A Clinic-Randomized Trial of a Clinical Decision Support System to Improve Dental Provider Delivery of Brief Tobacco Interventions and Quitline Referrals (ENGAGE: Engaging patients in Tobacco Cessation)
Principal Investigator: D. Brad Rindal, DDS
Study sponsor: National Institutes of Dental and Craniofacial Research
-University of Pittsburgh School of Dental Medicine
-Indiana University School of Dentistry
Purpose of study: Use of clinical decision support (CDS) within electronic dental record systems (EDRs) holds much potential to improve the translation of current scientific evidence into clinical practice and improve the delivery of optimal, evidence-based, personalized treatment. Health care providers have access to evidence-based guidelines that help patients quit smoking. Translation of that knowledge and awareness into daily practice, however, remains low.
This clinic-randomized trial will examine the rate at which dental providers deliver a smoking intervention and refer to a quitline when their EDR system includes health information technology-driven CDS compared with providers in control clinics without assistance from the CDS. Providers include experienced dentists and dental hygienists in private practices and predoctoral and dental hygiene students in dental schools. The primary outcome is a binary variable indicating whether the provider delivered a brief intervention or referral for treatment, as reported by the patient. Additional outcomes include patient self-reported actions toward quitting, smoking reduction, and smoking cessation. Provider-level barriers, facilitators, and potential mechanisms accounting for the effect of tobacco CDS will be examined. Using EDRs to translate current evidence into dental practice holds much potential yet is unrealized in both clinical training and practice. By leveraging the dental encounter as an opportunity to deliver smoking cessation, we can further decrease smoking rates, leading to improved population health.
Inclusion Criteria: Patients seen in the involved clinics will be screened for eligibility during usual care.
REdefining THerapy In Early COPD (RETHINC)
Principal Investigator: Charlene McEvoy, MD
University of Michigan
National Heart, Lung, and Blood Institute (NHLBI)
Location: Regions Hospital
Phase of Study: Phase 3
Purpose of study: The purpose of this study is to evaluate a drug (indacaterol/glycopyrrolate.) that may help improve breathing in people who do not meet the current criteria for COPD but have respiratory symptoms (such as coughing and shortness of breath). Indacaterol/glycopyrrolate is an inhaled medication that is a FDA approved medication for people who have Chronic Obstructive Pulmonary Disease (COPD). In this study, some people will receive the investigational drug (indacaterol/glycopyrrolate) and some people will receive a placebo. A placebo looks like the study drug but does not contain any drug. Researchers use a placebo to see if indacaterol/glycopyrrolate works better than taking placebo.
-Subject must be able to understand and provide informed consent
-≥10 pack-year smoking history
-Post-bronchodilator FEV1/FVC ratio ≥0.70
-Inability or unwillingness of a participant to give written informed consent or comply with study protocol.
-Subject is pregnant, breast-feeding, or plans to become pregnant.
-Active pulmonary infection or prior pulmonary infection where antibiotic and/or steroid treatment was completed ≤4 weeks prior to enrollment.
-Post-BD FVC < 70% predicted
-A primary diagnosis of asthma established by each study investigator based on ATS/ERS criteria as previously implemented in the MACRO clinical trial.
-Known concomitant lung disease, pulmonary tuberculosis (unless confirmed by chest x-ray to be no longer active), or clinically significant bronchiectasis.
-History (or family history) of long QT syndrome.
-History of paroxysmal (intermittent) atrial fibrillation will be considered an exclusion. Patients with persistent atrial fibrillation as defined by continuous atrial fibrillation for at least 6 months and controlled with a rate control strategy (i.e., selective beta blocker, calcium channel blocker, pacemaker placement, digoxin or ablation therapy) for at least 6 months may be considered for inclusion. In such patients, heart rate at enrollment must be < 100/min.
-Patients with BMI < 15 or more than 40 kg/m2.
-Patients with diabetes Type I or uncontrolled diabetes Type II.
-Patients who, in the judgment of the investigator, have a clinically relevant laboratory abnormality or a clinically significant condition such as (but not limited to) significant renal disease, psychiatric disease, gastrointestinal disease, unstable ischemic heart disease, arrhythmia (excluding chronic stable atrial fibrillation), uncontrolled hypertension or any other condition which in the opinion of investigator might compromise patient safety or compliance, interfere with evaluation, or preclude completion of the study.
-Patients with any history of lung cancer.
-Patients with narrow-angle glaucoma, symptomatic benign prostatic hyperplasia or bladder-neck obstruction or severe renal impairment or urinary retention. Benign Prostatic Hyperplasia (BPH) patients who are stable on treatment can be considered.
-Any other past or current medical problems or findings from physical examination or laboratory testing that are not listed above, which, in the opinion of the investigator, may pose additional risks from participation in the study, may interfere with the participant’s ability to comply with study requirements or that may impact the quality or interpretation of the data obtained from the study.
-Patients with a history of hypersensitivity to any of the study drugs or to drugs from similar chemical classification, including untoward reactions to sympathomimetic amines or inhaled medication or any component thereof.
-Patients unable to successfully use a dry powder inhaler device or perform spirometry measurements.
-Use of other investigational drugs at the time of enrollment or within 30 days or 5 half-lives of enrollment, whichever is longer.
-Patients receiving any protocol-specified prohibited medications..
-Patients receiving any protocol-specified prohibited COPD related medications (will be required to undergo a required washout period prior to enrollment).