The Emergency Department as a Potential Site for Smoking Cessation Intervention: A Randomized, Controlled Trial

Abstract

Abstract. Objective: To assess the effect of physician counseling and referral on smoking cessation rates and attendance at a smoking cessation program. Methods: This was a prospective, randomized clinical trial set in a suburban, community teaching hospital emergency department (ED). During study hours, dedicated research associates enrolled consecutive, stable, oriented patients who were smokers. Eligible, consenting patients were randomized to one of two intervention groups. The control group received a two-page ''Stop Smoking'' pamphlet from the American Heart Association (AHA). Patients in the intervention group were given the AHA pamphlet along with pharmacologic information and standardized counseling by the attending emergency physician, including written and oral referral to a smoking cessation program. The primary outcome measures were telephone contact/attendance at the smoking cessation program by the intervention group and the rate of smoking cessation in both study groups at three months post-ED visit. Categorical data were analyzed by chi-square and Fisher's exact tests. Rank data were analyzed by Mann-Whitney tests and continuous data by t-tests. All tests were two-tailed with alpha set at 0.05. Results: One hundred fifty-two patients were enrolled; 78 were randomized to the intervention group. Nearly 70% of patients (103) were available for telephone follow-up. The study groups were statistically similar with regard to baseline demographic characteristics and the prevalence of moderate or severe nicotine addiction. None of the patients (0%) in the intervention group contacted or attended the smoking cessation program during the study period (95% CI = 0-4%). The percentages of patients who stopped smoking after three months were similar in the two groups [10.4% (5/48) control vs 10.9% (6/55) intervention; p = 1]. Conclusion: The authors found no difference in the smoking cessation rates between ED patients who received written material and those who were counseled by emergency physicians. Referral of patients who smoked to a cessation program was unsuccessful.

Emergency Department Initiated Treatments for Tobacco (EDITT): A Pilot Study

“…This was expected, since the interventions were brief and patients were enrolled regardless of baseline motivation to quit. Such a pattern is characteristic of brief interventions in opportunistic settings [13,14] and consistent with the two published randomized trials in the ED setting [18,28]. Small effect sizes should not be viewed as evidence of non-viability.…”

“…However, they may not be particularly effective. A small pilot study of 152 patients by Richman et al [18] found that brief, scripted physician counseling did not lead to significantly higher cessation than a standard referral to a tobacco clinic alone. Moreover, research with alcohol suggests that there may be a trade-off between efficiency and efficacy.…”

Feasibility, acceptability, and cost of referring surgical patients for postdischarge cessation support from a quitline

“…Although the rate of uptake and utilization of the proactive quitline service in this trial appears to be superior relative to other strategies (Ockene et al, 1992;Richman et al, 2000;Winickoff, Hillis et al, 2003), 26% of referred patients did not receive a postdischarge call from the quitline. As part of the intervention protocol, preoperative nursing staff estimated the discharge date of patients, which was used by the quitline as a commencement date for patient contact.…”

“…The results also suggest that direct referral of patients to a proactive quitline service represents a more successful method of ensuring the provision of postdischarge support to smokers than other strategies such as referral to group support programs, primary care physicians, or free reactive telephone support services (Ockene et al, 1992;Richman et al, 2000;Winickoff, Hillis et al, 2003).…”

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

“…The ED is considered an appropriate setting for screening and counseling of tobacco usage by both public health and emergency medicine experts [6,7]. In spite of these opinions, in the two trials about smoking cessation counseling in EDs to date, neither was effective in decreasing smoking at a mean of 3-6 months [8,9].…”