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Proactively offered text messages and mailed nicotine replacement therapy for smokers in primary care practices: A pilot randomized trial.

BACKGROUND
Proactive, population health cessation programs can guide efforts to reach smokers outside of the clinic to encourage quit attempts and treatment use. This study aimed to measure trial feasibility and preliminary effects of a proactive intervention offering text messages and/or mailed nicotine replacement therapy (NRT) to smokers in primary care clinics.


METHODS
From 2017-2019 we performed a pilot randomized trial comparing brief telephone advice (control: BA), text messages (TM), 2-weeks of mailed NRT, or both interventions (TM+NRT). Patients were identified using electronic health records and contacted proactively by telephone to assess interest in the study. We compared quit attempts, treatment use, and cessation in the intervention arms with BA.


RESULTS
Of 986 patients contacted, 153 (16%) enrolled (mean age 53 years, 57% female, 76% white, 11% black, 8% Hispanic, 52% insured by Medicaid) and 144 (94%) completed the 12-week assessment. On average, patients in the TM arms received 159 messages (99.4% sent, 0.6% failed), sent 19 messages and stayed in the program for 61 days. In all groups, a majority of patients reported quit attempts (BA 67% versus TM 86% [p=0.07], NRT 81% [p=0.18], TM+NRT 79% [p=0.21]) and NRT use (BA 51% versus NRT 83% [p=0.007], TM 65% [p=0.25], TM+NRT 76% [p=0.03]). Effect estimates for reported 7-day abstinence were BA 10% versus TM 26% (p=0.09), NRT 28% (p=0.06), and TM+NRT 23% (p=0.14).


CONCLUSIONS
Proactively offering text messages or mailed nicotine medications was feasible among primary care smokers and a promising approach to promote quit attempts and short-term abstinence.