@文章{信息:doi/10.2196/38663，作者=“Dahne, Jennifer和Player, Marty S和Strange, Charlie和Carpenter, Matthew J和Ford, Dee W和King, Kathryn和Miller, Sarah和Kruis, Ryan和Hawes, Elizabeth和Hidalgo, Johanna E和Diaz, Vanessa A”，标题=“初级保健中戒烟和慢性阻塞性肺疾病筛查的主动电子访问:可行性、可接受性和有效性随机对照试验”，期刊=“J Med Internet Res”，年=“2022”，月=“8”，日=“30”，卷=“24”，数=“8”，页=“e38663”，关键词=“电子访诊”;e-visit;慢性阻塞性肺病;慢性阻塞性肺病;戒烟;远程医疗;电子健康档案;病人门户;电子健康档案; feasibility; efficacy; intervention; screening; diagnosis; prevention; treatment; management; acceptability; pulmonary; function", abstract="Background: Most smokers with chronic obstructive pulmonary disease (COPD) have not yet been diagnosed, a statistic that has remained unchanged for over two decades. A dual-focused telehealth intervention that promotes smoking cessation, while also facilitating COPD screening, could help address national priorities to improve the diagnosis, prevention, treatment, and management of COPD. The purpose of this study was to preliminarily evaluate an integrated asynchronous smoking cessation and COPD screening e-visit (electronic visit) that could be delivered proactively to adult smokers at risk for COPD, who are treated within primary care. Objective: The aims of this study were (1) to examine e-visit feasibility and acceptability, particularly as compared to in-lab diagnostic pulmonary function testing (PFT), and (2) to examine the efficacy of smoking cessation e-visits relative to treatment as usual (TAU), all within primary care. Methods: In a randomized clinical trial, 125 primary care patients who smoke were randomized 2:1 to receive either proactive e-visits or TAU. Participants randomized to the e-visit condition were screened for COPD symptoms via the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE). Those with scores ≥2 were invited to complete both home spirometry and in-lab PFTs, in addition to two smoking cessation e-visits. Smoking cessation e-visits assessed smoking history and motivation to quit and included completion of an algorithm to determine the best Food and Drug Administration--approved cessation medication to prescribe. Primary outcomes included measures related to (1) e-visit acceptability, feasibility, and treatment metrics; (2) smoking cessation outcomes (cessation medication use, 24-hour quit attempts, smoking reduction ≥50{\%}, self-reported abstinence, and biochemically confirmed abstinence); and (3) COPD screening outcomes. Results: Of 85 participants assigned to the e-visits, 64 (75.3{\%}) were invited to complete home spirometry and in-lab PFTs based on CAPTURE. Among those eligible for spirometry, 76.6{\%} (49/64) completed home spirometry, and 35.9{\%} (23/64) completed in-lab PFTs. At 1 month, all cessation outcomes favored the e-visit, with a significant effect for cessation medication use (odds ratio [OR]=3.22). At 3 months, all cessation outcomes except for 24-hour quit attempts favored the e-visit, with significant effects for cessation medication use (OR=3.96) and smoking reduction (OR=3.09). Conclusions: A proactive, asynchronous e-visit for smoking cessation and COPD screening may offer a feasible, efficacious approach for broad interventions within primary care. Trial Registration: ClinicalTrials.gov NCT04155073; https://clinicaltrials.gov/ct2/show/NCT04155073 ", issn="1438-8871", doi="10.2196/38663", url="//www.mybigtv.com/2022/8/e38663", url="https://doi.org/10.2196/38663", url="http://www.ncbi.nlm.nih.gov/pubmed/36040766" }