The Emergency Department Action in Smoking Cessation (EDASC) Trial: Impact on Delivery of Smoking Cessation Counseling

Abstract

Objectives The focus on acute care, time pressure, and lack of resources hamper the delivery of smoking cessation interventions in the emergency department (ED). The aim of this study was to 1) determine the effect of an emergency nurse-initiated intervention on delivery of smoking cessation counseling based on the 5As framework (ask-advise-assess-assist-arrange), and 2) assess ED nurses’ and physicians’ perceptions of smoking cessation counseling. Methods The authors conducted a pre-post trial in 789 adult smokers (five or more cigarettes/day) who presented to two EDs. The intervention focused on improving delivery of the 5As by ED nurses and physicians, and included face-to-face training and an online tutorial, use of a charting/reminder tool, fax referral of motivated smokers to the state tobacco quitline for proactive telephone counseling, and group feedback to ED staff. To assess ED performance of cessation counseling, a telephone interview of subjects was conducted shortly after the ED visit. Nurses’ and physicians’ self-efficacy, role satisfaction, and attitudes toward smoking cessation counseling were assessed by survey. Multivariable linear regression was used to assess the effect of the intervention on performance of the 5As, while adjusting for key covariates. Results Of 650 smokers who completed the post-ED interview, a greater proportion had been asked about smoking by an ED nurse (68% vs. 53%, adjusted OR = 2.0, 95% CI = 1.3 to 2.9), assessed for willingness to quit (31% vs. 9%, adjusted OR= 4.9, 95% CI = 2.9 to 7.9), assisted in quitting (23% vs. 6%, adjusted OR = 5.1, 95% CI = 2.7 to 9.5), and had arrangements for follow-up cessation counseling (7% vs. 1%, adjusted OR = 7.1, 95% CI = 2.3 to 21) during the intervention compared to the baseline period. A similar increase was observed for emergency physicians. ED nurses’ self-efficacy and role satisfaction in cessation counseling significantly improved following the intervention; however, there was no change in “pros” and “cons” attitudes toward smoking cessation in either ED nurses or physicians. Conclusions Emergency department nurses and physicians can effectively deliver smoking cessation counseling to smokers in a time-efficient manner. This trial also provides empirical support for expert recommendations that call for nursing staff to play a larger role in delivering public health interventions in the ED.

Guidelines for the Primary Prevention of Stroke

“…910 Numerous studies have demonstrated that the ED represents a promising site for smoking cessation interventions through self-service kiosks and culturally appropriate literature, brief interventions, and referrals to outpatient treatment. 911,912 With the high prevalence of smoking-related illnesses leading to ED visits, these episodes provide outstanding “teachable moments” to encourage cessation.…”

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).…”

Referring Hospitalized Smokers to Outpatient Quit Services

“…Katz and colleagues 31,32 successfully implemented brief counseling and referral to outpatient counseling programs in Veterans Administration hospitals and emergency departments, with modest impacts on referrals. They found that 23% of hospitalized smokers accepted referrals.…”

“…32 Smokers with an emergency department visit accepted a referral only 7% of the time. 31 A large study in primary care clinics found that less than 5% of smokers accepted a faxed referral to a state quitline. 33 In this study, acceptance rates were higher for outpatient counseling referrals (58%) and medications (43%), and 28% of patients accepted referrals for both counseling and medications.…”

“…6 Others suggest brief cessation services can be added effectively to unit nurse duties, 19,35,36 but the impact on delivery and outcomes appears limited. 6,31,35 Hospitals involved in this study supported the use of dedicated staff to deliver bedside tobacco consult services and referrals.…”