BACKGROUND Clinical decision support systems (CDSSs) may promote practitioner adherence to evidence-based guidelines. This study examined if the addition of a CDSS influenced practitioner delivery of a brief intervention with treatment-seeking smokers who were drinking above recommended alcohol consumption guidelines, compared with practitioners who do not receive a CDSS prompt. METHODS This was a cluster randomized controlled trial conducted in primary health care clinics across Ontario, Canada, implementing the Smoking Treatment for Ontario Patients (STOP) smoking cessation program. Clinics randomized to the intervention group received a prompt when a patient reported consuming alcohol above the Canadian Cancer Society (CCS) guidelines; the control group did not receive computer alerts. The primary outcome was an offer of an appropriate educational alcohol resource, an alcohol reduction workbook for patients drinking above the CCS guidelines, and an abstinence workbook to patients scoring above 20 points in the AUDIT screening tool; the secondary outcome was patient acceptance of the resource. The tertiary outcome was patient abstinence from smoking, and alcohol consumption within CCS guidelines, at 6-month follow-up. Results were analyzed using a generalized estimation approach for fitting logistic regression using a population-averaged method. RESULTS Two hundred and twenty-one clinics across Ontario were randomized for this study; 110 to the intervention arm and 111 to the control arm. From the 15,222 patients that enrolled in the smoking cessation program, 15,150 (99.6% of patients) were screened for alcohol use and 5715 patients were identified as drinking above the CCS guidelines. No statistically significant difference between groups was seen in practitioner offer of an educational alcohol resource to appropriate patients (OR = 1.19, 95% CI 0.88-1.64, p = 0.261) or in patient abstinence from smoking and drinking within the CCS guidelines at 6-month follow-up (OR = 0.93, 95% CI 0.71-1.22, p = 0.594). However, a significantly greater proportion of patients in the intervention group accepted the alcohol resource offered to them by their practitioner (OR = 1.48, 95% CI 1.01-2.16, p = 0.045). CONCLUSION A CDSS may not increase the likelihood of practitioners offering an educational alcohol resource, though it may have influenced patients' acceptance of the resource. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov, number NCT03108144 , registered on April 11, 2017, "retrospectively registered".

中文翻译：

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临床决策支持系统对在初级保健戒烟计划中提示高危饮酒的干预措施的效果：一项整群随机试验。

背景技术临床决策支持系统（CDSS）可以促进从业者遵守基于证据的指南。这项研究检查了CDSS的添加是否对从业者提供了短暂干预，而这些参与者与未接受CDSS提示的从业者相比，饮酒超过建议的饮酒指南的寻求治疗的吸烟者要进行简短的干预。方法这是一项在加拿大安大略省初级卫生保健诊所进行的整群随机对照试验，用于实施安大略省患者戒烟治疗（STOP）戒烟计划。当患者报告饮酒高于加拿大癌症协会（CCS）指南时，随机分配给干预组的诊所会收到提示。对照组没有收到计算机警报。主要结果是提供适当的教育性酒精资源，针对超过CCS指南的饮酒患者的减酒工作簿以及针对在AUDIT筛查工具中得分超过20分的患者的戒酒工作簿；次要结果是患者对资源的接受程度。三级结局是在6个月的随访中患者戒烟和CCS指南规定的饮酒量。使用广义估计方法对结果进行分析，以使用总体平均方法进行逻辑回归拟合。结果安大略省的221家诊所被随机分配用于这项研究。110到介入臂，111到控制臂。在参加戒烟计划的15222名患者中，有15150名（99。对6％的患者进行了酒精滥用筛查，并确定有5715例患者的饮酒水平高于CCS指南。在从业者向适当的患者提供教育性酒精资源（OR = 1.19，95％CI 0.88-1.64，p = 0.261）或在CCS指南6至6禁止吸烟和饮酒的患者中，两组之间没有统计学上的显着差异。个月随访（OR = 0.93，95％CI 0.71-1.22，p = 0.594）。但是，干预组中有更大比例的患者接受了从业人员提供给他们的酒精资源（OR = 1.48，95％CI 1.01-2.16，p = 0.045）。结论CDSS可能不会增加从业人员提供教育性酒精资源的可能性，尽管它可能影响患者对酒精资源的接受程度。