Testing a Computer-Assisted Intervention in Primary Care for Patients Who Smoke and Have a Sedentary Lifestyle

In 2000–2001, investigators at the Centers for Behavioral and Preventive Medicine at Miriam Hospital, in Providence, R.I., conducted a study to test the feasibility of using a point-of-care computer system to assess patient risk of smoking or physical inactivity and assist physicians with appropriate counseling.

Under this grant, researchers:

  • Developed content on smoking and physical activity for a 10-minute computer program.
  • Met with physicians and office staff to integrate use of the computerized system into the office routine.
  • Installed a laptop and a printer for a one-month trial in 10 practices.
  • Recruited 15 patients at each site to pretest the intervention system.
  • Subsequently monitored patients' unprompted use of the computer system. A total of 150 patients used the program and completed exit interviews during routine care.
  • Conducted exit meetings with each practice to discuss problems.

Key Findings

  • The computer program was underutilized in routine care.
  • Physicians and office staff reported four main barriers to incorporating the computer program into routine care.
    • Overall, the program was viewed as inconsistent with the practice workflow.
    • Staff were inexperienced with the program.
    • Technical problems emerged with the computer and/or printer.
    • The program placed an additional time burden on already overworked staff.
  • Physicians and office staff made four recommendations to improve the program and its utilization.
    • Shorten the program.
    • Orient the program to a target patient population (e.g., those with hypertension).
    • Include other conditions pertinent to primary care (e.g., screen for depression).
    • Select patients to use the system rather than ask all patients to use it.