The effect of removing cost as a barrier to treatment initiation with outpatient tobacco dependence clinics among emergency department patients

UMMS Affiliation

Department of Emergency Medicine; Department of Psychiatry

Publication Date


Document Type



*Directive Counseling; *Emergency Service, Hospital; Referral and Consultation; Physician-Patient Relations; Smoking Cessation


Emergency Medicine


Objectives: The campaign against tobacco addiction and smoking continues to play an important role in public health. However, referrals to outpatient tobacco cessation programs by emergency physicians are rarely pursued by patients following discharge. This study explored cost as a barrier to follow-up.

Methods: The study was performed at a large urban hospital emergency department (ED) in Camden, New Jersey. Enrollment included adults who reported tobacco use in the past 30 days. Study participants were informed about a "Stop Smoking Clinic" affiliated with the hospital and, depending on enrollment date, cost of treatment was advertised as $150 (standard fee), $20 (reduced fee), or $0 (no fee). Monitoring of patient inquiries and visits to the clinic was performed for 6 months following enrollment of the last study subject.

Results: The analyzed sample consisted of 577 tobacco users. There were no statistically significant demographic differences between treatment groups (p > 0.05). Two-hundred forty-seven (43%) participants reported "very much" interest in smoking cessation. However, there was no significant difference in initiating treatment with the Stop Smoking Clinic across experimental condition. Only a single subject, enrolled in the no-fee phase, initiated treatment with the clinic.

Conclusions: Cost is unlikely to be the only barrier to pursing outpatient tobacco treatment after an ED visit. Further research is needed to determine the critical components of counseling and referral that maximize postdischarge treatment initiation. (c) 2011 by the Society for Academic Emergency Medicine

DOI of Published Version



Acad Emerg Med. 2011 Jun;18(6):662-4. doi: 10.1111/j.1553-2712.2011.01048.x. Epub 2011 Apr 22. Link to article on publisher's site

Journal/Book/Conference Title

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine


Medical student Deepak Ozhathil participated in this study as part of the Senior Scholars research program at the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID