Real-Time Remote Therapies Effective for Smoking Cessation

Fran Lowry

December 11, 2018

BONITA SPRINGS, Florida — Offering evaluation and treatment for smoking cessation via audiovisual (AV) conferencing results in quit rates equivalent to those achieved with in-person treatment, new research shows.

Dr Kareem Seoudy

Real-time AV conferencing, or telemedicine, has the potential to bridge a big gap in healthcare delivery, making it easier to provide highly specialized care from academic centers, which are usually in urban areas, to any remote location, said lead investigator Kareem Seoudy, MD, University of Texas MD Anderson Cancer Center, Houston.

The study was presented here at the American Academy of Addiction Psychiatry (AAAP) 29th Annual Meeting.

"MD Anderson has three different locations other than the main location in Houston, and we wanted people who would go for treatment at those three regional care centers to have access to the same tobacco treatment program we have here, and we thought telemedicine would be worth trying," Seoudy told Medscape Medical News.

The AV conferencing uses software from Zoom Video Communications, Inc. Seoudy noted that the software works like Facetime or Skype but is more secure and reliable.

"Patients go to one of the three other MD Anderson locations and check in as though they are going to see a physician. They enter a room where there is a large TV screen and a camera. A program psychiatrist starts the session. This is followed by a therapy session, given by a psychotherapist, which lasts from 1 to 2 hours," said Seoudy.

Following the session, the psychiatrist returns to discuss potential medical treatment. Participants on both sidescan see each other clearly, he added.

"That's the reason it's as successful as an in-person consultation. Patients and physicians are able to see the facial expressions, they are able to interact just as if they were in the same room," Seoudy said.

Abstinence Rates

The current case-control study evaluated a total of 4779 patients in MD Anderson's Tobacco Treatment Program who were seen from January 2012 to August 2018.

Of these, 4481 patients (94%) were seen in person, and 298 patients (6%) were seen via AV conferencing. More than 90% of the follow-ups were conducted by telephone in both groups.

Abstinence rates were similar and did not show a significant difference at 3 months (P > .172), 6 months (P > .171), or 9 months (P > .54).

Other variables, such as years of smoking, scores on the Fagerstrom Test for Nicotine Dependence, and carbon monoxide levels, were similar for both groups, with no statistical difference.

Depression, anxiety, and sleep scores were significantly higher among patients who were seen in person. This was most likely due to the fact that the patients who were seen at MD Anderson's main campus were more acutely ill, Seoudy said.

Currently, patients living in remote areas have to travel to one of MD Anderson's auxiliary centers to receive smoking cessation treatment. However, this may change, he said.

"We are trying to extend the use of telepsychiatry for tobacco treatment to everyone in Texas by giving them the access to have Zoom on their phone and do the consultations any time they want. As long as we have enough therapists, we can do that," Seoudy said.

"Imagine how much it could help if you are a smoker, and you are looking for help, and you can do it from home, and not just over a telephone line. You can see someone talking to you, and that someone is going to prescribe medication and send it to your house. You would be saving money, and it would be so much more convenient," he said.

Findings Encouraging, Not Surprising

Commenting on the findings for Medscape Medical News, Jonathan C. Fellers, MD, Tufts University School of Medicine, and director of integrated medication-assisted treatment, Maine Medical Center, Portland, said it has been known for some time that telephone support for tobacco cessation is effective.

"We've known for a while that telephonic support for tobacco cessation — for instance, through telephone hot lines and help lines — is just as effective as in-person counseling for tobacco cessation, so it's not entirely surprising to me that real-time audiovisual counseling can work," he said.

He added that the findings are encouraging because they show there are ways to expand treatment to underserved populations.

"This is something that I am very interested in, because Maine is a rural state, and it's very hard to reach a lot of people," said Fellers, who was not part of the study.

He added that being able to prescribe medication via AV conferencing was noteworthy.

"We know that the counseling component is just as effective through the telephone, but being able to prescribe adjuvant medications via AV is very good news.

"We don't have that many studies comparing telepsychiatry services or telehealth services with in-person services, so I think this is a really neat study just because it does make that comparison," he said.

Dr Seoudy and Dr Fellers have disclosed no relevant financial relationships.

American Academy of Addiction Psychiatry (AAAP) 29th Annual Meeting: Poster 3. Presented December 9, 2018.

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