ATTUD Journal Club Postings

How effective is internet treatment? Should we replace or add to our in-person/quitline programs?

Currently, 77% of Americans have a smartphone and 88% have daily access to the internet via computer or smart phone, with only a slightly lower prevalence in smokers. The major advantages of e-therapy are easy access, affordability and reach.

A recent meta-analysis (Do et al, Patient Preference and Adherence 2018:12, p 2065) examined 108 (!) internet studies, most of which were those using text messages. E-therapy using the internet increased quit success by 70-80% (i.e., from about 10% to 15%). However, these maybe over-estimates as very few of the studies had long-term followups and most compared e-therapy with no therapy. The analysis also found that tailoring increased success and too many prompts decreased success and that simply using a computer to deliver a treatment manual was not effective. Unfortunately, none of the studies tested combining e-therapy with in person or quitline therapy. I also looked at other reviews and could not find ideas about when to refer to e-therapy vs other therapies.

I am naïve to e-therapy and have never thought how I might decide when to refer someone to e-therapy vs in-person or quitline treatment. Also, I have never tried combining an e-therapy with in-person counseling.

Has anyone else done so and how did that work?