). While costs associated with the Internet arm were higher due to increased penetration and intensity of NRT use, there were no statistically significant differences in the relative cost effectiveness (e.g., life years gained, quality adjusted life years) between the two arms.
  
  
  
  Current results suggest that using an electronic medical record to identify smokers and proactively offering smoking cessation services that are consistent with US Public Health Guidelines can significantly reduce smoking in veterans. Novel interventions that increase the reach of intensive treatment are needed to maximize quit rates in this population.
authors: Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA. Electronic address: Patrick.calhoun2@va.gov.
authors: Patrick S
authors: PS
authors: Calhoun
authors: Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA; Department of General Internal Medicine, Duke University Medical Center, Durham, NC, 27705, USA.
authors: Santanu
authors: S
authors: Datta
authors: Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, 27705, USA.
authors: Maren
authors: M
authors: Olsen
authors: Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA; Department of General Internal Medicine, Duke University Medical Center, Durham, NC, 27705, USA.
authors: Valerie A
authors: VA
authors: Smith
authors: Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA.
authors: Scott D
authors: SD
authors: Moore
authors: Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA.
authors: Lauren P
authors: LP
authors: Hair
authors: Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA.
authors: Eric A
authors: EA
authors: Dedert
authors: Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA.
authors: Angela
authors: A
authors: Kirby
authors: Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA.
authors: Michelle
authors: M
authors: Dennis
authors: Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA.
authors: Jean C
authors: JC
authors: Beckham
authors: Department of Medicine, University of Connecticut Medical Center, Farmington, CT, 06030, USA; VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, 06516, USA.
authors: Lori A
authors: LA
authors: Bastian
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D016540:Smoking Cessation / Q000191:economics / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D061485:Tobacco Use Cessation Devices / Q000191:economics; D014728:Veterans
keywords: Internet intervention; Smoking cessation; Tele-health; Veterans