Emergency Department-Initiated Tobacco Dependence Treatment

Department of Respiratory and Surgical Technology, College of Health Related Professions, University of Arkansas for Medical Sciences, Little Rock, USA.
American journal of health behavior (Impact Factor: 1.31). 09/2011; 35(5):546-56. DOI: 10.5993/AJHB.35.5.4
Source: PubMed


To examine the feasibility of a fax referral program to increase enrollment in tobacco dependence treatment in emergency department (ED) patients.
The control group received quit advice and printed information; the intervention group also received a faxed referral that generated telephone contacts.
Treatment enrollment was higher in the intervention group (13.5% vs 2.7%). Only the faxed referral was associated with treatment enrollment.
An ED intervention is feasible. Faxed referral resulted in a 5-fold increase in tobacco treatment enrollment. The ED may be an opportune setting to facilitate smoking-cessation behavior change among lower income, underserved patients.

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Available from: Christine Elizabeth Sheffer, Sep 23, 2015
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    • "Second, it is possible that screened individuals, in an effort to maintain social desirability, accepted referrals without really being interested in treatment or intentionally provided an incorrect phone number so they could not be reached. It is important to note that the current study demonstrated a very similar proportion of unreachable referred patients (Willett et al., 2009) and greater rates of treatment enrollment (Anders et al., 2011) than previous studies using faxed tobacco cessation referrals. Third, some institutions do not allow volunteers to perform the same services as paid employees (e.g., research assistants; project coordinators), which would negate much of the cost saving associated with the presented protocol. "
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    ABSTRACT: Objective: The objective of this study was to investigate the extent to which volunteer research associates (RAs) can be utilized to screen emergency department patients and their visitors for tobacco use and effectively refer tobacco users requesting help to state Tobacco Quitlines. Methods: A sample of 19,149 individuals in 10 emergency departments around the country was enrolled into a prospective, interventional study on tobacco cessation by pre-health professional RAs. Participants who screened positive for tobacco use were provided a brief description of Tobacco Quitline programs and then offered a faxed referral to their respective state Quitline. Results: A total of 10,303 (54%) participants reported tobacco use for more than one month during their lives, with 3861 (20%) currently using every day and an additional 1340 using on some days (7%). Most importantly, 2151 participants requested a faxed Tobacco Quitline referral (36% of individuals who used tobacco in the past month). Discussion: Pre-health professional RAs were shown to be an effective and cost-efficient resource for providing a strongly recommended service in the emergency department. Patient care (and the care of their visitors) was supplemented, emergency department personnel were not provided with additional burden, and RAs were provided with valuable experience for their futures in the health professions.
    Full-text · Article · Sep 2014 · Addictive Behaviors
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    ABSTRACT: Aim: Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of emergency department-initiated tobacco control (ETC). Methods: Literature search in 7 databases and gray literature sources. Point prevalence tobacco abstinence at 1-, 3-, 6-, and/or 12-month follow-up was abstracted from each study. The proportionate effect (relative risk) of ETC on tobacco abstinence was calculated separately for each study and follow-up time and pooled, at different follow-up times, by Mantel-Haenszel relative risks. The effects of ETC on combined point prevalence tobacco abstinence across all follow-up times were calculated using generalized linear mixed models. Results: Seven studies with overall 1,986 participants were included. The strongest effect of ETC on point prevalence tobacco abstinence was found at 1 month: Relative risk (RR) = 1.47 (3 studies) (95% confidence interval [CI]: 1.06-2.06), while the effect at 3, 6, and 12 months was RR = 1.24 (6 studies) (95% CI: 0.93-1.65); 1.13 (5 studies) (95% CI: 0.86-1.49); and 1.25 (1 study) (95% CI: 0.91-1.72). The benefit on combined point prevalence tobacco abstinence was RR = 1.33 (7 studies) (95% CI: 0.96-1.83), p = .08; with RR = 1.33 (95% CI: 0.92-1.92), p = .10, for the 5 studies combining motivational interviewing and booster phone calls. Conclusions: ETC combining motivational interviewing and booster phone calls showed a trend toward increased episodically measured tobacco abstinence up to 12 months. More methodologically rigorous trials are needed to effectively evaluate the impact of ETC.
    No preview · Article · Sep 2012 · Nicotine & Tobacco Research
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    ABSTRACT: Cigarette smoking remains the leading cause of preventable death in the United States, and tobacco use rates are known to be higher among emergency department (ED) patients than in the general population. Despite recommendations from the Society for Academic Emergency Medicine and the American College of Emergency Physicians, many emergency clinicians remain uncertain about the benefits of providing ED-based smoking cessation interventions. To address this gap in knowledge, we performed a systematic review of cessation interventions initiated in the adult or pediatric ED setting. We conducted an electronic search of the MEDLINE and CINAHL databases through February 2014 and hand searched references from potentially relevant articles. We identified eligible studies, evaluated bias and validity, and extracted data and synthesized findings. Seventeen studies underwent critical appraisal, with 13 included in qualitative synthesis. The majority (11/13, 85%) of investigations did not report significant differences in tobacco abstinence between cessation intervention groups. The 2 studies reporting significant differences in cessation both used motivational interviewing-based interventions. Two studies evaluated patient satisfaction with ED-based tobacco cessation interventions, and both reported greater than 90% satisfaction. Findings indicate that ED visits in combination with ED-initiated tobacco cessation interventions are correlated with higher cessation rates than those reported in the National Health Interview Survey. Clear data supporting the superiority of one intervention type were not identified. Lack of a standardized control group prevented quantitative evaluation of pooled data, and future research is indicated to definitively evaluate intervention efficacy.
    No preview · Article · Apr 2014 · The American journal of emergency medicine
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