Title

Emergency department initiated treatments for tobacco (EDITT): a pilot study

UMMS Affiliation

Department of Psychiatry; Department of Emergency Medicine

Date

12-4-2008

Document Type

Article

Medical Subject Headings

Adult; *Emergency Service, Hospital; Humans; Motivation; Patient Education as Topic; Pilot Projects; Smoking Cessation

Disciplines

Emergency Medicine | Health Services Research | Mental and Social Health | Psychiatric and Mental Health | Psychiatry | Psychiatry and Psychology

Abstract

BACKGROUND: Emergency departments (EDs) have strong potential to initiate tobacco interventions with economically disadvantaged populations.

PURPOSE: We piloted three ED-initiated tobacco interventions and derived parameter estimates for future trials.

METHODS: The study enrolled adult patients being treated in an urban ED who were daily smokers. Exclusion criteria included severe illness or pain, isolation (for contagion), altered mental status, an insurmountable language barrier, temporary residence, and lack of telephone access. Subjects in the Bedside + Booster group received motivational counseling by a trained counselor at the bedside, up to three telephone sessions post-visit, and a self-help guide. Subjects in the Faxed Referral group had their personal contact information faxed to the hospital's tobacco dependence clinic, whereupon they received identical treatment as the Bedside + Booster group, but all sessions occurred over the telephone (i.e., no bedside counseling). The Standard Referral group received the self-help guide and a referral to the hospital's tobacco dependence clinic. We used a 2:2:1 randomization schedule to maximize our experience with the motivational interventions. Outcomes were assessed at 1 and 3 months.

RESULTS: We enrolled 90 subjects. Of the 36 subjects assigned to the Bedside + Booster condition, 31 (87%) completed bedside counseling and at least one booster session, while 22 (61%) completed the maximum four sessions. Of the 37 subjects assigned to the Faxed Referral group, 28 (76%) completed at least one telephone session, while 19 (51%) completed the maximum four sessions. Quit attempts over the 3 months ranged from 18% (Standard Referral) to 57% (Faxed Referral). Seven-day abstinence was attained by 8% (Bedside + Booster), 14% (Faxed Referral), and 6% (Standard Referral) at 3 months.

CONCLUSIONS: Motivational cessation counseling can be feasibly initiated during the ED encounter with minimal medical staff involvement. Adequately powered trials are needed to study ED-initiated interventions that include post-visit follow-up.

Rights and Permissions

Citation: Ann Behav Med. 2008 Dec;36(3):314-25. Epub 2008 Dec 3. Link to article on publisher's site

Comments

At the time of publication, Edwin Boudreaux was not yet affiliated with the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID

19050988