Program Profile

Implementing Smoking Cessation Telehealth Technologies Within the VHA: Lessons Learned

Fed Pract. 2023 August;40(8):256-260 | doi:10.12788/fp.0393

References

2. Damschroder LJ, Lowery JC. Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR). Implement Sci. 2013;8:51. Published 2013 May 10. doi:10.1186/1748-5908-8-51

3. Pew Research Center. Mobile Fact Sheet. April 7, 2021. Accessed June 6, 2023. https://www.pewresearch.org/internet/fact-sheet/mobile/

4. Lieser EK. Study: Only 40 Percent of U.S. Households Have a Landline. The National Interest. March 20, 2020. Accessed June 6, 2023. https://nationalinterest.org/blog/buzz/study-only-40-percent-us-households-have-landline-135212

5. Lee H, Friedman ME, Cukor P, David Ahern. Interactive voice response system (IVRS) in health care services. Nurs Outlook. 2003;51(6):277-283. doi:10.1016/S0029-6554(03)00161-1

6. IBM Cloud Education. What is interactive voice response (IVR)? IBM. March 15, 2021. Accessed June 6, 2023. https://www.ibm.com/cloud/learn/interactive-voice-response

7. Sparrow D, Aloia M, Demolles DA, Gottlieb DJ. A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial. Thorax. 2010;65(12):1061-1066. doi:10.1136/thx.2009.133215

8. Cohen-Cline H, Wernli KJ, Bradford SC, Boles-Hall M, Grossman DC. Use of interactive voice response to improve colorectal cancer screening. Med Care. 2014;52(6):496-499. doi:10.1097/MLR.0000000000000116

9. Graham J, Tomcavage J, Salek D, Sciandra J, Davis DE, Stewart WF. Postdischarge Monitoring Using Interactive Voice Response System Reduces 30-Day Readmission Rates in a Case-managed Medicare Population. Med Care. 2012;50(1):50-57. doi:10.1097/MLR.0b013e318229433e

10. Piette JD, Newman S, Krein SL, et al. Patient-centered pain care using artificial intelligence and mobile health tools: a randomized comparative effectiveness trial. JAMA Intern Med. 2022;182(9):975-83. doi:10.1001/jamainternmed.2022.3178

11. Posadzki P, Mastellos N, Ryan R, et al. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev. 2016;12(12):CD009921. Published 2016 Dec 14. doi:10.1002/14651858.CD009921.pub2

12. Haas JS, Linder JA, Park ER, et al. Proactive tobacco cessation outreach to smokers of low socioeconomic status: A randomized clinical trial. JAMA Intern Med. 2015;175(2):218-226. doi:10.1001/jamainternmed.2014.6674

13. Fingrut W, Stewart L, Cheung KW. Choice of smoking cessation counselling via phone, text, or email in emergency department patients. Prev Med Rep. 2016;4:597-600. doi:10.1016/j.pmedr.2016.10.010

14. Levy DE, Klinger EV, Linder JA, et al. Cost-effectiveness of a health system-based smoking cessation program. Nicotine Tob Res. 2017;19(12):1508-1515. doi:10.1093/ntr/ntw243

15. Heapy AA, Higgins DM, LaChappelle KM, et al. Cooperative pain education and self-management (COPES): Study design and protocol of a randomized non-inferiority trial of an interactive voice response-based self-management intervention for chronic low back pain. BMC Musculoskelet Disord. 2016;17:85. doi:10.1186/s12891-016-0924-z

16. Chen D, Wu LT. Smoking cessation interventions for adults aged 50 or older: a systematic review and meta-analysis. Drug Alcohol Depend. 2015;154:14-24. doi:10.1016/j.drugalcdep.2015.06.004

17. Bennett-Levy J, Richards D, Farrand P, et al. Oxford Guide to Low Intensity CBT Interventions. 1st ed. Oxford University Press; 2010.

18. Unger S, Golden SE, Melzer AC, et al. Study design for a proactive teachable moment tobacco treatment intervention among patients with pulmonary nodules. Contemp Clin Trials. 2022;121:106908. doi:10.1016/j.cct.2022.106908

19. US Department of Veterans Affairs. VA Information Resource Center [Internet]. VIReC Research User Guides. 2016. https://www.virec.research.va.gov/Resources/RUGs.asp

20. PETALS. US Department of Veteran Affairs. Updated June 14, 2021. Accessed June 6, 2023. https://www.annarbor.hsrd.research.va.gov/ANNARBORHSRDRESEARCH/PETALS.asp

Patient Engagement, Tracking, and Long-term Support

The new Patient Engagement, Tracking, and Long-term Support (PETALS) initiative is an excellent place to start with any VA IVR-related questions. PETALS is used for research.²⁰ We hoped to use this system for our study, but its implementation was delayed until 2022. The PETALS system is designed for VA investigators who conduct research studies and need a secure platform that is compliant with VA policies for deploying SMS and IVR systems for research.²⁰ At this time, PETALS is for use only with veterans, so if research will occur outside the VA, you must use an outside vendor. Users who want to set up a new IVR system can ask their local contracting office whether any contracts have already been established for IVR development and support.

From our perspective as researchers who are not telehealth savvy, we encountered several delays from failing to ask the appropriate questions or inability to navigate complicated systems. For instance, there were several tasks that needed to be completed and were not included in the original timeline developed by the vendor and researcher. Therefore, it is important to have clear communication on both sides about who is doing what, when, and how. We tried to detail these unexpected steps to help researchers, administrators, or other VA employees in the future.

Conclusions

IVR systems, once they are developed and implemented, can be efficient, low-cost, resource-nonintensive solutions in a health care setting that can effectively connect patients with needed health care services. Our experience developing an IVR system within the VA was challenging and was a huge learning curve for our research team. We hope that our experience and lessons will help VA personnel in the future.

Acknowledgments

Thank you to everyone involved in this project and who answered questions about the process, especially Nicolle Marinec, MPH; Toan Tran, and Molly Delorit, BA. This study and Christopher Slatore, MD, are supported by an award from the US Department of Veterans Affairs (HSR&D IIR 19-425). It was also supported by resources from the Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon (VAPORHCS).

References

1. Lewis CC, Mettert K, Lyon AR. Determining the influence of intervention characteristics on implementation success requires reliable and valid measures: results from a systematic review. Implement Res Pract. 2021;2:2633489521994197. doi:10.1177/2633489521994197

2. Damschroder LJ, Lowery JC. Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR). Implement Sci. 2013;8:51. Published 2013 May 10. doi:10.1186/1748-5908-8-51

3. Pew Research Center. Mobile Fact Sheet. April 7, 2021. Accessed June 6, 2023. https://www.pewresearch.org/internet/fact-sheet/mobile/

4. Lieser EK. Study: Only 40 Percent of U.S. Households Have a Landline. The National Interest. March 20, 2020. Accessed June 6, 2023. https://nationalinterest.org/blog/buzz/study-only-40-percent-us-households-have-landline-135212

5. Lee H, Friedman ME, Cukor P, David Ahern. Interactive voice response system (IVRS) in health care services. Nurs Outlook. 2003;51(6):277-283. doi:10.1016/S0029-6554(03)00161-1

6. IBM Cloud Education. What is interactive voice response (IVR)? IBM. March 15, 2021. Accessed June 6, 2023. https://www.ibm.com/cloud/learn/interactive-voice-response

7. Sparrow D, Aloia M, Demolles DA, Gottlieb DJ. A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial. Thorax. 2010;65(12):1061-1066. doi:10.1136/thx.2009.133215

8. Cohen-Cline H, Wernli KJ, Bradford SC, Boles-Hall M, Grossman DC. Use of interactive voice response to improve colorectal cancer screening. Med Care. 2014;52(6):496-499. doi:10.1097/MLR.0000000000000116

9. Graham J, Tomcavage J, Salek D, Sciandra J, Davis DE, Stewart WF. Postdischarge Monitoring Using Interactive Voice Response System Reduces 30-Day Readmission Rates in a Case-managed Medicare Population. Med Care. 2012;50(1):50-57. doi:10.1097/MLR.0b013e318229433e

10. Piette JD, Newman S, Krein SL, et al. Patient-centered pain care using artificial intelligence and mobile health tools: a randomized comparative effectiveness trial. JAMA Intern Med. 2022;182(9):975-83. doi:10.1001/jamainternmed.2022.3178

11. Posadzki P, Mastellos N, Ryan R, et al. Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database Syst Rev. 2016;12(12):CD009921. Published 2016 Dec 14. doi:10.1002/14651858.CD009921.pub2

12. Haas JS, Linder JA, Park ER, et al. Proactive tobacco cessation outreach to smokers of low socioeconomic status: A randomized clinical trial. JAMA Intern Med. 2015;175(2):218-226. doi:10.1001/jamainternmed.2014.6674

13. Fingrut W, Stewart L, Cheung KW. Choice of smoking cessation counselling via phone, text, or email in emergency department patients. Prev Med Rep. 2016;4:597-600. doi:10.1016/j.pmedr.2016.10.010

14. Levy DE, Klinger EV, Linder JA, et al. Cost-effectiveness of a health system-based smoking cessation program. Nicotine Tob Res. 2017;19(12):1508-1515. doi:10.1093/ntr/ntw243

15. Heapy AA, Higgins DM, LaChappelle KM, et al. Cooperative pain education and self-management (COPES): Study design and protocol of a randomized non-inferiority trial of an interactive voice response-based self-management intervention for chronic low back pain. BMC Musculoskelet Disord. 2016;17:85. doi:10.1186/s12891-016-0924-z

16. Chen D, Wu LT. Smoking cessation interventions for adults aged 50 or older: a systematic review and meta-analysis. Drug Alcohol Depend. 2015;154:14-24. doi:10.1016/j.drugalcdep.2015.06.004

17. Bennett-Levy J, Richards D, Farrand P, et al. Oxford Guide to Low Intensity CBT Interventions. 1st ed. Oxford University Press; 2010.

18. Unger S, Golden SE, Melzer AC, et al. Study design for a proactive teachable moment tobacco treatment intervention among patients with pulmonary nodules. Contemp Clin Trials. 2022;121:106908. doi:10.1016/j.cct.2022.106908

19. US Department of Veterans Affairs. VA Information Resource Center [Internet]. VIReC Research User Guides. 2016. https://www.virec.research.va.gov/Resources/RUGs.asp

20. PETALS. US Department of Veteran Affairs. Updated June 14, 2021. Accessed June 6, 2023. https://www.annarbor.hsrd.research.va.gov/ANNARBORHSRDRESEARCH/PETALS.asp

A new and completely different pain medicine

Implementing Smoking Cessation Telehealth Technologies Within the VHA: Lessons Learned

Author disclosures

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References

Patient Engagement, Tracking, and Long-term Support

Conclusions

Acknowledgments

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