Are emergency department visits really a teachable moment? Smoking cessation promotion in emergency department

Ersel, Murat; Kitapçıoğlu, Gül; Solak, Zeynep Ayfer; Yürüktümen, Aslıhan; Karahalli, Eylem; Çevrim, Özgür

doi:10.1097/mej.0b013e32832e67d6

Cited by 15 publications

(14 citation statements)

References 23 publications

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“…This may explain why only 27% of physicians surveyed in this study reported that they routinely advised smokers to quit. Although evidence of the long-term efficacy of smoking cessation counseling in the ED has been limited [ 18 - 22 ], one recent study found that, in the short-term, ED-based counseling for smoking cessation was as effective as counseling performed in an outpatient clinic [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Teachable moments and missed opportunities for smoking cessation counseling in a hospital emergency department: a mixed-methods study of patient-provider communication

Buchbinder

Wilbur

Zuskov

et al. 2014

BMC Health Serv Res

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BackgroundWhile primary care medical clinics have been the most common setting for the delivery of advice about smoking cessation, the hospital emergency department (ED) is a valuable context for counseling medically underserved tobacco users. We conducted a secondary analysis based on a larger audio-recorded study of patient-provider communication about pain and analgesics in the ED. Within a sample of ED patients with back pain, the purpose of this mixed-methods study was to examine how physicians and nurse practitioners capitalize on “teachable moments” for health education to offer spontaneous smoking cessation counseling in the ED.MethodsPatients presenting to an academic ED with a primary complaint of back pain were invited to participate in a study of patient-provider communication. Audio-recorded encounters were transcribed verbatim. Two coders reviewed each transcript to determine whether smoking was discussed and to build a corpus of smoking-related discussions. We then developed inductively generated coding categories to characterize how providers responded when patients endorsed smoking behavior. Categories were refined iteratively to accommodate discrepancies.ResultsOf 52 patient-provider encounters during which smoking was discussed, two-thirds of the patients indicated that they were smokers. Providers missed opportunities for smoking cessation counseling 70% of the time. Eleven encounters contained teachable moments for smoking cessation. We identified four primary strategies for creating teachable moments: 1) positive reinforcement, 2) encouragement, 3) assessing readiness, and 4) offering concrete motivating reasons.ConclusionsMost providers missed opportunities to offer teachable moments for smoking cessation. In encounters that contained teachable moments, providers employed multiple strategies, combining general advice with motivation tailored to the patient’s particular circumstances. Creating motivational links to enhance smoking cessation efforts may be possible with a minimal investment of ED resources.

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Section: Introductionmentioning

confidence: 99%

“…In both ED and primary care settings, much of the literature on patient-provider communication about smoking is situated within targeted smoking cessation interventions [ 19 , 23 - 26 ]. Fewer studies have described how ED providers offer smoking counseling spontaneously, within ongoing health care interactions [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Teachable moments and missed opportunities for smoking cessation counseling in a hospital emergency department: a mixed-methods study of patient-provider communication

Buchbinder

Wilbur

Zuskov

et al. 2014

BMC Health Serv Res

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“…Therefore, in addition to their primary acute-care role, EDs appear as potential places to provide preventive health care [3]–[6]. Because screening is a component of secondary disease prevention, many attempts have been made to implement ED screening programs for a range of conditions including depression [7], alcohol abuse [8], smoking [9], intimate partner violence [10], diabetes [11], hypertension [12] and more recently HIV infection in the USA [13].…”

Section: Introductionmentioning

confidence: 99%

Understanding Providers’ Offering and Patients’ Acceptance of HIV Screening in Emergency Departments: A Multilevel Analysis. ANRS 95008, Paris, France

et al. 2013

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ObjectiveWe assessed the EDs’ characteristics associated with the offer and acceptance rates of a nontargeted HIV rapid-test screening in 29 Emergency Departments (EDs) in the metropolitan Paris region (11.7 million inhabitants), where half of France’s new HIV cases are diagnosed annually.MethodsEDs nurses offered testing to all patients 18–64-year-old, able to provide consent, either with or without supplemental staff (hybrid staff model or indigenous staff model). The EDS’ characteristics collected included structural characteristics (location, type, size), daily workload (patients’ number and severity, length of stay in hours), staff’s participation (training, support to the intervention, leadership), type of week day (weekends vs weekdays) and time (in days). Associations between these variables and the staff model, the offer and acceptance rates were studied using multilevel modeling.ResultsIndigenous staff model was more frequent in EDs with a lower daily patient flow and a higher staff support score to the intervention. In indigenous-model EDs, the offer rate was associated with the patient flow (OR = 0.838, 95% CI = 0.773–0.908), was lower during weekends (OR = 0.623, 95% CI = 0.581–0.667) and decreased over time (OR = 0.978, 95% CI = 0.975–0.981). Similar results were found in hybrid-model EDs. Acceptance was poorly associated with EDs characteristics in indigenous-model EDs while in hybrid-model EDs it was lower during weekends (OR = 0.713, 95% CI = 0.623–0.816) and increased after the first positive test (OR = 1.526, 95% CI = 1.142–2.038).The EDs’ characteristics explained respectively 38.5% and 15% of the total variance in the offer rate across indigenous model-EDs and hybrid model-EDs vs 12% and 1% for the acceptance rate.ConclusionOur findings suggest the need for taking into account EDs’ characteristics while considering the implementation of an ED-based HIV screening program. Strategies allowing the optimization of human resources’ utilization such as HIV targeted screening in the EDs might be privileged.

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“…One study found ED-based counselling to be as efficacious as that delivered in an outpatient setting. 23 Similarly, a recent systematic review demonstrated that exposure to ED-based cessation interventions resulted in greater cessation rates than the US National Health Interview Survey average 6 , but that studies are highly heterogeneous in intervention type, follow-up timing, outcome assessment and control groups used. In a metaanalysis, ED-initiated tobacco control that incorporated motivational interviewing with booster telephone calls trended towards tobacco abstinence for up to 12 months.…”

Section: Intervention Preferencesmentioning

confidence: 99%

Tobacco smoking by adult emergency department patients in Australia: a point-prevalence study

Weiland

Jelinek

Taylor

et al. 2016

Public Health Res Pract

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Objectives and importance of study: Tobacco smoking is the leading single cause of preventable death. International findings suggest that rates of smoking are higher among emergency department (ED) patients than the general population, suggesting that the ED may be a strategic location in which to initiate smoking cessation programs. We aimed to determine the prevalence of smoking among adult ED patients in Australia, their desire for smoking cessation and preferred methods of cessation. Study type: Point-prevalence surveyMethod: A sample of adult ED patients was recruited from two tertiary referral hospital EDs. Participants were asked whether or not they currently smoked. Smokers were asked 15 additional questions, including about their readiness for smoking cessation. Demographics were collected from patients, and ED presentation characteristics were collected from medical records.Results: Of 443 consecutive ED patients, 348 were eligible and 338 consented to participate. Data for 335 participants were available for analysis and 78 (23.3%; 95% confidence interval [CI] 19.1, 28.1) reported being current smokers. The mean age of smokers was 42.1 years, and 64.1% were male. Forty-one per cent (31/75) reported difficulty refraining from smoking, 78.1% (57/73) anticipated health problems because of smoking and 69.7% (53/76) had a desire to quit. Overall, 23/61 (37.7% of smokers) had a desire to cease smoking in the next month. The majority (44/73, 60.3%) were willing to undergo brief counselling. Multisession face-to-face counselling was most commonly preferred (22/55, 40.0%) and more than one-third (20/55, 36.4%) preferred group counselling. A session with an ED doctor (6/55, 10.9%) and multiple telephone-delivered interventions (7/55, 12.7%) were least preferred. Conclusion:Smoking is more prevalent among ED patients than statistics reported for the general population. Delivery of appropriate brief interventions suited to the stage of change should be trialled, along with referral from ED to counselling services.

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Are emergency department visits really a teachable moment? Smoking cessation promotion in emergency department

Abstract: ED-based counseling for smoking cessation was as effective as that performed in the OC setting. Referral of smokers from the ED to a smoking cessation program was unsuccessful in our patient population.

Cited by 15 publications

References 23 publications

Teachable moments and missed opportunities for smoking cessation counseling in a hospital emergency department: a mixed-methods study of patient-provider communication

Teachable moments and missed opportunities for smoking cessation counseling in a hospital emergency department: a mixed-methods study of patient-provider communication

Understanding Providers’ Offering and Patients’ Acceptance of HIV Screening in Emergency Departments: A Multilevel Analysis. ANRS 95008, Paris, France

Tobacco smoking by adult emergency department patients in Australia: a point-prevalence study

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