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Reed EN, Papp J, Oh Y, LeVine K, Tarabichi Y, Bastian E, Pollock K, Wilson LD, Siff J, Piktel JS. Evaluation of an emergency department-based approach to reduce subsequent opioid overdoses. J Am Coll Emerg Physicians Open 2024; 5:e13304. [PMID: 39445120 PMCID: PMC11496383 DOI: 10.1002/emp2.13304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 08/15/2024] [Accepted: 08/23/2024] [Indexed: 10/25/2024] Open
Abstract
Objective The purpose of this study was to determine the association of a multi-pronged treatment program in emergency department (ED) patients with an acute presentation of opioid use disorder (OUD) on the rate of subsequent opioid overdose (OD). This approach included ED-initiated take-home naloxone, prescription buprenorphine, and an ED-based peer support and recovery program. Methods This was a retrospective observational analysis of adult patients presenting to the ED at a large urban hospital system from November 1, 2017 to March 17, 2023. Patients with an ED discharge diagnosis of OD or OUD were included. Outcomes determined were subsequent 90-day OD and 180-day OD death. Post hoc analyses were performed to identify intervention utilization throughout the study period including the COVID-19 pandemic as well as ED characteristics associated with subsequent OD and OD death. Statistical comparisons were made using logistic regression and chi-squared test. Results A total of 2634 patients presented to the ED with an opioid OD or diagnosis of OUD. Subsequent 90-day OD decreased significantly over time (11.5%-2.3%, odds ratio [OR] 0.85, confidence interval [CI] 0.82-0.89). No single intervention was independently associated with 90-day OD or 180-day OD death. Resource utilization was stable during the COVID-19 pandemic and increased afterward. A higher buprenorphine fill-rate among all patients and the Back race subgroup was associated with a decrease in 90-day OD. Conclusions Subsequent OD and OD death decreased over time after implementation of a multi-pronged treatment program to ED patients with OUD. No single intervention was associated with a decrease of subsequent OD or OD death.
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Affiliation(s)
- Eric N. Reed
- Department of Emergency MedicineThe MetroHealth SystemCase Western Reserve UniversityClevelandOhioUSA
| | - Joan Papp
- Department of Emergency MedicineThe MetroHealth SystemCase Western Reserve UniversityClevelandOhioUSA
| | - Yesol Oh
- Department of Emergency MedicineThe MetroHealth SystemCase Western Reserve UniversityClevelandOhioUSA
| | - Kellie LeVine
- Department of Emergency MedicineThe MetroHealth SystemCase Western Reserve UniversityClevelandOhioUSA
| | - Yasir Tarabichi
- Department of Emergency MedicineThe MetroHealth SystemCase Western Reserve UniversityClevelandOhioUSA
| | - Estella Bastian
- Department of Emergency MedicineThe MetroHealth SystemCase Western Reserve UniversityClevelandOhioUSA
| | - Kailee Pollock
- Department of Emergency MedicineThe MetroHealth SystemCase Western Reserve UniversityClevelandOhioUSA
| | - Lance D. Wilson
- Department of Emergency MedicineThe MetroHealth SystemCase Western Reserve UniversityClevelandOhioUSA
| | - Jonathan Siff
- Department of Emergency MedicineThe MetroHealth SystemCase Western Reserve UniversityClevelandOhioUSA
| | - Joseph S. Piktel
- Department of Emergency MedicineThe MetroHealth SystemCase Western Reserve UniversityClevelandOhioUSA
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Sisson ML, Gajos JM, Wolford-Clevenger C, Chichester KR, Hawes ES, Hill SV, Shelton RC, Hendricks PS, Businelle MS, Carpenter MJ, Cropsey KL. Impact of Nicotine Replacement Therapy Sampling on Cessation-Related Processes. J Addict Med 2024; 18:397-403. [PMID: 38446860 PMCID: PMC11290993 DOI: 10.1097/adm.0000000000001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Smoking prevalence remains high among low-income smokers. Understanding processes (eg, withdrawal, craving, motivation) in early smoking cessation is crucially important for designing effective interventions for this population. METHODS This is a secondary analysis of a novel, in-session sampling intervention (ie, In Vivo) as compared with standard care behavioral smoking cessation counseling (SC) among community-dwelling low-income smokers (n = 83). This analysis examined the effect of 5 in-session sampling interventions on cessation-related processes and perceived advantages or disadvantages of nicotine replacement therapy (NRT) products over time using daily diaries. RESULTS The In Vivo treatment had an early positive impact in terms of decreasing withdrawal symptoms and cravings, and increasing perceived advantages to NRT, with moderate to large effect sizes. Results also showed that the treatment effectively reduced withdrawal symptoms and cravings in-session, with small-to-medium and medium-to-large effect sizes, respectively. In-session reduction of withdrawal symptoms and cravings did not occur for the SC group, with the exception of decreased withdrawal symptoms occurring during week 4. The In Vivo treatment did not impact quit goal, desire to quit, abstinence self-efficacy, perceived difficulty in quitting, motivational engagement, or perceived disadvantages to NRT. The In Vivo group reported less daily cigarette use relative to the SC group, in addition to reporting less cigarette use on days they reported greater combination NRT use. CONCLUSIONS There is preliminary support for this In Vivo treatment over SC in reducing withdrawal, craving, and the number of cigarettes smoked per day, as well as promoting perceived advantages of NRT among low-income smokers.
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Affiliation(s)
- Michelle L Sisson
- From the Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL (MLS, CW-C, KRC, ESH, RCS, KLC); Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, AL (JMG); Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL (SVH); Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL (PSH); Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK (MSB); and Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC (MJC)
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Pope I, Clark LV, Clark A, Ward E, Belderson P, Stirling S, Parrott S, Li J, Coats T, Bauld L, Holland R, Gentry S, Agrawal S, Bloom BM, Boyle AA, Gray AJ, Morris MG, Livingstone-Banks J, Notley C. Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial. Emerg Med J 2024; 41:276-282. [PMID: 38531658 DOI: 10.1136/emermed-2023-213824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/17/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Supporting people to quit smoking is one of the most powerful interventions to improve health. The Emergency Department (ED) represents a potentially valuable opportunity to deliver a smoking cessation intervention if it is sufficiently resourced. The objective of this trial was to determine whether an opportunistic ED-based smoking cessation intervention can help people to quit smoking. METHODS In this multicentre, parallel-group, randomised controlled superiority trial conducted between January and August 2022, adults who smoked daily and attended one of six UK EDs were randomised to intervention (brief advice, e-cigarette starter kit and referral to stop smoking services) or control (written information on stop smoking services). The primary outcome was biochemically validated abstinence at 6 months. RESULTS An intention-to-treat analysis included 972 of 1443 people screened for inclusion (484 in the intervention group, 488 in the control group). Of 975 participants randomised, 3 were subsequently excluded, 17 withdrew and 287 were lost to follow-up. The 6-month biochemically-verified abstinence rate was 7.2% in the intervention group and 4.1% in the control group (relative risk 1.76; 95% CI 1.03 to 3.01; p=0.038). Self-reported 7-day abstinence at 6 months was 23.3% in the intervention group and 12.9% in the control group (relative risk 1.80; 95% CI 1.36 to 2.38; p<0.001). No serious adverse events related to taking part in the trial were reported. CONCLUSIONS An opportunistic smoking cessation intervention comprising brief advice, an e-cigarette starter kit and referral to stop smoking services is effective for sustained smoking abstinence with few reported adverse events. TRIAL REGISTRATION NUMBER NCT04854616.
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Affiliation(s)
- Ian Pope
- Norwich Medical School, University of East Anglia Norwich Medical School, Norwich, UK
| | - Lucy V Clark
- Norwich Medical School, University of East Anglia Norwich Medical School, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia Norwich Medical School, Norwich, UK
| | - Emma Ward
- Norwich Medical School, University of East Anglia Norwich Medical School, Norwich, UK
| | - Pippa Belderson
- Norwich Medical School, University of East Anglia Norwich Medical School, Norwich, UK
| | - Susan Stirling
- Norwich Medical School, University of East Anglia Norwich Medical School, Norwich, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Tim Coats
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Linda Bauld
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Sarah Gentry
- Norwich Medical School, University of East Anglia Norwich Medical School, Norwich, UK
| | | | | | - Adrian A Boyle
- Emergency Department, Addenbrooke's Hospital, Cambridge, UK
| | - Alasdair J Gray
- Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, UK
| | - M Geraint Morris
- Emergency Department, Homerton University Hospital NHS Foundation Trust, London, UK
| | | | - Caitlin Notley
- Norwich Medical School, University of East Anglia Norwich Medical School, Norwich, UK
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Mukadam A, Shetiya SH. Smoking cessation through nicotine replacement therapy for patients visiting the Dental College, Pune - A quasi-experimental study. J Cancer Res Ther 2023; 19:1365-1370. [PMID: 37787310 DOI: 10.4103/jcrt.jcrt_834_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background and Aim Smoking leads to a very unhealthy lifestyle and has many deleterious effects on the body and surroundings. Studies have indicated that aiding contemplating smokers using behavior counseling and nicotine replacement therapy has shown positive results for abstaining from the habit. We aimed to assess and carry out smoking cessation for smokers using behavioral counseling, motivational interviewing, and nicotine replacement therapy (NRT) and assess their carbon monoxide (CO) cutoff level, Fagerstrom nicotine dependence test (FTND) scoring, and transtheoretical model (TTM) of change at baseline and 6 months, along with abstinence from the habit. Materials and Methods CO cutoff, FTND scoring, and TTM of change were assessed at baseline and 6 months for smokers. Behavioral counseling with motivational interviewing was provided to the participants on the day of recruitment, and baseline data were recorded. All smokers included in the study were in the precontemplation and contemplation stages to quit smoking. Based on the frequency of smoking, NRT was prescribed to them in the form of a patch (21, 14, or 7 mg), only gums (2 mg), or a combination of both. Counseling was provided telephonically every month for 6 months. Urine cotinine assessment was carried out to verify the self-reported smoking status of the participants at the sixth month. Results The CO cutoff, FTND scoring, and TTM of change showed statistically significant difference from baseline to the sixth month. Also, 20% (confidence interval [CI] 0.10-0.33) of participants who abstained from the habit were in the action and maintenance stages of change. Among 20% of participants, 16% (CI 0.10-0.36) of participants self-reported quitting within 6 months using combination therapy. Two percent (CI 0.00-0.40) each abstained by using nicotine gums and combination therapy of patch and gums, which was validated through urine cotinine. Conclusion The cotinine test provided negative results, confirming the self-reported abstinence of 20% of participants, who were mostly male students and professionals in the age group of 20-40 years and those who used NRT. Nicotine patches provided the highest point prevalence of abstinence compared to gums and combination therapy.
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Affiliation(s)
- Ajinky Mukadam
- Department of Public Health Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Sahana H Shetiya
- Department of Public Health Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
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Miller TR, Johnson MB, Dziura JD, Weiss J, Carpenter KM, Grau LE, Pantalon MV, Abroms L, Collins LM, Toll BA, Bernstein SL. Cost-Effectiveness of Smoking Cessation Approaches in Emergency Departments. Am J Prev Med 2023; 65:39-44. [PMID: 36710199 PMCID: PMC10293014 DOI: 10.1016/j.amepre.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Americans of lower SES use tobacco products at disproportionately high rates and are over-represented as patients of emergency departments. Accordingly, emergency department visits are an ideal time to initiate tobacco treatment and aftercare for this vulnerable and understudied population. This research estimates the costs per quit of emergency department smoking-cessation interventions and compares them with those of other approaches. METHODS Previously published research described the effectiveness of 2 multicomponent smoking cessation interventions, including brief negotiated interviewing, nicotine replacement therapy, quitline referral, and follow-up communication. Study 1 (collected in 2010-2012) only analyzed the combined interventions. Study 2 (collected in 2017-2019) analyzed the intervention components independently. Costs per participant and per quit were estimated separately, under distinct intervention with dedicated staff and intervention with repurposed staff assumptions. The distinction concerns whether the intervention used dedicated staff for delivery or whether time from existing staff was repurposed for intervention if available. RESULTS Data were analyzed in 2021-2022. In the first study, the cost per participant was $860 (2018 dollars), and the cost per quit was $11,814 (95% CI=$7,641, $25,423) (dedicated) and $227 per participant and $3,121 per quit (95% CI=$1,910, $7,012) (repurposed). In Study 2, the combined effect of brief negotiated interviewing, nicotine replacement therapy, and quitline cost $808 per participant and $6,100 per quit (dedicated) (95% CI=$4,043, $12,274) and $221 per participant and $1,669 per quit (95% CI=$1,052, $3,531) (repurposed). CONCLUSIONS Costs varied considerably per method used but were comparable with those of other smoking cessation interventions.
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Affiliation(s)
- Ted R Miller
- Pacific Institute for Research and Evaluation, Beltsville, Maryland, School of Public Health, Curtin University, Perth, Australia.
| | - Mark B Johnson
- Pacific Institute for Research and Evaluation, Beltsville, Maryland, School of Public Health, Curtin University, Perth, Australia
| | - James D Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Lauretta E Grau
- Yale Center for Implementation Science, Yale School of Medicine, New Haven, Connecticut
| | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lorien Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, District of Columbia
| | - Linda M Collins
- School of Global Public Health, New York University, New Haven, Connecticut
| | - Benjamin A Toll
- Yale Cancer Center, New Haven, Connecticut; Medical University of South Carolina, Charleston, South Carolina
| | - Steven L Bernstein
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth Geisel School of Medicine, Hanover, New Hampshire; C. Everett Koop Institute at Dartmouth, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
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Murphy CE, Coralic Z, Wang RC, Montoy JCC, Ramirez B, Raven MC. Extended-Release Naltrexone and Case Management for Treatment of Alcohol Use Disorder in the Emergency Department. Ann Emerg Med 2023; 81:440-449. [PMID: 36328851 DOI: 10.1016/j.annemergmed.2022.08.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/01/2022] [Accepted: 08/25/2022] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To assess the feasibility of initiating treatment for alcohol use disorder with extended-release naltrexone and case management services in the emergency department (ED) and measure the intervention's impact on daily alcohol consumption and quality of life. METHODS This is a 12-week prospective open-label single-arm study of a multimodal treatment for alcohol use disorder consisting of monthly extended-release naltrexone injections and case management services initiated at an urban academic ED. Participants were actively drinking adult patients in ED with known or suspected alcohol use disorder and an AUDIT-C score more than 4. The main feasibility outcomes included the rates of participant enrollment, retention in the study, and continuing treatment after study completion. Efficacy outcomes were the change in daily alcohol consumption (drinks per day; 14 g ethanol per drink), measured by a 14-day timeline followback, and the change in quality of life measured with a single-item Kemp quality of life scale. RESULTS One hundred seventy-nine patients were approached, and 32 were enrolled (18%). Of the 32 enrolled patients, 25 (78%) completed all visits, and 22 (69%) continued naltrexone after the trial. The mean baseline daily alcohol consumption was 7.6 drinks per day (interquartile range, 4.5, 13.4), and the mean quality of life was 3.6 (SD 1.7) on a 7-point scale. The median daily alcohol consumption change was -7.5 drinks per day (Hodges-Lehmann 95% confidence interval -8.6, -5.9). The mean quality of life change was 1.2 points (95% confidence interval 0.5, 1.9; P<.01). CONCLUSION We found that initiation of treatment of alcohol use disorder with extended-release naltrexone and case management is feasible in an ED setting and observed significant reductions in drinking with improved quality of life in the short term. Multicenter randomized controlled trials are needed to further validate these findings.
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Affiliation(s)
- Charles E Murphy
- Department of Emergency Medicine, University of California, San Francisco, CA.
| | - Zlatan Coralic
- Department of Emergency Medicine, University of California, San Francisco, CA; Department of Pharmacy, University of California, San Francisco, CA
| | - Ralph C Wang
- Department of Emergency Medicine, University of California, San Francisco, CA
| | | | - Bianca Ramirez
- Department of Emergency Medicine, University of California, San Francisco, CA
| | - Maria C Raven
- Department of Emergency Medicine, University of California, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
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Walder JR, Faiz SA, Sandoval M. Lung cancer in the emergency department. EMERGENCY CANCER CARE 2023; 2:3. [PMID: 38799792 PMCID: PMC11116267 DOI: 10.1186/s44201-023-00018-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/13/2023] [Indexed: 05/29/2024]
Abstract
Background Though decreasing in incidence and mortality in the USA, lung cancer remains the deadliest of all cancers. For a significant number of patients, the emergency department (ED) provides the first pivotal step in lung cancer prevention, diagnosis, and management. As screening recommendations and treatments advance, ED providers must stay up-to-date with the latest lung cancer recommendations. The purpose of this review is to identify the many ways that emergency providers may intersect with the disease spectrum of lung cancer and provide an updated array of knowledge regarding detection, management, complications, and interdisciplinary care. Findings Lung cancer, encompassing 10-12% of cancer-related emergency department visits and a 66% admission rate, is the most fatal malignancy in both men and women. Most patients presenting to the ED have not seen a primary care provider or undergone screening. Ultimately, half of those with a new lung cancer diagnosis in the ED die within 1 year. Incidental findings on computed tomography are mostly benign, but emergency staff must be aware of the factors that make them high risk. Radiologic presentations range from asymptomatic nodules to diffuse metastatic lesions with predominately pulmonary symptoms, and some may present with extra-thoracic manifestations including neurologic. The short-term prognosis for ED lung cancer patients is worse than that of other malignancies. Screening offers new hope through earlier diagnosis but is underutilized which may be due to racial and socioeconomic disparities. New treatments provide optimism but lead to new complications, some long-term. Multidisciplinary care is essential, and emergency medicine is responsible for the disposition of patients to the appropriate specialists at inpatient and outpatient centers. Conclusion ED providers are intimately involved in all aspects of lung cancer care. Risk factor modification and referral for lung cancer screening are opportunities to further enhance patient care. In addition, with the advent of newer cancer therapies, ED providers must stay vigilant and up-to-date with all aspects of lung cancer including disparities, staging, symptoms of disease, prognosis, treatment, and therapy-related complications.
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Affiliation(s)
- Jeremy R. Walder
- Divisions of Critical Care, Pulmonary and Sleep Medicine, McGovern Medical School at UTHealth, 6431 Fannin St., Ste. MSB 1.282, Houston, TX 77030 USA
| | - Saadia A. Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1462, Houston, TX 77030 USA
| | - Marcelo Sandoval
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1468, Houston, TX 77030 USA
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Pettit NR, Li X, Stewart L, Kline J. Worsened outcomes of newly diagnosed cancer in patients with recent emergency care visits: A retrospective cohort study of 3699 adults in a safety net health system. Cancer Med 2023; 12:4832-4841. [PMID: 36394210 PMCID: PMC9972123 DOI: 10.1002/cam4.5303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/11/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Many patients receive a suspected diagnosis of cancer through an emergency department (ED) visit. Time to treatment for a new diagnosis of cancer is directly associated with improved outcomes with little no describing the ED utilization prior to the diagnosis of cancer. We hypothesize that patients that have an ED visit in proximity to a diagnosis of cancer will have worse outcomes, including mortality. METHODS This study is a retrospective cohort study of all patients with cancer diagnosed at Eskenazi Health (Indiana) between 2016 and 2019. Individual health characteristics, ED utilization, cancer types, and mortality were studied. We compared those patients seen in the ED within 6 months prior to their diagnosis (cases) to patients not seen in the ED (controls). RESULTS A total of 3699 patients with cancer were included, with 1239 cases (33.50%). Patients of black race had higher frequencies in the cases vs. controls (46.57% vs. 40.68%). Lung cancer was the most frequently observed cancer among cases vs. controls (11.70% vs. 5.57%). For the cases, 232 patients were deceased (18.72%) compared with 247 patients among the controls (10.04%, p < 0.0001, OR 2.06 95% confidence interval [CI] 1.70-2.51). An ED visit in past 6 months (OR = 1.73, 95% CI 1.38-2.18) and Medicaid insurance type (versus commercial, OR = 4.16, 95% CI 2.45-7.07) were associated with of mortality. Female gender (OR = 0.76, 95% CI 0.67-0.88), tobacco use (OR = 1.62, 95% CI 138-1.90), and Medicaid insurance type (versus commercial, OR = 2.56, 95% CI 2.07-3.47) were associated with prior ED use. CONCLUSIONS Over one third of patients with cancer were seen in the ED within 6 months prior to their cancer diagnosis. Higher mortality rates were observed for those seen in the ED. Future studies are needed to investigate the association and impact that the ED has on eventual cancer diagnoses and outcomes.
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Affiliation(s)
- Nicholas R Pettit
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA.,Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Xin Li
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Lauren Stewart
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Jeffrey Kline
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA.,Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
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Bernstein SL, Dziura J, Weiss J, Brooks AH, Miller T, Vickerman KA, Grau LE, Pantalon MV, Abroms L, Collins LM, Toll B. Successful Optimization of Tobacco Dependence Treatment in the Emergency Department: A Randomized Controlled Trial Using the Multiphase Optimization Strategy. Ann Emerg Med 2023; 81:209-221. [PMID: 36585318 PMCID: PMC9868063 DOI: 10.1016/j.annemergmed.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/23/2022] [Accepted: 08/08/2022] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVE Tobacco dependence treatment initiated in the hospital emergency department (ED) is effective. However, trials typically use multicomponent interventions, making it difficult to distinguish specific components that are effective. In addition, interactions between components cannot be assessed. The Multiphase Optimization Strategy allows investigators to identify these effects. METHODS We conducted a full-factorial, 24 or 16-condition optimization trial in a busy hospital ED to examine the performance of 4 tobacco dependence interventions: a brief negotiation interview; 6 weeks of nicotine replacement therapy with the first dose delivered in the ED; active referral to a telephone quitline; and enrollment in SmokefreeTXT, a free short-messaging service program. Study data were analyzed with a novel mixed methods approach to assess clinical efficacy, cost-effectiveness, and qualitative participant feedback. The primary endpoint was tobacco abstinence at 3 months, verified by exhaled carbon monoxide using a Bedfont Micro+ Smokerlyzer. RESULTS Between February 2017 and May 2019, we enrolled 1,056 adult smokers visiting the ED. Odd ratios (95% confidence intervals) from the primary analysis of biochemically confirmed abstinence rates at 3 months for each intervention, versus control, were: brief negotiation interview, 1.8 (1.1, 2.8); nicotine replacement therapy, 2.1 (1.3, 3.2); quitline, 1.4 (0.9, 2.2); SmokefreeTXT, 1.1 (0.7, 1.7). There were no statistically significant interactions among components. Economic and qualitative analyses are in progress. CONCLUSION The brief negotiation interview and nicotine replacement therapy were efficacious. This study is the first to identify components of ED-initiated tobacco dependence treatment that are individually effective. Future work will address the scalability of the brief negotiation interview and nicotine replacement therapy by offering provider-delivered brief negotiation interviews and nicotine replacement therapy prescriptions.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Yale Center for Implementation Science, New Haven, CT; Yale Cancer Center, New Haven, CT.
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Avis H Brooks
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Ted Miller
- Pacific Institute of Research and Evaluation, Calverton, MD
| | | | - Lauretta E Grau
- Yale Center for Implementation Science, New Haven, CT; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Lorien Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, DC
| | - Linda M Collins
- The Methodology Center and Department of Human Development and Family Studies, Pennsylvania State University, State College, PA
| | - Benjamin Toll
- Yale Cancer Center, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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10
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Notley C, Clark L, Belderson P, Ward E, Clark AB, Parrott S, Agrawal S, Bloom BM, Boyle AA, Morris G, Gray A, Coats T, Man MS, Bauld L, Holland R, Pope I. Cessation of smoking trial in the emergency department (CoSTED): protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13:e064585. [PMID: 36657751 PMCID: PMC9853266 DOI: 10.1136/bmjopen-2022-064585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Attendees of emergency departments (EDs) have a higher than expected prevalence of smoking. ED attendance may be a good opportunity to prompt positive behaviour change, even for smokers not currently motivated to quit. This study aims to determine whether an opportunist smoking cessation intervention delivered in the ED can help daily smokers attending the ED quit smoking and is cost-effective. METHODS AND ANALYSIS A two-arm pragmatic, multicentred, parallel-group, individually randomised, controlled superiority trial with an internal pilot, economic evaluation and mixed methods process evaluation. The trial will compare ED-based brief smoking cessation advice, including provision of an e-cigarette and referral to local stop smoking services (intervention) with the provision of contact details for local stop smoking services (control). Target sample size is 972, recruiting across 6 National Health Service EDs in England and Scotland. Outcomes will be collected at 1, 3 and 6 months. The primary outcome at 6 months is carbon monoxide verified continuous smoking abstinence. ETHICS AND DISSEMINATION The trial was approved by the South Central-Oxford B Research Committee (21/SC/0288). Dissemination will include the publication of outcomes, and the process and economic evaluations in peer-reviewed journals. The findings will also be appropriately disseminated to relevant practice, policy and patient representative groups. TRIAL REGISTRATION NUMBER NCT04854616; protocol V.4.2.
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Affiliation(s)
- Caitlin Notley
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lucy Clark
- Norwich Clincial Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Pippa Belderson
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Emma Ward
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan B Clark
- Norwich Clincial Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Sanjay Agrawal
- Institute of Lung Health, University of Leicester, Leicester, UK
| | - Ben M Bloom
- Emergency Department, Barts Health NHS Trust, London, UK
| | - Adrian A Boyle
- Emergency Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Geraint Morris
- Department of Emergency Medicine, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Alasdair Gray
- Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tim Coats
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Mei-See Man
- Norwich Clincial Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Linda Bauld
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, UK
| | | | - Ian Pope
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Emergency Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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11
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O’Connell N, Burke E, Dobbie F, Dougall N, Mockler D, Darker C, Vance J, Bernstein S, Gilbert H, Bauld L, Hayes CB. The effectiveness of smoking cessation interventions for socio-economically disadvantaged women: a systematic review and meta-analysis. Syst Rev 2022; 11:111. [PMID: 35655281 PMCID: PMC9164420 DOI: 10.1186/s13643-022-01922-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/06/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION This systematic review and meta-analysis assessed the effectiveness of smoking cessation interventions among women smokers in low socio-economic status (SES) groups or women living in disadvantaged areas who are historically underserved by smoking cessation services. METHODS A systematic literature search was conducted using MEDLINE (OVID), EMBASE, Cochrane, CINAHL, PsychINFO and Web of Science databases. Eligibility criteria included randomised controlled trials of any smoking cessation intervention among women in low SES groups or living in socio-economically disadvantaged areas. A random effects meta-analysis assessed effectiveness of interventions on smoking cessation. Risk of bias was assessed with the Cochrane Risk of Bias tool. The GRADE approach established certainty of evidence. RESULTS A total of 396 studies were screened for eligibility and 11 (6153 female participants) were included. Seven studies targeted women-only. 5/11 tested a form of face-to-face support. A pooled effect size was estimated in 10/11 studies. At end of treatment, two-thirds more low SES women who received a smoking cessation intervention were more likely to stop smoking than women in control groups (risk ratio (RR) 1.68, 95% CI 1.36-2.08, I2= 34%). The effect was reduced but remained significant when longest available follow-up periods were pooled (RR 1.23, 95% CI 1.04-1.48, I2 = 0%). There was moderate-to-high risk of bias in most studies. Certainty of evidence was low. CONCLUSIONS Behavioural and behavioural + pharmacotherapy interventions for smoking cessation targeting women in low SES groups or women living in areas of disadvantage were effective in the short term. However, longer follow-up periods indicated reduced effectiveness. Future studies to explore ways to prevent smoking relapse in this population are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42019130160.
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Affiliation(s)
- Nicola O’Connell
- The Discipline of Public Health and Primary Care, The Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH74 Ireland
| | - Emma Burke
- The Discipline of Public Health and Primary Care, The Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH74 Ireland
| | - Fiona Dobbie
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, EH11 4BN UK
| | - David Mockler
- Trinity College Library, Trinity College Dublin, Dublin 2, Ireland
| | - Catherine Darker
- The Discipline of Public Health and Primary Care, The Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH74 Ireland
| | - Joanne Vance
- Irish Cancer Society, 43/45 Northumberland Road, Dublin 4, Ireland
| | - Steven Bernstein
- Emergency Medicine, Yale University School of Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519-1315 USA
| | - Hazel Gilbert
- Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Catherine B. Hayes
- The Discipline of Public Health and Primary Care, The Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, Dublin, D24 DH74 Ireland
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12
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Pipe AL, Evans W, Papadakis S. Smoking cessation: health system challenges and opportunities. Tob Control 2022; 31:340-347. [PMID: 35241609 DOI: 10.1136/tobaccocontrol-2021-056575] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
The systematic integration of evidence-based tobacco treatment has yet to be broadly viewed as a standard-of-care. The Framework Convention on Tobacco Control recommends the provision of support for tobacco cessation. We argue that the provision of smoking cessation services in clinical settings is a fundamental clinical responsibility and permits the opportunity to more effectively assist with cessation. The role of clinicians in prioritising smoking cessation is essential in all settings. Clinical benefits of implementing cessation services in hospital settings have been recognised for three decades-but have not been consistently provided. The Ottawa Model for Smoking Cessation has used an 'organisational change' approach to its introduction and has served as the basis for the introduction of cessation programmes in hospital and primary care settings in Canada and elsewhere. The significance of smoking cessation dwarfs that of many preventive interventions in primary care. Compelling evidence attests to the importance of providing cessation services as part of cancer treatment, but implementation of such programmes has been slow. We recognise that the provision of such services must reflect the realities and resources of a particular health system. In low-income and middle-income countries, access to treatment facilities pose unique challenges. The integration of cessation programmes with tuberculosis control services may offer opportunities; and standardisation of peri-operative care to include smoking cessation may not require additional resources. Mobile phones afford unique opportunities for interactive cessation programming. Health system change is fundamental to improving the provision of cessation services; clinicians can be powerful advocates for such change.
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Affiliation(s)
- Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - William Evans
- Department of Oncology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Sophia Papadakis
- Clinic of Social and Family Medicine, University of Crete School of Medicine, Heraklion, Crete, Greece
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13
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Bernstein SL, Carter PM, Meurer W, Walton MA, Kidwell KM, Cunningham RM, Dziura J, Collins LM. Advances in clinical trials methodology: Intervention optimization approaches in emergency medicine. Am J Emerg Med 2022; 53:6-11. [PMID: 34968972 PMCID: PMC8844226 DOI: 10.1016/j.ajem.2021.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
The classical two-arm randomized clinical trial (RCT) is designed to test the efficacy or effectiveness of an intervention, which may consist of one or more components. However, this approach does not enable the investigator to obtain information that is important in intervention development, such as which individual components of the intervention are efficacious, which are not and possibly should be removed, and whether any components interact. The Multiphase Optimization Strategy (MOST) is a new framework for development, optimization, and evaluation of interventions. MOST includes the RCT for purposes of evaluation, but inserts a phase of research before the RCT aimed at intervention optimization. The optimization phase requires one or more separate trials similar in scope to an RCT, but employing a different experimental design. The design of the optimization trial is selected strategically so as to maximize the amount of scientific information gained using the available resources. One consideration in selecting this experimental design is the type of intervention to be optimized. If a fixed intervention, i.e. one in which the same intervention content and intensity is provided to all participants, is to be optimized, a factorial experiment is often appropriate. If an adaptive intervention, i.e. one in which intervention content or intensity is varied in a principled manner, is to be optimized, a sequential multiple-assignment randomized trial (SMART) is often a good choice. The objective of this article is to describe MOST and the scientific rationale for its use; describe two current applications of MOST in emergency medicine research, one using a factorial experiment and the other using a SMART; and discuss funding strategies and potential future applications in studying the care of individuals with acute illness, injury, or behavioral disorders.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT, United States of America; Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT, United States of America.
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - William Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Maureen A Walton
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Kelly M Kidwell
- Department of Statistics, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America; University of Michigan Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
| | - James Dziura
- Department of Emergency Medicine, Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT, United States of America
| | - Linda M Collins
- The Methodology Center and Department of Human Development & Family Studies, Penn State, University Park, PA, United States of America
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14
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Thomas KH, Dalili MN, López-López JA, Keeney E, Phillippo D, Munafò MR, Stevenson M, Caldwell DM, Welton NJ. Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess 2021; 25:1-224. [PMID: 34668482 DOI: 10.3310/hta25590] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cigarette smoking is one of the leading causes of early death. Varenicline [Champix (UK), Pfizer Europe MA EEIG, Brussels, Belgium; or Chantix (USA), Pfizer Inc., Mission, KS, USA], bupropion (Zyban; GlaxoSmithKline, Brentford, UK) and nicotine replacement therapy are licensed aids for quitting smoking in the UK. Although not licensed, e-cigarettes may also be used in English smoking cessation services. Concerns have been raised about the safety of these medicines and e-cigarettes. OBJECTIVES To determine the clinical effectiveness, safety and cost-effectiveness of smoking cessation medicines and e-cigarettes. DESIGN Systematic reviews, network meta-analyses and cost-effectiveness analysis informed by the network meta-analysis results. SETTING Primary care practices, hospitals, clinics, universities, workplaces, nursing or residential homes. PARTICIPANTS Smokers aged ≥ 18 years of all ethnicities using UK-licensed smoking cessation therapies and/or e-cigarettes. INTERVENTIONS Varenicline, bupropion and nicotine replacement therapy as monotherapies and in combination treatments at standard, low or high dose, combination nicotine replacement therapy and e-cigarette monotherapies. MAIN OUTCOME MEASURES Effectiveness - continuous or sustained abstinence. Safety - serious adverse events, major adverse cardiovascular events and major adverse neuropsychiatric events. DATA SOURCES Ten databases, reference lists of relevant research articles and previous reviews. Searches were performed from inception until 16 March 2017 and updated on 19 February 2019. REVIEW METHODS Three reviewers screened the search results. Data were extracted and risk of bias was assessed by one reviewer and checked by the other reviewers. Network meta-analyses were conducted for effectiveness and safety outcomes. Cost-effectiveness was evaluated using an amended version of the Benefits of Smoking Cessation on Outcomes model. RESULTS Most monotherapies and combination treatments were more effective than placebo at achieving sustained abstinence. Varenicline standard plus nicotine replacement therapy standard (odds ratio 5.75, 95% credible interval 2.27 to 14.90) was ranked first for sustained abstinence, followed by e-cigarette low (odds ratio 3.22, 95% credible interval 0.97 to 12.60), although these estimates have high uncertainty. We found effect modification for counselling and dependence, with a higher proportion of smokers who received counselling achieving sustained abstinence than those who did not receive counselling, and higher odds of sustained abstinence among participants with higher average dependence scores. We found that bupropion standard increased odds of serious adverse events compared with placebo (odds ratio 1.27, 95% credible interval 1.04 to 1.58). There were no differences between interventions in terms of major adverse cardiovascular events. There was evidence of increased odds of major adverse neuropsychiatric events for smokers randomised to varenicline standard compared with those randomised to bupropion standard (odds ratio 1.43, 95% credible interval 1.02 to 2.09). There was a high level of uncertainty about the most cost-effective intervention, although all were cost-effective compared with nicotine replacement therapy low at the £20,000 per quality-adjusted life-year threshold. E-cigarette low appeared to be most cost-effective in the base case, followed by varenicline standard plus nicotine replacement therapy standard. When the impact of major adverse neuropsychiatric events was excluded, varenicline standard plus nicotine replacement therapy standard was most cost-effective, followed by varenicline low plus nicotine replacement therapy standard. When limited to licensed interventions in the UK, nicotine replacement therapy standard was most cost-effective, followed by varenicline standard. LIMITATIONS Comparisons between active interventions were informed almost exclusively by indirect evidence. Findings were imprecise because of the small numbers of adverse events identified. CONCLUSIONS Combined therapies of medicines are among the most clinically effective, safe and cost-effective treatment options for smokers. Although the combined therapy of nicotine replacement therapy and varenicline at standard doses was the most effective treatment, this is currently unlicensed for use in the UK. FUTURE WORK Researchers should examine the use of these treatments alongside counselling and continue investigating the long-term effectiveness and safety of e-cigarettes for smoking cessation compared with active interventions such as nicotine replacement therapy. STUDY REGISTRATION This study is registered as PROSPERO CRD42016041302. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kyla H Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael N Dalili
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - José A López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Phillippo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus R Munafò
- Faculty of Life Sciences, School of Psychological Science, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, University of Bristol, Bristol, UK
| | - Matt Stevenson
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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15
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Cropsey KL, Wolford-Clevenger C, Sisson ML, Chichester KR, Hugley M, Azuero A, Businelle MS, Hendricks PS, Shelton RC, Carpenter MJ. A Pilot Study of Nicotine Replacement Therapy Sampling and Selection to Increase Medication Adherence in Low-Income Smokers. Nicotine Tob Res 2021; 23:1575-1583. [PMID: 33608735 PMCID: PMC8372633 DOI: 10.1093/ntr/ntab029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/12/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Adherence to smoking cessation medications remains suboptimal, particularly among low-income smokers. Guided, experiential sampling of nicotine replacement therapies (NRTs) may increase NRT adherence and smoking cessation over gold standard counseling plus NRT. The present pilot study aimed to examine feasibility, acceptability, and preliminary efficacy of a novel experiential intervention. AIMS AND METHODS This pilot randomized controlled trial (N = 83) compared gold standard smoking cessation treatment (four weekly sessions of behavioral counseling followed by self-selected combination NRT in week 5) to a novel experiential approach (ie, In Vivo; four weekly sessions of sampling each short form of NRT-gum, lozenge, inhaler, nasal spray-in-session while wearing the nicotine patch followed by NRT selection in week 5). Both groups received 8 weeks of nicotine patch plus their selected additional short form NRT for smoking cessation followed by a 1-month assessment. RESULTS Screening and enrollment rates supported feasibility. In Vivo was comparable in acceptability with the gold standard of care intervention; however, there was greater attrition in the In Vivo group compared with the gold standard of care group. Results suggested higher medication adherence and improvements in smoking behavior in the In Vivo intervention; with generally small-to-medium effect sizes. CONCLUSIONS This experiential approach to sampling NRT is feasible and acceptable to low-income people who smoke. This intervention may increase adherence and reduce harmful smoking behavior but needs to be tested on a larger scale. IMPLICATIONS Medication adherence remains a significant impediment to the successful smoking cessation. The results of this study suggest that guided sampling of NRT products improves adherence among low-income smokers. Additionally, this approach yielded greater improvements in smoking behavior compared with gold standard smoking cessation treatment. This intervention shows promise as a feasible smoking cessation treatment for low-income smokers.
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Affiliation(s)
- Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caitlin Wolford-Clevenger
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle L Sisson
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keith R Chichester
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mickeah Hugley
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andres Azuero
- Department of Nursing, Family, Community & Health Systems, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael S Businelle
- Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Peter S Hendricks
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard C Shelton
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Hollings Cancer Center, Charleston, SC, USA
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16
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Pantalon MV, Dziura J, Li FY, D'Onofrio G, Weiss J, Bernstein SL. A Brief Negotiation Interview Adherence Scale for Smoking Cessation: A psychometric evaluation. J Subst Abuse Treat 2021; 126:108398. [PMID: 34116807 DOI: 10.1016/j.jsat.2021.108398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/01/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
Practitioner adherence to the Brief Negotiation Interview (BNI) for high-risk alcohol consumption and opioid use disorder can be measured using the BNI Adherence Scale, for alcohol (BAS-A) and opioids (BAS-O), respectively. However, no psychometrically validated brief intervention adherence scale for smoking cessation has been reported in the literature. Our objective was to develop and examine the psychometric properties of a BAS for smoking cessation (BASS). In the context of a clinical trial of the BNI in an emergency department (ED)-which incorporates motivational interviewing (MI), feedback, and behavioral contracting-plus nicotine replacement therapy (NRT), and a Smokers' Quitline referral and brochure (BNI), compared with brochure-only (control), we developed and examined the psychometric properties of the BAS-S, a scale that requires raters to answer whether each critical action of the BNI was implemented. Three independent raters rated three hundred and eighty-eight audio-recorded BNI sessions. The results indicated that the BAS-S had excellent internal consistency, and discriminant validity, inter-rater reliability, and construct validity. The following 3-factor (10-item) solution accounted for 43% of the variance: factor 1, "Feedback,", factor 2, "NRT Motivation," and factor 3, "Plan Negotiation." The study found predictive validity for the Feedback factor, suggesting that patients who were provided feedback on the harms of their smoking were significantly less likely to achieve biologically confirmed 7-day tobacco abstinence at their 3-month follow-up than those who were not provided such feedback (p < 0.03). The BAS-S is a psychometrically valid measure of adherence to the BNI for smoking cessation.
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Affiliation(s)
- Michael V Pantalon
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA.
| | - James Dziura
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA; Yale School of Public Health, 60 College St., New Haven, CT 06510, USA
| | - Fang-Yong Li
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA
| | - Gail D'Onofrio
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA
| | - June Weiss
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA
| | - Steven L Bernstein
- Yale University School of Medicine Department of Emergency Medicine 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA; Yale School of Public Health, 60 College St., New Haven, CT 06510, USA; Yale Cancer Center, 333 Cedar St., New Haven, CT 06510, USA
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17
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McCarthy ML, Zheng Z, Wilder ME, Elmi A, Li Y, Zeger SL. The Influence of Social Determinants of Health on Emergency Departments Visits in a Medicaid Sample. Ann Emerg Med 2021; 77:511-522. [PMID: 33715829 DOI: 10.1016/j.annemergmed.2020.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE We evaluate the relationship between social determinants of health and emergency department (ED) visits in the Medicaid Cohort of the District of Columbia. METHODS We conducted a retrospective cohort analysis of 8,943 adult Medicaid beneficiaries who completed a social determinants of health survey at study enrollment. We merged the social determinants of health data with participants' Medicaid claims data for up to 24 months before enrollment. Using latent class analysis, we grouped our participants into 4 distinct social risk classes based on similar responses to the social determinants of health questions. We classified ED visits as primary care treatable or ED care needed, using the Minnesota algorithm. We calculated the adjusted log relative primary care treatable and ED care needed visit rates among the social risk classes by using generalized linear mixed-effects models. RESULTS The majority (71%) of the 49,111 ED visits made by the 8,943 participants were ED care needed. The adjusted log relative rate of both primary care treatable and ED care needed visit rates increased with each higher (worse) social risk class compared with the lowest class. Participants in the highest social risk class (ie, unemployed and many social risks) had a log relative primary care treatable and ED care needed rate of 39% (range 28% to 50%) and 29% (range 21% to 38%), respectively, adjusted for age, sex, and illness severity. CONCLUSION There is a strong relationship between social determinants of health and ED utilization in this Medicaid sample that is worth investigating in other Medicaid samples and patient populations.
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Affiliation(s)
- Melissa L McCarthy
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC.
| | - Zhaonian Zheng
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Marcee E Wilder
- Department of Emergency Medicine, George Washington University, Washington, DC; Medical Faculty Associates, Washington, DC
| | - Angelo Elmi
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Yixuan Li
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Scott L Zeger
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Mahabee-Gittens EM, Ammerman RT, Khoury JC, Tabangin ME, Ding L, Merianos AL, Stone L, Gordon JS. A Parental Smoking Cessation Intervention in the Pediatric Emergency Setting: A Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8151. [PMID: 33158230 PMCID: PMC7663571 DOI: 10.3390/ijerph17218151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 01/05/2023]
Abstract
We examined the efficacy of a pediatric emergency visit-based screening, brief intervention, and referral to treatment (SBIRT) condition compared to a control condition (Healthy Habits Control, HHC) to help parental smokers quit smoking. We enrolled 750 parental smokers who presented to the pediatric emergency setting with their child into a two-group randomized controlled clinical trial. SBIRT participants received brief cessation coaching, quitting resources, and up to 12-weeks of nicotine replacement therapy (NRT). HHC participants received healthy lifestyle coaching and resources. The primary outcome was point-prevalence tobacco abstinence at six weeks (T1) and six months (T2). The mean (SD) age of parents was 31.8 (7.7) years, and 86.8% were female, 52.7% were Black, and 64.6% had an income of ≤$15,000. Overall abstinence rates were not statistically significant with 4.2% in both groups at T1 and 12.9% and 8.3% in the SBIRT and HHC groups, respectively, at T2. There were statistically significant differences in SBIRT versus HHC participants on the median (IQR) reduction of daily cigarettes smoked at T1 from baseline (-2 [-5, 0] versus 0 [-4, 0], p = 0.0008),at T2 from baseline (-4 [-9, -1] vs. -2 [-5, 0], p = 0.0006), and on the mean (SD) number of quit attempts at T2 from baseline (1.25 (6.5) vs. 0.02 (4.71), p = 0.02). Self-reported quitting rates were higher in SBIRT parents who received NRT (83.3% vs. 50.9%, p = 0.04). The novel use of the pediatric emergency visit to conduct cessation interventions helped parents quit smoking. The near equivalent abstinence rates in both the SBIRT and HHC groups may be due to underlying parental concern about their child's health. Cessation interventions in this setting may result in adult and pediatric public health benefits.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA;
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
| | - Robert T. Ammerman
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Jane C. Khoury
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Meredith E. Tabangin
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Lili Ding
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA;
| | - Judith S. Gordon
- College of Nursing, University of Arizona, Tucson, AZ 85721, USA;
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Mahabee-Gittens EM, Merianos AL, Dexheimer JW, Meyers GT, Stone L, Tabangin M, Khoury JC, Gordon JS. Utilization of a Clinical Decision Support Tool to Reduce Child Tobacco Smoke Exposure in the Urgent Care Setting. Pediatr Emerg Care 2020; 36:527-531. [PMID: 30346363 PMCID: PMC6474832 DOI: 10.1097/pec.0000000000001646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical decision support systems (CDSS) may facilitate caregiver tobacco screening and counseling by pediatric urgent care (UC) nurses. OBJECTIVE This study aimed to assess the feasibility of a CDSS to address caregivers' tobacco use and child tobacco smoke exposure (TSE). METHODS We conducted a 3-month prospective study on caregivers screened using a CDSS. Nurses used the CDSS to advise, assess, and assist caregivers to quit. We assessed caregiver sociodemographics, smoking habits, and child TSE. RESULTS We screened 185 caregivers whose children were exposed to TSE for study inclusion; 155 (84%) met the eligibility criteria, and 149 (80.5%) were included in the study. Study nurses advised 35.2% of the caregivers to quit, assessed 35.9% for readiness to quit, and assisted 32.4%. Of the 149 participants, 83.1% were female; 47.0% were white and 45.6% African American; 84.6% had public insurance or were self-pay; 71.1% were highly nicotine dependent; 50.0% and 50.7% allowed smoking in the home and car, respectively; and 81.3% of children were biochemically confirmed to be exposed to tobacco smoke. At follow-up (86.6% retention), 58.9% reported quit attempts at 3 months. There was a significant decrease in nicotine dependence and a significant increase in motivation to quit. Self-reported quit rate was 7.8% at 3 months. CONCLUSIONS An electronic health record-embedded CDSS was feasible to incorporate into busy UC nurses' workloads and was associated with encouraging changes in the smoking behavior of caregivers. More research on the use of CDSS to screen and counsel caregivers who smoke in the UC and other acute care settings is warranted.
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Affiliation(s)
| | | | - Judith W. Dexheimer
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Gabe T. Meyers
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Meredith Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Mahabee-Gittens EM, Merianos AL, Tabangin ME, Stone L, Gordon JS, Khoury JC. Provision of free nicotine replacement therapy to parental smokers in the pediatric emergency setting. Tob Prev Cessat 2020; 6:30. [PMID: 32760865 PMCID: PMC7398133 DOI: 10.18332/tpc/119125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/06/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Although the administration of free Nicotine Replacement Therapy (NRT) is effective in helping smokers quit, the feasibility, acceptability and safety of this practice have not been examined in the emergency setting of the pediatric emergency department (PED) or urgent care (UC). We examined the characteristics of parental smokers who were interested and eligible for free NRT during their child's emergency visit and the uptake, usage, and associated side effects of NRT use. METHODS We analyzed data from 377 parental smokers who were randomized to receive cessation counseling and free NRT as part of an emergency visit-based randomized controlled trial. Parents interested in NRT were screened for medical contraindications; eligible parents were given a 6-week supply of NRT patches or lozenges during their child's emergency visit and offered another supply 6 weeks later. We conducted Wilcoxon rank-sum tests and chi-squared tests to address our main study objective. RESULTS The majority of parents were female (87.5%), non-Hispanic Black (52.5%), and mean (SD) age was 33.1 (8.2) years. A total of 252 (66.8%) parents were interested in receiving NRT. Compared to uninterested parents, interested parents were more likely to: be older [33.6 (8.2) vs 31.9 (8.2), years]; be non-Hispanic Black (54.0% vs 49.6%); have older children [5.5 (5.0) vs 4.2 (4.6)]; have a higher readiness to quit [7.0 (2.4) vs 5.2 (2.6)]; and have a child being evaluated in UC compared to the PED (72.4% vs 56.5%). A total of 53 (21%) interested parents had >1 NRT contraindications. At 6 weeks, 94 (79.0%) parents reported some ≥NRT usage and 50 (53.2%) requested an additional 6-week supply. There were no serious adverse events and 5 (5.3%) reported minor side effects. CONCLUSIONS Parental smokers in the emergency setting are interested in receiving free NRT, the majority use it, and use is not associated with adverse side effects. The emergency visit may be an optimal time to offer NRT to parental smokers.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, United States
| | - Meredith E. Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Judith S. Gordon
- College of Nursing, University of Arizona, Tucson, United States
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, United States
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Katz DA, Hamlin C, Vander Weg MW, Grant KM, Stewart Steffensmeier KR, Paez M, Hawley ST, Gaeth G. Veterans' preferences for tobacco treatment in primary care: A discrete choice experiment. PATIENT EDUCATION AND COUNSELING 2020; 103:652-660. [PMID: 31629558 DOI: 10.1016/j.pec.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate US veterans' preferences for smoking cessation counseling and pharmacotherapy. METHODS A discrete choice experiment (DCE) was conducted in 123 Veterans Health Administration primary care outpatients who planned to quit smoking within 6 months. Key attributes of tobacco cessation treatment were based on literature review and expert opinion. We used a hierarchical Bayesian approach with a logit model to estimate the part-worth utility of each attribute level and used latent class logit models to explore preference heterogeneity. RESULTS In the aggregate, participants valued counseling options with the following attributes: higher quit rate at 1 year, emphasis on autonomy, familiarity of the counselor, counselor's communication skills, and inclusion of printed materials on smoking cessation. Participants valued pharmacotherapy options with the following attributes: higher quit rate at 1 year, lower risk of physical side effects, zero copayment, monthly check-in calls, and less weight gain. Latent class analysis revealed distinct clusters of patients with a unique preference "phenotype." CONCLUSIONS Veterans have distinct preferences for attributes of cessation counseling and pharmacotherapy. PRACTICE IMPLICATIONS Identifying patients' preferences provides an opportunity for clinicians to offer tailored treatment options that better engage veterans in their own care and boost adherence to guideline-recommended counseling and pharmacotherapy.
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Affiliation(s)
- David A Katz
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA; Department of Medicine, University of Iowa, Iowa City, IA, USA; Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.
| | - Christine Hamlin
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Mark W Vander Weg
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA; Department of Medicine, University of Iowa, Iowa City, IA, USA; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Kathleen M Grant
- VA Nebraska-Western Iowa Health Care System and the Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kenda R Stewart Steffensmeier
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Monica Paez
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Sarah T Hawley
- Ann Arbor Veterans Administration (VA) Healthcare System, University of Michigan, Ann Arbor, MI, USA; Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Gary Gaeth
- Tippie School of Business, University of Iowa, Iowa City, IA, USA
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Grobe JE, Goggin K, Harris KJ, Richter KP, Resnicow K, Catley D. Race moderates the effects of Motivational Interviewing on smoking cessation induction. PATIENT EDUCATION AND COUNSELING 2020; 103:350-358. [PMID: 31466882 PMCID: PMC7012686 DOI: 10.1016/j.pec.2019.08.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/31/2019] [Accepted: 08/17/2019] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Health disparities necessitate exploration of how race moderates response to smoking cessation treatment. Data from a randomized clinical trial of Motivational Interviewing (MI) for smoking cessation induction were used to explore differential treatment response between African American (AA) vs Non-Black (NB) smokers. METHODS Adult tobacco smokers (138 AA vs 66 NB) with low desire to quit were randomly assigned to four sessions of MI or health education (HE). Outcomes (e.g., quit attempts) were assessed 3- and 6-months. RESULTS There was evidence of a Race by Treatment interaction such that MI was less effective than HE in AA smokers. Mean Cohen's d for the interaction effect was -0.32 (95% CI [-0.44, -0.20]). However, the race interaction could be accounted for by controlling for baseline relationship status and communication preference (wants directive approach). CONCLUSIONS MI may be less effective for smoking cessation induction in AA vs NB smokers when compared to another active and more directive therapy. The differential response between races may be explained by psychosocial variables. PRACTICE IMPLICATIONS MI may not be an ideal choice for all African American smokers. Patients' relationship status and preference for a directive counseling approach might explain disparities in response to MI treatment.
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Affiliation(s)
- James E Grobe
- JEGrobe Consulting, 9209 Heatherdale Drive, Dallas, Texas, 75243, United States.
| | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City Hospitals and Clinics, and Schools of Medicine and Pharmacy, University of Missouri - Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, United States.
| | - Kari Jo Harris
- School of Public and Community Health Sciences, 32 Campus Drive Skaggs Building Room 352, The University of Montana, Missoula, Montana, 406-243-4685, United States.
| | - Kimber P Richter
- Department of Preventive Medicine & Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1008, 4004 Robinson, Kansas City, KS, 66160, United States.
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, United States.
| | - Delwyn Catley
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, United States.
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Northrup TF, Suchting R, Klawans MR, Khan AM, Villarreal YR, Green C, Stotts AL. Proactive delivery of nicotine replacement therapy to families of hospitalized infants in a NICU: A randomized controlled pilot trial. ACTA ACUST UNITED AC 2020; 26:201-206. [PMID: 32863730 DOI: 10.1016/j.jnn.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Neonatal ICU (NICU) hospitalizations provide opportunities to engage individuals/families who smoke with evidence-based cessation treatments to protect infants from tobacco smoke exposure. The aim of this pilot study was to establish the feasibility and potential efficacy of providing motivational advice and NRT (MA+NRT) to families of NICU infants. RCT methodology equally allocated participants who reported ≥1 household smoker (N=32) from a large NICU to MA+NRT or referral to a Quitline. The primary outcome was accepting NRT patches (MA+NRT) and use of NRT. Bayesian analyses modeled NRT use as a function of treatment group. Most MA+NRT participants (81.3%; n=13) accepted the patches. No Quitline participants called the Quitline. NRT use differed across groups, indicating a 0.907 posterior probability that a positive effect for MA+NRT exists (RR=2.32, 95% CI=[0.68-11.34]). This study demonstrated feasibility and acceptability for offering NRT and motivational advice to NICU parents and supports further intervention refinement with NICU families.
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Affiliation(s)
- Thomas F Northrup
- Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, 6431 Fannin, JJL 324, Houston, TX 77030
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, UTHealth, McGovern Medical School, 1941 East Road, Houston, TX 77030
| | - Michelle R Klawans
- Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, 6431 Fannin, JJL 328, Houston, TX 77030
| | - Amir M Khan
- Department of Pediatrics, UTHealth, McGovern Medical School, 6431 Fannin, MSB 3.236, Houston, TX 77030
| | - Yolanda R Villarreal
- Department of Family and Community Medicine, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, 6431 Fannin, JJL 328, Houston, TX 77030
| | - Charles Green
- Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, UTHealth, McGovern Medical School, 6431 Fannin, MSB 2.106, Houston, TX 77030
| | - Angela L Stotts
- Department of Family and Community Medicine, Department of Psychiatry and Behavioral Sciences, UTHealth, McGovern Medical School, 6431 Fannin, JJL 324, Houston, TX 77030
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Cunradi CB, Lee J, Pagano A, Caetano R, Alter HJ. Gender Differences in Smoking Among an Urban Emergency Department Sample. Tob Use Insights 2019; 12:1179173X19879136. [PMID: 31598064 PMCID: PMC6763935 DOI: 10.1177/1179173x19879136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Urban emergency department (ED) patients have elevated smoking and substance
use compared with the general population. We analyzed gender differences in
smoking among an urban ED sample and assessed the contribution of substance
use, demographic, and couple factors. Methods: We conducted a secondary analysis of data obtained from a cross-sectional,
observational survey (N = 1037 participants) on drinking, drug use, and
intimate partner violence (IPV). Gender-specific logistic regression models
for current (past 30-day) smoking and multinomial regression models for
smoking intensity (light: ⩽5 cigarettes per day [CPD]; moderate: 6 to 10
CPD; heavier: >10 CPD) were estimated. Results: Smoking prevalence was higher among men than women (35.5% vs 18.9%;
P < .001). Substance use (frequency of intoxication,
marijuana, amphetamine, and cocaine use), demographic (food insufficiency,
unemployment), and couple-related factors (having a spouse/partner who
smoked, IPV involvement, being in a same-gender couple) were differentially
associated with current smoking and level of intensity among men and
women. Conclusions: Emergency department staff should consider the impact of polysubstance use,
food insufficiency, unemployment, and whether both partners in the couple
smoke when screening patients for smoking and formulating cessation
treatment plans. Women in same-gender relationships and those who have
experienced IPV involvement may require additional referral.
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Affiliation(s)
- Carol B Cunradi
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Juliet Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Harrison J Alter
- The Andrew Levitt Center for Social Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA, USA
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Ability to Reach Low-Income Smokers Enrolled in a Randomised Controlled Trial Varies with Time of Month. J Smok Cessat 2019; 13:227-232. [PMID: 31452822 DOI: 10.1017/jsc.2017.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Because of financial pressures, low-income individuals sometimes run out of cellphone service towards the end of the month. Aims To determine if the time of month affects ability to reach low-income smokers by telephone. Methods We reviewed data from a completed trial in the United States of emergency department (ED)-initiated tobacco dependence treatment for low-income smokers at a busy, academic ED in an urban community. We recorded the date of each one-month follow-up call, and divided each month into four time blocks: Week 1, Week 2, Week 3, and Week 4. Results A total of 2,049 phone calls were made to reach 769 participants. Of these calls, 677 (33%) resulted in contact; 88% of all participants were contacted. Using generalised estimating equations with Week 4 as reference, the odds of a successful contact at Weeks 1, 2, and 3 were, respectively, 1.52 (95% CI 1.18, 1.96), 1.30 (95% CI 1.01, 1.66), and 1.37 (95% CI 1.07, 1.76). Conclusions Study participants became progressively difficult to reach. This result may reflect low-income smokers' decreased rates of active telephone service later in the month and suggests a mechanism to improve follow-up rates in future studies of low-income populations.
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Phelan MP, Nithianandam B, Eikoff N, Good D, Hustey FM, Meldon S. An intervention based on the Electronic Medical Record to improve smoking cessation guidance in an urban tertiary care center emergency department. Tob Prev Cessat 2019; 5:16. [PMID: 32411880 PMCID: PMC7205161 DOI: 10.18332/tpc/107116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Smoking remains a major public health issue and a leading cause of death and disability in the United States. The objective of this study was to determine the effect of a simple intervention on smoking guidance, based on the electronic medical record (EMR), including providing discharge instructions and/or cessation counseling to emergency department (ED) patients who smoke. METHODS This was an interventional before-and-after study in an ED with 70000 visits per year. A pre-intervention and post-intervention chart review was performed on a random sample of ED visits occurring in 2014 and 2016, identifying smokers and the frequency with which smokers received discharge instructions and/or cessation counseling. In the fall of 2015, our EMR was programmed to deploy smoking cessation discharge instructions automatically. RESULTS In all, 28.7% (172/600; 95% CI: 25.2–32.4%) reported current smoking in the pre-intervention ED population and 27.6% (166/600; 95% CI: 24.2–31.4%) reported smoking in the post-intervention population. Smoking cessation guidance was provided to a total of 3.5% of self-reported smokers in the pre-intervention group (6/172; 95% CI: 1.4–7.6%); 1.2% (2/172; 95% CI: 0.3–4.1%) were informed of smoking cessation resources as part of their printed ED discharge instructions and 2.3% (4/172; 95% CI: 0.9–5.8%) received smoking cessation counseling by the ED provider. There was a statistically significant increase in the proportion of patients receiving any smoking cessation guidance after the intervention. All patients (166/166; 95% CI: 97–100% in this period received ED discharge instructions and a list of smoking cessation resources and 3.6% of smokers (6/166; 95% CI: 1.7–7.7%) received smoking cessation counseling by the ED provider. CONCLUSIONS Automated deployment of smoking cessation discharge instructions in the EMR improves smoking cessation discharge instructions, and also has a positive impact on improving rates of in-person counseling by ED providers.
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Affiliation(s)
- Michael P Phelan
- Cleveland Clinic, Emergency Services Institute, Cleveland, Ohio, United States
| | | | - Nathan Eikoff
- Cleveland Clinic, Emergency Services Institute, Cleveland, Ohio, United States
| | - Daniel Good
- Northeast Ohio Medical University, Rootstown, Ohio, United States
| | - Fredric M Hustey
- Cleveland Clinic, Emergency Services Institute, Cleveland, Ohio, United States
| | - Stephen Meldon
- Cleveland Clinic, Emergency Services Institute, Cleveland, Ohio, United States
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Hawk KF, Glick RL, Jey AR, Gaylor S, Doucet J, Wilson MP, Rozel JS. Emergency Medicine Research Priorities for Early Intervention for Substance Use Disorders. West J Emerg Med 2019; 20:386-392. [PMID: 30881562 PMCID: PMC6404722 DOI: 10.5811/westjem.2019.1.39261] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction Patients with substance use disorders (SUDs) frequently seek emergency care, and the emergency department (ED) may be their only point of contact with the healthcare system. While the ED visit has been increasingly recognized as providing opportunity for interventions around substance use, many questions remain. Methods In December 2016 the Coalition on Psychiatric Emergencies (CPE) convened the first Research Consensus Conference on Acute Mental Illness, which consisted of clinical researchers, clinicians from emergency medicine, emergency psychiatry, emergency psychology, representatives from governmental agencies and patient advocacy groups. Background literature review was conducted prior to the meeting, and questions were iteratively focused, revised, voted on and ranked by perceived importance using nominal group method. Results The main goal of the SUD workgroup was to identify research priorities and develop a research agenda to improve the early identification of and management of emergency department (ED) patients with SUDs with the goal of improving outcomes. This article is the product of a breakout session on “Special Populations: Substance Use Disorder.” The workgroup identified with high consensus six research priorities for their importance related to the care of ED patients with SUDs in these overall domains: screening; ED interventions; the role of peer navigators; initiation of SUD management in the ED; specific patient populations that may impact the effectiveness of interventions including sociogenerational and cultural factors; and the management of the acutely intoxicated patient. Conclusion Emergency providers are increasingly recognizing the important role of the ED in reducing adverse outcomes associated with untreated SUDs. Additional research is required to close identified knowledge gaps and improve care of ED patients with SUD.
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Affiliation(s)
- Kathryn F Hawk
- Yale University, Department of Emergency Medicine, New Haven, Connecticut
| | - Rachel L Glick
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
| | - Arthur R Jey
- Sutter Medical Center, Department of Emergency Medicine, Sacramento, California
| | - Sydney Gaylor
- University of California-San Diego, Department of Emergency Medicine, San Diego, California
| | | | - Michael P Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, Arkansas
| | - John S Rozel
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania
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Guignard R, Nguyen-Thanh V, Delmer O, Lenormand MC, Blanchoz JM, Arwidson P. [Interventions for smoking cessation among low socioeconomic status smokers: a literature review]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2018; 30:45-60. [PMID: 29589689 DOI: 10.3917/spub.181.0045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In most western countries, smoking appears to be highly differentiated according to socio-economic level. Two systematic reviews published in 2014 showed that most of the recommended interventions for smoking cessation, particularly individual interventions, tend to increase social inequalities in health. An analysis of the most recent literature was carried out in order to provide policy makers and stakeholders with a set of evidence on the modalities of interventions to encourage and help disadvantaged smokers quit smoking. METHODS This review was based on articles published between January 2013 and April 2016. Only studies conducted in European countries or countries in stage 4 of the tobacco epidemic (USA, Canada, Australia, New Zealand) were included. Selected articles were double-screened. RESULTS Twenty-three studies were identified, including evaluation of media campaigns, face-to-face behavioural support, phone- and web-based support or awareness of passive smoking among children. Some interventions adapted to precarious populations have been shown to be effective. CONCLUSIONS Some characteristics would facilitate access and improve the support of disadvantaged groups, including a local intervention, a proactive approach and co-construction with targeted smokers.
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Bernstein SL, Dziura J, Weiss J, Miller T, Vickerman KA, Grau LE, Pantalon MV, Abroms L, Collins LM, Toll B. Tobacco dependence treatment in the emergency department: A randomized trial using the Multiphase Optimization Strategy. Contemp Clin Trials 2018; 66:1-8. [PMID: 29287665 PMCID: PMC5851600 DOI: 10.1016/j.cct.2017.12.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/29/2017] [Accepted: 12/25/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tobacco dependence remains the leading preventable cause of death in the developed world. Smokers are disproportionately from lower socioeconomic groups, and may use the hospital emergency department (ED) as an important source of care. A recent clinical trial demonstrated the efficacy of a multicomponent intervention to help smokers quit, but the independent contributions of those components is unknown. METHODS This is a full-factorial (16-arm) randomized trial in a busy hospital ED of 4 tobacco dependence interventions: brief motivational interviewing, nicotine replacement therapy, referral to a telephone quitline, and a texting program. The trial utilizes the Multiphase Optimization Strategy (MOST) and a novel mixed methods analytic design to assess clinical efficacy, cost effectiveness, and qualitative participant feedback. The primary endpoint is tobacco abstinence at 3months, verified by participants' exhaled carbon monoxide. RESULTS Study enrollment began in February 2017. As of April 2017, 52 of 1056 planned participants (4.9%) were enrolled. Telephone-based semi-structured participant interviews and in-person biochemical verification of smoking abstinence are completed at the 3-month follow-up. Efficacy and cost effectiveness analyses will be conducted after follow-up is completed. DISCUSSION The goal of this study is to identify a clinically efficacious, cost-effective intervention package for the initial treatment of tobacco dependence in ED patients. The efficacy of this combination can then be tested in a subsequent confirmatory trial. Our approach incorporates qualitative feedback from study participants in evaluating which intervention components will be tested in the future trial. TRIAL REGISTRATION Trial (NCT02896400) registered in ClinicalTrials.gov on September 6, 2016.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, United States; Department of Health Policy, Yale School of Public Health, United States; Yale Cancer Center, New Haven, CT, United States.
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, United States; Department of Health Policy, Yale School of Public Health, United States
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, United States
| | - Ted Miller
- Pacific Institute of Research and Evaluation, Calverton, MD, United States
| | | | - Lauretta E Grau
- Department of Health Policy, Yale School of Public Health, United States
| | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, United States
| | - Lorien Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, United States
| | - Linda M Collins
- The Methodology Center and Department of Human Development and Family Studies, Pennsylvania State University, College Station, PA, United States
| | - Benjamin Toll
- Yale Cancer Center, New Haven, CT, United States; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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An Electronic Health Record-Based Strategy to Address Child Tobacco Smoke Exposure. Am J Prev Med 2018; 54:64-71. [PMID: 29102458 PMCID: PMC5736447 DOI: 10.1016/j.amepre.2017.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/07/2017] [Accepted: 08/08/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION A high proportion of children presenting to pediatric urgent cares are exposed to tobacco smoke. An electronic health record-based clinical decision support system for nurses to facilitate guideline-based tobacco smoke exposure screening and counseling for caregivers who smoke was designed and evaluated. DESIGN A mixed-methods, 3-month, prospective study that began in November 2015, data were analyzed in June 2016. SETTING/PARTICIPANTS Five urgent cares that were part of a large children's hospital in Cincinnati, OH. Participants were urgent care nurses. INTERVENTION The clinical decision support system prompted nurses to Ask, Advise, Assess, and Assist caregivers to quit smoking. Monthly feedback reports were also provided. MAIN OUTCOME MEASURE Clinical decision support system use rates, nurses' attitudes towards tobacco smoke exposure intervention, and percentage of children screened and caregivers counseled. RESULTS All nurses used the clinical decision support system. Compared with Month 1, nurses were twice as likely to advise and assess during Months 2 and 3. There was significant improvement in nurses feeling prepared to assist caregivers in quitting. Nurses reported that feedback reports motivated them to use the clinical decision support system, and that it was easy to use. Almost 65% of children were screened for tobacco smoke exposure; 19.5% screened positive. Of caregivers identified as smokers, 26% were advised to quit and 29% were assessed for readiness to quit. Of those assessed, 67% were interested in quitting, and of those, 100% were assisted. CONCLUSIONS A clinical decision support system increased rates of tobacco smoke exposure screening and intervention in pediatric urgent cares. Rates might further improve by incorporating all components of the clinical decision support system into the electronic health record. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02489708.
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Lemhoefer C, Rabe GL, Wellmann J, Bernstein SL, Cheung KW, McCarthy WJ, Lauridsen SV, Spies C, Neuner B. Emergency Department-Initiated Tobacco Control: Update of a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Prev Chronic Dis 2017; 14:E89. [PMID: 28981403 PMCID: PMC5645196 DOI: 10.5888/pcd14.160434] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A 2012 systematic review and meta-analysis of randomized controlled trials on emergency department-initiated tobacco control (ETC) showed only short-term efficacy. The aim of this study was to update data through May 2015. METHODS After registering the study protocol on the international prospective register of systematic reviews (PROSPERO) in May 2015, we searched 7 databases and the gray literature. Our outcome of interest was the point prevalence of tobacco-use abstinence at 1-month, 3-month, 6-month, or 12-month follow-up. We calculated the relative risk (RR) of tobacco-use abstinence after ETC at each follow-up time separately for each study and then pooled Mantel-Haenszel RRs by follow-up time. These results were pooled with results of the 7 studies included in the previous review. We calculated the effect of ETC on the combined point prevalence of tobacco-use abstinence across all follow-up times by using generalized linear mixed models. RESULTS We retrieved 4 additional studies, one published as an abstract, comprising 1,392 participants overall. The 1-month follow-up point prevalence of tobacco-use abstinence after ETC resulted in an RR of 1.49 (95% confidence interval [CI], 1.08-2.05) across 3 studies; 3-month follow-up, an RR of 1.38 (95% CI, 1.12-1.71) across 9 studies; 6-month follow-up, an RR of 1.09 (95% CI, 0.84-1.41) across 6 studies; and 12-month follow-up, an RR of 1.26 (95% CI, 1.00-1.59) across 3 studies. The effect on the combined point prevalence of abstinence was an RR of 1.40 (95% CI, 1.06-1.86) (P = .02). CONCLUSION ETC is effective in promoting continual tobacco-use abstinence up to 12 months after intervention. ETC may be a critically important public health strategy for engaging hard-to-reach smokers in tobacco-use cessation.
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Affiliation(s)
- Christina Lemhoefer
- Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Berlin, Germany
| | - Gwen Lisa Rabe
- Krankenhaus der Augustinerinnen, Department of Internal Medicine, Cologne, Germany
| | - Jürgen Wellmann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale University School of Medicine; Yale Cancer Center; Department of Health Policy, Yale School of Public Health, New Haven, Connecticut
| | - Ka Wai Cheung
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - William J McCarthy
- University of California Los Angeles, Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Susanne Vahr Lauridsen
- University Hospital of Copenhagen, Rigshospitalet, Department of Urology, Copenhagen, Denmark
| | - Claudia Spies
- Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Berlin, Germany
| | - Bruno Neuner
- Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Virchow Klinikum and Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany.
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Bernstein SL, D'Onofrio G. Screening, treatment initiation, and referral for substance use disorders. Addict Sci Clin Pract 2017; 12:18. [PMID: 28780906 PMCID: PMC5545867 DOI: 10.1186/s13722-017-0083-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 06/16/2017] [Indexed: 11/10/2022] Open
Abstract
Substance use remains a leading cause of preventable death globally. A model of intervention known as screening, brief intervention, and referral to treatment (SBIRT) was developed decades ago to facilitate time- and resource-sensitive interventions in acute care and outpatient settings. SBIRT, which includes a psychosocial intervention incorporating the principles of motivational interviewing, has been shown to be effective in reducing alcohol consumption and consequences in unhealthy drinkers both in primary care and emergency department settings. Subsequently, SBIRT for unhealthy alcohol use has been endorsed by governmental agencies and professional societies in multiple countries. Although most trials support the efficacy of SBIRT for unhealthy alcohol use (McQueen et al. in Cochrane Database Syst Rev 8, 2011; Kaner et al. in Cochrane Database Syst Rev 2, 2007; O'Donnell et al. in Alcohol Alcohol 49(1):66-78, 2014), results are heterogenous; negative studies exist. A newer approach to screening and intervention for substance use can incorporate initiation of medication management at the index visit, for individuals willing to do so, and for providers and healthcare systems that are appropriately trained and resourced. Our group has conducted two successful trials of an approach we call screening, treatment initiation, and referral (STIR). In one trial, initiation of nicotine pharmacotherapy coupled with screening and brief counseling in adult smokers resulted in sustained biochemically confirmed abstinence. In a second trial, initiation of buprenorphine for opioid dependent individuals resulted in greater engagement in treatment at 30 days and greater self-reported abstinence. STIR may offer a new, clinically effective approach to the treatment of substance use in clinical care settings.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA. .,Department of Health Policy, Yale School of Public Health, New Haven, CT, USA. .,Yale Cancer Center, New Haven, CT, USA.
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
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Randomized controlled trial of emergency department initiated smoking cessation counselling and referral to a community counselling service. CAN J EMERG MED 2017; 20:556-564. [PMID: 28693638 DOI: 10.1017/cem.2017.345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Worldwide, tobacco smoke is still the leading cause of preventable morbidity and mortality. Many smokers develop chronic smoking-related conditions that require emergency department (ED) visits. However, best practices for ED smoking cessation counselling are still unclear. METHODS A randomized controlled trial was conducted to determine whether an "ask, advise, and refer" approach increases 12-month, 30-day quit rates in the stable adult ED smoking population compared to usual care. Patients in the intervention group were referred to a community counselling service that offers a quitline, a text-based program, and a Web-based program. Longitudinal intention-to-treat analyses were performed. RESULTS From November 2011 to March 2013, 1,295 patients were enrolled from one academic tertiary care ED. Six hundred thirty-five were allocated to usual care, and 660 were allocated to intervention. Follow-up data were available for 70% of all patients at 12 months. There was no statistically significant difference in 12-month, 30-day quit rates between the two groups. However, there was a trend towards higher 7-day quit attempts, 7-day quit rates, and 30-day quit rates at 3, 6, and 12 months in the intervention group. CONCLUSION In this study, there was a trend towards increased smoking cessation following referral to a community counselling service. There was no statistically significant difference. However, if ED smoking cessation efforts were to provide even a small positive effect, such an intervention may have a significant public health impact given the extensive reach of emergency physicians.
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Choice of smoking cessation counselling via phone, text, or email in emergency department patients. Prev Med Rep 2016; 4:597-600. [PMID: 27843760 PMCID: PMC5107645 DOI: 10.1016/j.pmedr.2016.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/14/2016] [Accepted: 10/24/2016] [Indexed: 11/23/2022] Open
Abstract
Globally, tobacco smoke is the leading cause of preventable deaths. Smoking cessation counselling services are widely available in Canada. In British Columbia, our government-funded smoking cessation service offers counselling via phone, text, or email. In this study, we sought to determine whether age, gender, or motivation to quit affect a patient's choice of service modality. We included all adults ≥ 18 years who had used tobacco within 30 days prior to their Emergency Department (ED) visit and who chose to receive phone, text, or email counselling services from November 2011–February 2013 at Vancouver General Hospital as part of a randomized-controlled trial (ClinicalTrials.gov, NCT0145437). A one-way ANOVA was used to compare the mean age of patients in each group. Chi-squared tests of independence were used to determine if gender or motivation to quit were associated with modality selection. In total, 368 patients were included. The average age was 41.7 years and 67% were female. In our study, 44% chose phone, 17% chose text, and 40% chose email services. The average age for patients preferring text services (mean = 33.6 years) was significantly lower than both the email (mean = 41.3 years) and phone (mean = 45.1 years) groups (p < 0.001). Gender and motivation to quit were not associated with service modality choice. Over 80% of ED smokers who accepted a referral to counselling services chose the phone or email modality. The lesser chosen text modality was more popular with younger patients. With further research, smoking cessation counselling services can refine their programs to meet the needs of the population they serve. Many smoking cessation quit lines offer counselling by phone, text, or internet. > 80% of smokers in our study who accepted referral chose phone or internet counselling. The lesser chosen text referral modality was more popular with younger patients. Smoking cessation counselling services should work to meet their demographic's needs. Counselling services that text should know they may attract a younger population.
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Bernstein SL, Weiss JM, Toll B, Zbikowski SM. Association Between Utilization of Quitline Services and Probability of Tobacco Abstinence in Low-Income Smokers. J Subst Abuse Treat 2016; 71:58-62. [PMID: 27776679 DOI: 10.1016/j.jsat.2016.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 08/02/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Quitlines (QL) are an effective means for smoking cessation, but a paucity of data exist examining the dose-response relationship between use of QL services and quit rates, especially among low-income smokers. The purpose of this study was to study the relationship between tobacco abstinence and use of QL services among low-income smokers. METHODS Secondary analysis of a randomized trial of every- or some-day smokers aged 18 years or older visiting an urban emergency department. Inclusion criteria included self-pay or Medicaid insurance, as a proxy for low-income and low socioeconomic status. Intervention participants received a motivational interview, 6 weeks of nicotine patches and gum, a referral faxed to the state-sponsored QL, a booster call, and a quitline brochure. Control participants received the brochure. Smoking status was assessed by phone at 1 and 3 months, with confirmation via exhaled carbon monoxide testing at 3 months for those reporting abstinence. QL usage was obtained by utilization data from the QL database. RESULTS Of 778 subjects, 197 (25.3%) reported any use of QL services at 3 months. Participants were trichotomized: no QL usage, 1 call only, and >1 call (583, 99, and 98 participants, respectively). Quit rates at 3 months in these no, low-, and high-use groups were, respectively, 7.2%, 9.1%, and 15.3% (P=0.03). Participants who used the QL had a median of 28 total minutes of telephone contact. CONCLUSION Among low-income smokers, greater use of QL services is associated with higher abstinence. Whether this resulted from a direct effect of the QL, or greater motivation among smokers using QL services cannot be determined from these data.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, New Haven, CT, United States; Yale Comprehensive Cancer Center, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States.
| | - June-Marie Weiss
- Department of Emergency Medicine, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States
| | - Benjamin Toll
- Department of Psychiatry, New Haven, CT, United States; Yale Comprehensive Cancer Center, New Haven, CT, United States; Yale School of Medicine, New Haven, CT, United States; Medical University of South Carolina, Seattle, WA, United States; Hollings Cancer Center, Seattle, WA, United States
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Bernstein SL, Rosner J, Toll B. Concordance between timeline follow-back and single-question assessment of self-reported smoking in a clinical trial. Subst Abus 2016; 37:398-401. [PMID: 27007476 PMCID: PMC5035170 DOI: 10.1080/08897077.2016.1154494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Smoking cessation clinical trials assess tobacco abstinence using self-report and biomarkers. Optimum methods for each are unclear; a common question assesses smoking in the prior 7 days. In contrast, timeline follow-back (TLFB) is another technique often used to assess use of alcohol in treatment trials; it is used less frequently in studies of smoking cessation. The goal of this study was to assess concordance between the 7-day smoking question and a 7-day TLFB. METHODS Secondary analysis of data from a randomized clinical trial of smoking cessation was conducted at a busy, urban hospital emergency department (ED) from October 2010 to December 2012. At 1, 3, and 12 months, subjects were contacted by phone to assess smoking status. Those reporting abstinence at 3 months were asked to return for an in-person measurement of exhaled carbon monoxide. For this analysis, smoking status at 1 month was compared for subjects in response to 2 questions asked concurrently, addressing 7-day point prevalence tobacco use and a 7-day TLFB. RESULTS Of 780 subjects, 666 (85.4%) were available for 1-month follow-up. Of these, 99 (14.9%) reported no smoking in response to the 7-day question, and 96 (14.4%) reported no smoking in response to the 7-day TLFB. The overall proportionate agreement between the 2 methods was 98.6%, with a kappa of 0.95 (95% confidence interval [CI]: 0.91-0.98). CONCLUSIONS A single question that assesses smoking at 7 days provides excellent concordance with the more detailed TLFB. The single question appears adequate to assess self-reported tobacco use in clinical trials of smoking cessation.
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Affiliation(s)
- Steven L. Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy, Yale School of Public Health, New Haven, Connecticut, USA
| | - June Rosner
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin Toll
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
- Medical University of South Carolina, Charleston, South Carolina, USA
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Anderson ES, Hsieh D, Alter HJ. Social Emergency Medicine: Embracing the Dual Role of the Emergency Department in Acute Care and Population Health. Ann Emerg Med 2016; 68:21-5. [DOI: 10.1016/j.annemergmed.2016.01.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Indexed: 10/22/2022]
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Bernstein SL, Rosner J, Toll B. A Multicomponent Intervention Including Texting to Promote Tobacco Abstinence in Emergency Department Smokers: A Pilot Study. Acad Emerg Med 2016; 23:803-8. [PMID: 27146116 PMCID: PMC4938754 DOI: 10.1111/acem.12990] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency department (ED) patients commonly smoke. Current treatment approaches use motivational interviewing, which is effective, but resource-intensive. Mobile health approaches may be more feasible and generalizable. OBJECTIVE The objective was to assess the feasibility of an ED-initiated program of tobacco dependence treatment that employs text messaging. METHODS Smokers age 18 or older were randomized to intervention or control arms. Control subjects received a brochure describing the state smokers' quitline. Intervention subjects received the brochure, 4 weeks of nicotine patches and gum (with the initial dose administered in the ED), a referral to the quitline, and enrollment in SmokefreeTXT, a free SMS-messaging service. SmokefreeTXT delivered 28 days of messages, two to five messages/day. Some messages ask subjects to provide data on mood or craving. Follow-up was conducted by phone call. RESULTS Sixty subjects were enrolled in May 2014. Of all subjects, 33 (55%) were nonwhite; 78% were insured by Medicaid. All intervention subjects used the texting program, with 24/30 (80%) using the program for all 28 days. At 1 month, 14/30 subjects (47%) in the intervention arm reported abstinence versus 3/30 (10%) in the control arm (p = 0.003). At 3 months, the abstinence rates in the intervention and control arms were, respectively, 9/30 (30%) and 4/30 (13%; p = 0.21). Subjects responding to more assessments of mood or craving were more likely to report abstinence at 1 month. CONCLUSION A texting program, combined with pharmacotherapy and a quitline referral, is feasible and may promote tobacco abstinence in ED smokers. A larger trial is planned to assess these results.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine
- Yale School of Medicine, the Yale Cancer Center
- Department of Health Policy, Yale School of Public Health, New Haven, CT
| | | | - Benjamin Toll
- Department of Psychiatry
- Yale School of Medicine, the Yale Cancer Center
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Mullen KA, Manuel DG, Hawken SJ, Pipe AL, Coyle D, Hobler LA, Younger J, Wells GA, Reid RD. Effectiveness of a hospital-initiated smoking cessation programme: 2-year health and healthcare outcomes. Tob Control 2016; 26:293-299. [PMID: 27225016 PMCID: PMC5543264 DOI: 10.1136/tobaccocontrol-2015-052728] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/20/2016] [Indexed: 11/23/2022]
Abstract
Background Tobacco-related illnesses are leading causes of death and healthcare use. Our objective was to determine whether implementation of a hospital-initiated smoking cessation intervention would reduce mortality and downstream healthcare usage. Methods A 2-group effectiveness study was completed comparing patients who received the ‘Ottawa Model’ for Smoking Cessation intervention (n=726) to usual care controls (n=641). Participants were current smokers, >17 years old, and recruited during admission to 1 of 14 participating hospitals in Ontario, Canada. Baseline data were linked to healthcare administrative data. Competing-risks regression analysis was used to compare outcomes between groups. Results The intervention group experienced significantly lower rates of all-cause readmissions, smoking-related readmissions, and all-cause emergency department (ED) visits at all time points. The largest absolute risk reductions (ARR) were observed for all-cause readmissions at 30 days (13.3% vs 7.1%; ARR, 6.1% (2.9% to 9.3%); p<0.001), 1 year (38.4% vs 26.7%; ARR, 11.7% (6.7% to 16.6%); p<0.001), and 2 years (45.2% vs 33.6%; ARR, 11.6% (6.5% to 16.8%); p<0.001). The greatest reduction in risk of all-cause ED visits was at 30 days (20.9% vs 16.4%; ARR, 4.5% (0.4% to 8.7%); p=0.03). Reduction in mortality was not evident at 30 days, but significant reductions were observed by year 1 (11.4% vs 5.4%; ARR 6.0% (3.1% to 9.0%); p<0.001) and year 2 (15.1% vs 7.9%; ARR, 7.3% (3.9% to 10.7%); p<0.001). Conclusions Considering the relatively low cost, greater adoption of hospital-initiated tobacco cessation interventions should be considered to improve patient outcomes and decrease subsequent healthcare usage.
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Affiliation(s)
- Kerri A Mullen
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Andrew L Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Laura A Hobler
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jaime Younger
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - George A Wells
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert D Reid
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Agarwal P, Bias TK, Madhavan S, Sambamoorthi N, Frisbee S, Sambamoorthi U. Factors Associated With Emergency Department Visits: A Multistate Analysis of Adult Fee-for-Service Medicaid Beneficiaries. Health Serv Res Manag Epidemiol 2016; 3. [PMID: 27512721 PMCID: PMC4977022 DOI: 10.1177/2333392816648549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. Methods: A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. Results: In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96). Conclusion: Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.
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Affiliation(s)
- Parul Agarwal
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Thomas K Bias
- Department of Health Policy, Management and Leadership, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Suresh Madhavan
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | | | - Stephanie Frisbee
- Department of Health Policy, Management and Leadership, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
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Bernstein SL, Rosner JM, Toll B. Cell Phone Ownership and Service Plans Among Low-Income Smokers: The Hidden Cost of Quitlines. Nicotine Tob Res 2016; 18:1791-3. [PMID: 26920647 DOI: 10.1093/ntr/ntw042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/17/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Quitlines (QLs) are free, effective sources of treatment for tobacco dependence. Although the QL number is toll-free, the use of cell phones as the sole source of telephony may impose an unintended cost, in terms of cell minutes. OBJECTIVES To quantify the use of cell-only telephony among self-pay or Medicaid smokers, assess their calling plans, and estimate the impact of a typical course of QL counseling. METHODS A survey of smokers age at least 18 years visiting an American urban emergency department from April to July, 2013. RESULTS Seven-hundred seventy-three smokers were surveyed, of whom 563 (72.8%) were low-income, defined as having Medicaid or no insurance. All low-income smokers had at least one phone: 48 (8.5%) reported land-lines only, 159 (28.2%) land-lines and cells, and 356 (63.2%) cells only. Of the cell phone owners, monthly calling plans provided unlimited minutes for 339/515 (65.8%), at most 250 minutes for 124 (24.1%), and more than 250 minutes for 52 (10.0%). Another recent trial found that QL users make a median of 1 call lasting 28 minutes, with the 75th and 90th percentiles of calls and minutes at 3 and 4 calls, and 48 and 73.6 minutes, respectively. Thus, robust use of QL services could consume 11%-29% of a low-income smoker's typical 250 monthly cell minutes. CONCLUSION Among low-income smokers, cell phones are often the sole telephone. Robust use of the QL may impose a substantial burden on low-income smokers' calling plans, and therefore deter use of the QL. Exempting calls to QLs from counting against smokers' plans may help promote QL utilization. IMPLICATIONS Low-income individuals have high rates of smoking, and are more likely to own only cell phones, not landlines, for telephone access. Because cell phone calling plans often have limited numbers of monthly minutes, cell-only individuals may have to spend a substantial proportion of their monthly minutes on QL services. This may act as a deterrent to using an otherwise free, effective means of treatment for tobacco dependence. Exempting QLs from monthly calling plans may improve access for low-income smokers.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT; Department of Health Policy, Yale School of Public Health, New Haven, CT;
| | - June-Marie Rosner
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Benjamin Toll
- Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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D'Onofrio G, Bernstein SL. Screening, brief intervention and referral of emergency department patients with unhealthy drug use: efficacious or not? EVIDENCE-BASED MENTAL HEALTH 2015; 18:e8. [PMID: 26459472 PMCID: PMC11234569 DOI: 10.1136/eb-2014-102037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 09/17/2015] [Accepted: 09/22/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Gail D'Onofrio
- Emergency Medicine, Yale School of Medicine, Connecticut, USA
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Bernstein SL, Feldman J. Incentives to participate in clinical trials: practical and ethical considerations. Am J Emerg Med 2015; 33:1197-200. [PMID: 26095131 PMCID: PMC4562811 DOI: 10.1016/j.ajem.2015.05.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/19/2015] [Accepted: 05/19/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical trials often offer incentives to encourage individuals to enroll and to enhance follow-up. The scope and nature of incentives used in emergency department (ED)-based trials are unknown. OBJECTIVES The objective of this study is to characterize the quantity and quality of incentives and other forms of compensation used in clinical trials of human subjects recruited in US EDs. A secondary goal is to provide an historical and ethical analysis of the use of incentives in clinical trials. METHODS We reviewed English-language randomized clinical trials conducted in US EDs from 2009 to 2013. Full text of the studies was reviewed to identify whether incentives were used, their value, and timing. Funding source was noted as well. Data are presented with descriptive statistics. RESULTS Of 1151 articles identified, 76 (6.6%) fit criteria for review. Of these, 7 (9.2%) provided incentive payments. A recently published eighth trial was included as well. The total cash value of incentives offered ranged from $10 to $195. Four studies offered payment at enrollment only. Incentives included cash, debit cards, and gift cards. CONCLUSION The use of financial incentives in ED-based trials is uncommon. Studies that use incentives are generally extramurally funded, usually by a federal agency, and include waves of follow-up that continue after discharge from the ED. Payment size is modest. Incentives may improve recruitment and retention in ED-based trials, but authoritative data are lacking. Investigators need to take care to avoid incentives that may be coercive or unduly influence research participants.
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Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
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