Emergency Department Provider Preferences Related to Clinical Practice Guidelines for Tobacco Cessation: A Multicenter Survey

Abstract

Objectives To assess current emergency department (ED) provider practices and preferences for tobacco cessation interventions. The ED is an opportune place to initiate smoking cessation interventions. However, little is known about ED provider current practices and preferences for cessation counseling in the ED. Methods This was a survey of ED providers conducted in 2008–2009 (including physicians, nurse practitioners, physician assistants, and nurses), working at least half-time at ten U.S. academic EDs, regarding adherence to clinical practice guidelines (“5 As”) and preferences for cessation interventions/styles. Data analysis occurred in 2012–2013. Results The response rate was 64% (799 out of 1,246 completed surveys). Providers reported strongest adherence to asking about patient smoking status, followed by advising, with significant variance by clinical role. Assessing, assisting, and arranging support for patients was low overall. Most frequently used interventions were to provide patients with a list of telephone numbers for stop-smoking counseling (87%), pamphlets on smoking health risks and the benefits of stopping (85%), and referrals to the National Toll-Free Smoker’s Quitline (84%). Most providers (80%) were supportive of personally conducting brief (less than three minutes) smoking cessation counseling sessions during the ED visit, emphasizing education and encouragement. The least appealing intervention was writing a prescription for nicotine replacement therapies or medications to stop smoking (35%). Conclusions Interventions most likely to be used were brief, delivered with a positive tone, and included referral to external resources. The logical next step is to design and test interventions that ED providers find acceptable.

Barriers to implementation of pediatric emergency department interventions for parental tobacco use and dependence: a qualitative study using the theoretical domains framework

“…Also, the stress of completing acute care-related tasks during the visit due to time constraints was also identified. Lack of time and resources have been widely cited among ED/PED-based general preventive intervention research (e.g., vaccinations) [ 11 ] and tobacco control research [ 36 , 38 , 52 , 53 ].…”

Estudio de corte transversal sobre el estado de conocimientos, actitudes y prácticas de médicos colombianos ante el tabaquismo

“…Finalmente, se encontró que el 98.38% considera que se debe realizar educación médica continua en tabaquismo, similar a los hallazgos en otras encuestas que evalúan la necesidad de capacitación por parte del personal de salud y que revelan que más del 90% están de acuerdo con la implementación de este tipo de temas académicos (17,22,35,36); sin embargo, en Kirguistan solo el 63% de los médicos piensa que se requiere más información (37); lo cual se encuentra sustentado en que el entrenamiento a los profesionales de la salud aumentaba la asesoría con la estrategia de las 5As, sobre todo en brindar ayuda, donde el 79.1% de los médicos familiares que tenía entrenamiento en tabaquismo realizaba asesoría a los padres de niños con enfermedades respiratorias y cerca 85% de los profesionales de la salud a nivel de urgencias ofrecían ayuda y asesoría (29,38), cifra que concuerda con el hallazgo de Kats et al, que solo el 5.7% de las enfermeras y el 5.1% realizaba esta intervención antes del entrenamiento, comparado con los datos posteriores donde el 22.5% de las enfermeras y el 18.4% de los médicos realizó la intervención (39).…”

Physician‐directed smoking cessation using patient “opt‐out” approach in the emergency department: A pilot program

“…[3][4][5][6][7][8] Prior research has found tobacco cessation management to be unappealing to some ED providers. 9 This may be attributed to the lack of familiarity by physicians with tobacco cessation strategies and the few studies in emergency medicine literature. Although tobacco cessation screening and interventions in the ED setting have been discussed, recommended, and reported, 10-22 none have measured the success of an "opt-out" approach to a prescriptive intervention.…”

“…The few studies that have reported rates of tobacco use in patients seeking care in the emergency department have shown great variability in prevalence (21%–41%) and report that rates are greater than that of the general population 3‐8 . Prior research has found tobacco cessation management to be unappealing to some ED providers 9 . This may be attributed to the lack of familiarity by physicians with tobacco cessation strategies and the few studies in emergency medicine literature.…”