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Bauer A, Brenner L, Moser J, Trudzinski F, Köllner V, Bals R. The effects of a short-term physician training on smoking cessation in a university pulmonary department. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2020; 18:Doc06. [PMID: 32733176 PMCID: PMC7373096 DOI: 10.3205/000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 01/21/2020] [Indexed: 11/30/2022]
Abstract
Objective: The objective was to evaluate the effect of a short physician training in smoking cessation on the physicians' performance of smoking cessation interventions. The effects on patients' cessation rates were analyzed as well. A further aim was to identify barriers for providing cessation interventions. The study was conducted in an acute care pulmonology department of a German university hospital. Methods: 24 physicians of the pulmonology department of a German university hospital received a two-hour training in smoking cessation. 109 pre- and 89 post-training group patients were compared with regard to the frequencies of received smoking cessation interventions (Ask, Advise, Assist) and three- and six-month abstinence rates. Physicians estimated their intervention frequencies and gave reasons for not providing cessation interventions. Results: In a multivariable analysis (p<0.05), the physicians' application of "Ask" (OR 3.28, 95% CI 1.13-9.53) and the six-month abstinence rates (OR 2.70, 95% CI 1.24-5.84) were significantly higher in the post-training group. The univariate analysis also showed a significant effect on "Assist" (OR 2.05, 95% CI 1.09-3.87). No significant effect was seen on "Advise to quit". Physicians overestimated their intervention frequencies and reported the patients' low motivation to stop, an oncological disease and palliative care situation as barriers to performing smoking cessation. Conclusion: A short physician training in a hospital department of pulmonology increases the use of guideline-based cessation strategies and may improve cessation rates. The findings show that hospital-based strategies such as physician trainings could be useful in the improvement of smoking cessation. Strategies for overcoming barriers for providing smoking cessation interventions are needed.
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Affiliation(s)
- Anna Bauer
- Department of Internal Medicine V – Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany
| | - Lorena Brenner
- Department of Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Germany
| | - Julia Moser
- Department of Internal Medicine V – Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany
| | - Franziska Trudzinski
- Department of Internal Medicine V – Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany
| | - Volker Köllner
- Department of Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Germany
| | - Robert Bals
- Department of Internal Medicine V – Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany
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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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Purkabiri K, Steppacher V, Bernardy K, Karl N, Vedder V, Borgmann M, Rogausch A, Stammberger U, Bals R, Raupach T, Koellner V, Hamacher J. Outcome of a four-hour smoking cessation counselling workshop for medical students. Tob Induc Dis 2016; 14:37. [PMID: 27924139 PMCID: PMC5123240 DOI: 10.1186/s12971-016-0103-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 11/18/2016] [Indexed: 11/25/2022] Open
Abstract
Background Lack of smoking cessation education in undergraduate medical training hinders healthcare professionals in providing adequate tobacco cessation counselling. We developed a comprehensive 4-h smoking cessation counselling course for medical students that is easy to incorporate in a medical school curriculum, and assessed its short-term outcome for knowledge, skills, and attitudes. Methods Eighty-eight medical students (53f, 35 m) were educated by a doctoral student in five identical 4-h courses. A 45-min theoretical introduction was followed by patient-physician role-playing by student pairs. Knowledge, skills, and attitude were assessed before and 4 weeks after the course by questionnaires, and by blinded analysis of pre- and post-course videos of a five-minute standardized patient situation. Results Knowledge: Before the course 10.6 (mean, SD: 2.7) questions out of 29 were answered correctly, and increased to 19.2 (3.6) after the course (p < 0.0005). Major features of the students’ counselling skills improved. Significant and highly relevant attitude changes reflected increased motivation to counselling smokers. Conclusion Implementing a four-hour smoking intervention workshop into a medical curriculum was highly effective in improving students’ knowledge, skills and attitudes towards smoking counselling, as well as providing them with additional clinical competencies. Electronic supplementary material The online version of this article (doi:10.1186/s12971-016-0103-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kurosch Purkabiri
- Division of Pulmonary Medicine, Internal Medicine, University Hospitals of Homburg/ Saar, Saarland University, Homburg/Saar, Germany.,Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland
| | - Valentina Steppacher
- Division of Pulmonary Medicine, Internal Medicine, University Hospitals of Homburg/ Saar, Saarland University, Homburg/Saar, Germany
| | - Kathrin Bernardy
- Division of Pain Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Bochum, Germany
| | - Nikola Karl
- Division of Pulmonary Medicine, Internal Medicine, University Hospitals of Homburg/ Saar, Saarland University, Homburg/Saar, Germany.,Divison of Internal Medicine, Hospital of Münsingen, Münsingen, Switzerland
| | - Verena Vedder
- Division of Pulmonary Medicine, Internal Medicine, University Hospitals of Homburg/ Saar, Saarland University, Homburg/Saar, Germany.,University Hospital of Psychiatry, Bern, Switzerland
| | - Michèle Borgmann
- Clinic of Internal Medicine, Lindenhofspital, Bremgartenstrasse 119, CH-3012 Bern, Switzerland
| | - Anja Rogausch
- Clinic Sonnenhalde, Riehen, Switzerland.,Division of Assessment und Evaluation, Institute for Medical Teaching, University of Bern, Bern, Switzerland
| | - Uz Stammberger
- Division of Pulmonary Medicine, Internal Medicine, University Hospitals of Homburg/ Saar, Saarland University, Homburg/Saar, Germany
| | - Robert Bals
- Division of Pulmonary Medicine, Internal Medicine, University Hospitals of Homburg/ Saar, Saarland University, Homburg/Saar, Germany
| | - Tobias Raupach
- Department of Cardiology and Pneumology, University Hospital Göttingen, Göttingen, Germany
| | - Volker Koellner
- Department of Behavioral Therapy and Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany.,Medical Faculty, Saarland University Hospitals, Homburg/Saar, Germany
| | - Jürg Hamacher
- Division of Pulmonary Medicine, Internal Medicine, University Hospitals of Homburg/ Saar, Saarland University, Homburg/Saar, Germany.,Clinic of Internal Medicine, Lindenhofspital, Bremgartenstrasse 119, CH-3012 Bern, Switzerland
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Boudreaux ED, Abar B, Haskins B, Bauman B, Grissom G. Health evaluation and referral assistant: a randomized controlled trial to improve smoking cessation among emergency department patients. Addict Sci Clin Pract 2015; 10:24. [PMID: 26542471 PMCID: PMC4672559 DOI: 10.1186/s13722-015-0045-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computer technologies hold promise for implementing tobacco screening, brief intervention, and referral to treatment (SBIRT). This study aims to evaluate a computerized tobacco SBIRT system called the Health Evaluation and Referral Assistant (HERA). METHODS Smokers (n = 421) presenting to an emergency department were randomly assigned to the HERA or a minimal-treatment Control and were followed for 3 months. Analyses compared smoking cessation treatment provider contact, treatment initiation, treatment completion, and smoking behavior across condition using univariable comparisons, generalized estimating equations (GEE), and post hoc Chi square analyses. RESULTS HERA participants were more likely to initiate contact with a treatment provider but did not differ on treatment initiation, quit attempts, or sustained abstinence. Subanalyses revealed HERA participants who accepted a faxed referral were more likely to initiate treatment but were not more likely to stop smoking. CONCLUSIONS The HERA promoted initial contact with a smoking cessation provider and the faxed referral further promoted treatment initiation, but it did not lead to improved abstinence. TRIAL REGISTRATION ClinicalTrials.gov number NCT01153373.
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Affiliation(s)
- Edwin D Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, LA-189, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Beau Abar
- Departments of Emergency Medicine, Psychiatry, and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Brianna Haskins
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Brigitte Bauman
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
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Educating Physical Therapist Students in Tobacco Cessation Counseling: Feasibility and Preliminary Outcomes. ACTA ACUST UNITED AC 2015; 29:68-79. [PMID: 26848209 DOI: 10.1097/00001416-201529030-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Smoking is the leading preventable cause of chronic disease and premature morbidity. People with physical disabilities experience elevated smoking prevalence when compared with their non-disabled peers. The physical therapy profession is dedicated to meeting needs of people with physical disabilities, yet most physical therapists (PT) do not typically provide tobacco cessation interventions. Similar deficits exist among other health professions, creating a demand for improved services to address smoking-related health burdens. Within other health professions, insufficient tobacco cessation counseling (TCC) education has been linked to a lack of interventions and may account for similar deficits in physical therapy practice. STUDY PURPOSE Goals were to assess feasibility, implementation, and results of a tailored TCC educational program for entry-level physical therapist (PT) students. SUBJECTS Two cohorts of entry-level physical therapist (PT) students (n = 12 and n = 17). METHODS Educational objectives were established based on prior review of the literature, a survey of national PT education programs, and clinical guidelines for TCC established by the United States Public Health Service (USPHS). Based on these objectives, the team designed a 3-hour workshop involving didactic content and problem-based skills practice. A pre- and post-test survey was used to measure 6 dimensions: knowledge, perceived barriers, perceived facilitators, self-efficacy, outcome expectations, and self-rated skill in TCC. Within each cohort, changes in score were compared using a paired t test. The ability to apply clinical guidelines for TCC was assessed using case scenarios and structured observation. These outcomes were selected based on the Theory of Reasoned Action, which states that future behavior is determined by intention to act. Intention to act is a product of knowledge, a positive balance between perceived barriers and facilitators, strong self-efficacy, favorable outcome expectations, and necessary skills. Student satisfaction with training was assessed through anonymous written feedback. Feasibility was based on cost analysis, including material resources, as well as faculty time and effort. RESULTS Following participation, both cohorts improved in knowledge, perceived facilitators, outcome expectations, and self-rated skill. Cohort 2 also showed an increase in self-efficacy (P < .01). Structured observation revealed competencies in application of clinical guidelines for case-based scenarios. Mean student satisfaction ratings for the educational experience were 5/5, and cost-estimate for delivery of the 3-hour educational intervention was approximately $32 per student. CONCLUSIONS This research study demonstrated feasibility and impact of an evidence-based curricular model designed to increase likelihood of TCC by future PTs by enhancing factors known to promote TCC behaviors. The program was well-received by students, and objectives were achieved through efficient use of faculty time and resources. Subsequent research should examine the effects of training on the provision of TCC within clinical settings, as well as the impact of TCC on smoking quit rates for patients who have received this intervention as a component of their physical therapy plan of care.
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McNamara RS, Song EY, Reboussin BA, Spangler J, Pockey JR, Kimes C, Foley KL, Sutfin EL. Motivational interviewing intervention with college student tobacco users: providers' beliefs and behaviors. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2015; 63:286-290. [PMID: 25580630 PMCID: PMC4428958 DOI: 10.1080/07448481.2014.1003376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This study assessed college student health providers' use of Motivational Interviewing (MI) with tobacco users, as well as their beliefs about the use of brief interventions to help college student tobacco users quit. MI is recommended by the United States Public Health Service to increase tobacco users' willingness to quit. PARTICIPANTS Participants included 83 clinicians from health clinics at 7 different universities in North Carolina. METHODS Paper-and-pencil baseline survey from a cluster randomized trial of college student health clinicians. RESULTS Twenty-two percent of respondents reported always or usually using MI during the past month for tobacco-using patients not ready to make a quit attempt. Student health providers also reported information with regards to their beliefs about tobacco cessation treatment, barriers to intervening with patients, and confidence in motivating students to consider quitting. CONCLUSIONS Results highlight the need to encourage clinicians' use of motivationally focused interventions with student tobacco users. [Table: see text].
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Affiliation(s)
- Robert S. McNamara
- Counseling Center, Wake Forest University, Winston-Salem, North Carolina
- Counseling Center, University of North Carolina Wilmington, Wilmington, North Carolina (current)
| | - Eun-Young Song
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Beth A. Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Caroline Kimes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristie L. Foley
- Medical Humanities Program, Davidson College, Davidson, North Carolina
| | - Erin L. Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Katz DA, Paez MW, Reisinger HS, Gillette MT, Weg MWV, Titler MG, Nugent AS, Baker LJ, Holman JE, Ono SS. Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions. Addict Sci Clin Pract 2014; 9:1. [PMID: 24460974 PMCID: PMC3902188 DOI: 10.1186/1940-0640-9-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 01/17/2014] [Indexed: 11/13/2022] Open
Abstract
Background The US Public Health Service smoking cessation practice guideline specifically recommends that physicians and nurses strongly advise their patients who use tobacco to quit, but the best approach for attaining this goal in the emergency department (ED) remains unknown. The aim of this study was to characterize emergency physicians’ (EPs) and nurses’ (ENs) perceptions of cessation counseling and to identify barriers and facilitators to implementation of the 5 A’s framework (Ask-Advise-Assess-Assist-Arrange) in the ED. Methods We conducted semi-structured, face-to-face interviews of 11 EPs and 19 ENs following a pre-post implementation trial of smoking cessation guidelines in two study EDs. We used purposeful sampling to target EPs and ENs with different attitudes toward cessation counseling, based on their responses to a written survey (Decisional Balance Questionnaire). Conventional content analysis was used to inductively characterize the issues raised by study participants and to construct a coding structure, which was then applied to study transcripts. Results The main findings of this study converged upon three overarching domains: 1) reactions to the intervention; 2) perceptions of patients’ receptivity to cessation counseling; and 3) perspectives on ED cessation counseling and preventive care. ED staff expressed ambivalence toward the implementation of smoking cessation guidelines. Both ENs and EPs agreed that the delivery of smoking cessation counseling is important, but that it is not always practical in the ED on account of time constraints, the competing demands of acute care, and resistance from patients. Participants also called attention to the need for improved role clarity and teamwork when implementing the 5 A’s in the ED. Conclusions There are numerous challenges to the implementation of smoking cessation guidelines in the ED. ENs are generally willing to take the lead in offering brief cessation counseling, but their efforts need to be reinforced by EPs. ED systems need to address workflow, teamwork, and practice policies that facilitate prescription of smoking cessation medication, referral for cessation counseling, and follow-up in primary care. The results of this qualitative evaluation can be used to guide the design of future ED intervention studies. Trial registration ClinicalTrials.gov registration number NCT00756704
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Affiliation(s)
- David A Katz
- Department of Medicine, University of Iowa, Iowa City, IA, USA.
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Bernstein SL, D’Onofrio G. A Promising Approach For Emergency Departments To Care For Patients With Substance Use And Behavioral Disorders. Health Aff (Millwood) 2013; 32:2122-8. [DOI: 10.1377/hlthaff.2013.0664] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Steven L. Bernstein
- Steven L. Bernstein is a professor in the Department of Emergency Medicine, Yale University School of Medicine, in New Haven, Connecticut
| | - Gail D’Onofrio
- Gail D’Onofrio is a professor in and chair of the Department of Emergency Medicine, Yale University School of Medicine
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Katz DA, Holman JE, Nugent AS, Baker LJ, Johnson SR, Hillis SL, Tinkelman DG, Titler MG, Vander Weg MW. The emergency department action in smoking cessation (EDASC) trial: impact on cessation outcomes. Nicotine Tob Res 2013; 15:1032-43. [PMID: 23125437 PMCID: PMC6080418 DOI: 10.1093/ntr/nts219] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 09/04/2012] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The focus on acute care, time pressure, and lack of resources hamper the implementation of smoking cessation guidelines in the emergency department (ED). The purpose of this study was to determine whether an emergency nurse- initiated intervention based on the 5A's (Ask-Advise-Assess-Assist-Arrange) framework improves quit rates. METHODS We conducted a pre-post implementation trial in 789 adult smokers who presented to two EDs in Iowa between August 13, 2008 and August 4, 2010. The intervention focused on improving delivery of the 5A's by ED nurses and physicians using academic detailing, charting/reminder tools, and group feedback. Performance of ED cessation counseling was measured using a 5A's composite score (ranging from 0 to 5). Smoking status was assessed by telephone interview at 3- and 6-month follow-up (with biochemical confirmation in those participants who reported abstinence at 6-month follow-up). RESULTS Based on data from 650 smokers who completed the post-ED interview, there was a significant improvement in the mean 5A's composite score for emergency nurses during the intervention period at both hospitals combined (1.51 vs. 0.88, difference = 0.63, 95% confidence interval [CI] [0.41, 0.85]). At 6-month follow-up, 7-day point prevalence abstinence (PPA) was 6.8 and 5.1% in intervention and preintervention periods, respectively (adjusted odds ratio [OR] = 1.7, 95% CI [0.99, 2.9]). CONCLUSIONS It is feasible to improve the delivery of brief smoking cessation counseling by ED staff. The observed improvements in performance of cessation counseling, however, did not translate into statistically significant improvements in cessation rates. Further improvements in the effectiveness of ED cessation interventions are needed.
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Affiliation(s)
- David A Katz
- Department of Medicine, University of Iowa, Iowa City, IA, USA.
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Carson KV, Verbiest MEA, Crone MR, Brinn MP, Esterman AJ, Assendelft WJJ, Smith BJ. Training health professionals in smoking cessation. Cochrane Database Syst Rev 2012:CD000214. [PMID: 22592671 PMCID: PMC10088066 DOI: 10.1002/14651858.cd000214.pub2] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cigarette smoking is one of the leading causes of preventable death world wide. There is good evidence that brief interventions from health professionals can increase smoking cessation attempts. A number of trials have examined whether skills training for health professionals can lead them to have greater success in helping their patients who smoke. OBJECTIVES To determine the effectiveness of training health care professionals in the delivery of smoking cessation interventions to their patients, and to assess the additional effects of training characteristics such as intervention content, delivery method and intensity. SEARCH METHODS The Cochrane Tobacco Addiction Group's Specialised Register, electronic databases and the bibliographies of identified studies were searched and raw data was requested from study authors where needed. Searches were updated in March 2012. SELECTION CRITERIA Randomized trials in which the intervention was training of health care professionals in smoking cessation. Trials were considered if they reported outcomes for patient smoking at least six months after the intervention. Process outcomes needed to be reported, however trials that reported effects only on process outcomes and not smoking behaviour were excluded. DATA COLLECTION AND ANALYSIS Information relating to the characteristics of each included study for interventions, participants, outcomes and methods were extracted by two independent reviewers. Studies were combined in a meta-analysis where possible and reported in narrative synthesis in text and table. MAIN RESULTS Of seventeen included studies, thirteen found no evidence of an effect for continuous smoking abstinence following the intervention. Meta-analysis of 14 studies for point prevalence of smoking produced a statistically and clinically significant effect in favour of the intervention (OR 1.36, 95% CI 1.20 to 1.55, p= 0.004). Meta-analysis of eight studies that reported continuous abstinence was also statistically significant (OR 1.60, 95% CI 1.26 to 2.03, p= 0.03).Healthcare professionals who had received training were more likely to perform tasks of smoking cessation than untrained controls, including: asking patients to set a quit date (p< 0.0001), make follow-up appointments (p< 0.00001), counselling of smokers (p< 0.00001), provision of self-help material (p< 0.0001) and prescription of a quit date (p< 0.00001). No evidence of an effect was observed for the provision of nicotine gum/replacement therapy. AUTHORS' CONCLUSIONS Training health professionals to provide smoking cessation interventions had a measurable effect on the point prevalence of smoking, continuous abstinence and professional performance. The one exception was the provision of nicotine gum or replacement therapy, which did not differ between groups.
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Affiliation(s)
- Kristin V Carson
- Clinical Practice Unit, The Queen Elizabeth Hospital, Adelaide, Australia.
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Katz DA, Vander Weg MW, Holman J, Nugent A, Baker L, Johnson S, Hillis SL, Titler M. The Emergency Department Action in Smoking Cessation (EDASC) trial: impact on delivery of smoking cessation counseling. Acad Emerg Med 2012; 19:409-20. [PMID: 22506945 DOI: 10.1111/j.1553-2712.2012.01331.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The focus on acute care, time pressure, and lack of resources hamper the delivery of smoking cessation interventions in the emergency department (ED). The aim of this study was to 1) determine the effect of an emergency nurse-initiated intervention on delivery of smoking cessation counseling based on the 5As framework (ask-advise-assess-assist-arrange) and 2) assess ED nurses' and physicians' perceptions of smoking cessation counseling. METHODS The authors conducted a pre-post trial in 789 adult smokers (five or more cigarettes/day) who presented to two EDs. The intervention focused on improving delivery of the 5As by ED nurses and physicians and included face-to-face training and an online tutorial, use of a charting/reminder tool, fax referral of motivated smokers to the state tobacco quitline for proactive telephone counseling, and group feedback to ED staff. To assess ED performance of cessation counseling, a telephone interview of subjects was conducted shortly after the ED visit. Nurses' and physicians' self-efficacy, role satisfaction, and attitudes toward smoking cessation counseling were assessed by survey. Multivariable logistic regression was used to assess the effect of the intervention on performance of the 5As, while adjusting for key covariates. RESULTS Of 650 smokers who completed the post-ED interview, a greater proportion had been asked about smoking by an ED nurse (68% vs. 53%, adjusted odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.3 to 2.9), assessed for willingness to quit (31% vs. 9%, adjusted OR= 4.9, 95% CI = 2.9 to 7.9), and assisted in quitting (23% vs. 6%, adjusted OR = 5.1, 95% CI = 2.7 to 9.5) and had arrangements for follow-up cessation counseling (7% vs. 1%, adjusted OR = 7.1, 95% CI = 2.3 to 21) during the intervention compared to the baseline period. A similar increase was observed for emergency physicians (EPs). ED nurses' self-efficacy and role satisfaction in cessation counseling significantly improved following the intervention; however, there was no change in "pros" and "cons" attitudes toward smoking cessation in either ED nurses or physicians. CONCLUSIONS Emergency department nurses and physicians can effectively deliver smoking cessation counseling to smokers in a time-efficient manner. This trial also provides empirical support for expert recommendations that call for nursing staff to play a larger role in delivering public health interventions in the ED.
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Affiliation(s)
- David A Katz
- Department of Medicine, University of Iowa, Iowa City, USA.
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Bernstein SL, Bijur P, Cooperman N, Jearld S, Arnsten JH, Moadel A, Gallagher EJ. A randomized trial of a multicomponent cessation strategy for emergency department smokers. Acad Emerg Med 2011; 18:575-83. [PMID: 21676054 DOI: 10.1111/j.1553-2712.2011.01097.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to determine the efficacy of an emergency department (ED)-based smoking cessation intervention. METHODS This study was a randomized trial conducted from January 2006 to September 2007 at an urban ED that treats 90,000 adults per year. Discharged adults who smoked at least 10 cigarettes per day were randomized to 1) usual care, receiving a smoking cessation brochure; or 2) enhanced care, receiving the brochure, a motivational interview (MI), nicotine patches, and a phone call at 3 days. Interventions were performed by a peer educator trained in tobacco treatment. Blinded follow-up was performed at 3 months. RESULTS A total of 338 subjects were enrolled, mean (±SD) age was 40.2 (±12.0) years, 51.8% were female, and 56.5% were either self-pay or Medicaid. Demographic and clinical variables were comparable between groups. Enhanced and usual care arms showed similar cessation rates at 3 months (14.7% vs. 13.2%, respectively). The proportion of subjects making a quit attempt (69.2% vs. 66.5%) and decrease in daily cigarette use (five vs. one; all p > 0.05) were also similar. In logistic modeling, factors associated with quitting included any tobacco-related International Classification of Diseases, ninth revision (ICD-9), code for the ED visit (odds ratio [OR]= 3.42, 95% confidence interval [CI] = 1.61 to 7.26) or subject belief that the ED visit was tobacco-related (OR = 2.47, 95% CI = 1.17 to 5.21). Conversely, subjects who reported having a preexisting tobacco-related illness were less likely to quit (OR = 0.22, 95% CI = 0.10 to 0.50). CONCLUSIONS The primary endpoint was negative, reflecting a higher-than-expected quit rate in the control group. Subjects whose ED visit was tobacco-related, based either on physician diagnosis or subject perception, were more than twice as likely to quit. These data suggest that even low-intensity screening and referral may prompt substantial numbers of ED smokers to quit or attempt to quit.
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Affiliation(s)
- Steven L Bernstein
- Montefiore Medical Center, Albert Einstein College of Medicine, Albert Einstein Cancer Center, Bronx, New York, USA.
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Menchine MD, Arora S, Camargo CA, Ginde AA. Prevalence of undiagnosed and suboptimally controlled diabetes by point-of-care HbA1C in unselected emergency department patients. Acad Emerg Med 2011; 18:326-9. [PMID: 21362098 DOI: 10.1111/j.1553-2712.2011.01014.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective was to estimate the glycemic control of patients with known diabetes and to assess the prevalence of undiagnosed diabetes in an unselected emergency department (ED) population. Secondary objectives include evaluating the prevalence of undiagnosed diabetes in high-risk groups of ED patients such as Hispanic patients, African Americans, and patients with body mass index (BMI) ≥ 30 kg/m(2) . METHODS A convenience sample of adult ED patients was screened for diabetes using a National Glycohemoglobin Standardization Program-certified point-of-care (POC) glycated hemoglobin (HbA1C) meter at a single academic medical center during eight 24-hour periods. Diabetes was defined as HbA1C ≥ 6.5%, consistent with new American Diabetes Association (ADA) guidelines. RESULTS Of the 1,611 patients evaluated in the ED during the study period, 313 were included in the study sample. Of these, 15% reported a history of diabetes, 42% of whom were suboptimally controlled. An additional 14% of the study sample was found to have previously undiagnosed diabetes. In our limited sample, the prevalence of previously undiagnosed diabetes in Hispanics, African Americans, and patients with BMI ≥ 30 kg/m(2) was 14, 27, and 22%, respectively. CONCLUSIONS Patients in our sample had a high prevalence of suboptimally controlled and undiagnosed diabetes. New POC HbA1C devices and simplified diagnostic criteria for diabetes significantly enhance the possibility of ED-based screening programs. Future research should validate our findings in a broader array of EDs and study the acceptance of such ED-based diabetes screening programs.
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Affiliation(s)
- Michael D Menchine
- Department of Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
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Awad MA, El Kouatly M, Fakhry R. Smoking counseling practices of physicians in the United Arab Emirates. Glob Health Promot 2011; 17:5-14. [DOI: 10.1177/1757975910383926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Despite the cost effectiveness of physician smoking cessation counseling, many physicians do not adhere to current clinical practice guidelines. Methods. A cross-sectional mail survey was conducted in a sample of general practitioners in the United Arab Emirates (UAE), emirates of Sharjah, Dubai and Abu Dhabi, to document cessation-counseling practices and identify correlates of these activities. Results. Of 391 eligible GPs, 218 (56%) completed the questionnaire. Despite favorable beliefs/attitudes about cessation counseling, less than half of GPs (47%) indicated that they have the skills to help their patients quit smoking and only 24% knew of community resources to refer patients to. GPs who perceived physician barriers in offering smoking counseling as very important were significantly less likely to ascertain smoking status of most of their patients (OR: 0.28, 95% CI: 0.09,0.88). Moreover, high self-efficacy and favorable beliefs/attitudes were significantly associated with high level of counseling completeness (OR: 4.44, 95% CI: 1.21, 16.37; OR: 3.78, 95% CI: 1.25, 11.35; respectively). Conclusion. Support, training and intervention programs to overcome lack of awareness and knowledge, unfavorable beliefs/attitudes, and low self-efficacy could increase and enhance cessation-counseling practices among general practitioners in the UAE.
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Affiliation(s)
- Manal A. Awad
- College of Dentistry, University of Sharjah, Sharjah, P.O. Box: 27272, United Arab Emirates,
| | - Mona El Kouatly
- Department of Natural Science and Public Health, Zayed University, Dubai, United Arab Emirates
| | - Randa Fakhry
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Kuhn GJ, Shayne P, Coates WC, Fisher J, Lin M, Maggio LA, Farrell SE. Critical appraisal of emergency medicine educational research: the best publications of 2009. Acad Emerg Med 2010; 17 Suppl 2:S16-25. [PMID: 21199079 DOI: 10.1111/j.1553-2712.2010.00899.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to critically appraise and highlight methodologically superior medical education research specific to emergency medicine (EM) published in 2009. METHODS A search of the English language literature in 2009 querying Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE 1950 to Present, Web of Science, Education Resources Information Center (ERIC), and PsychInfo identified 36 EM studies that used hypothesis-testing or observational investigations of educational interventions. Six reviewers independently ranked all publications based on 10 criteria, including four related to methodology, that were chosen a priori to standardize evaluation by reviewers. This was a refinement of the methods used to appraise medical education published in 2008. RESULTS Seven studies met the standards as determined by the averaged rankings and are highlighted and summarized here. This year, 16 of 36 (44%) identified studies had funding, compared to 11 of 30 (36%) identified last year; five of seven (71%) highlighted publications were funded in 2009 compared to three of five (60%) highlighted in 2008. Use of technology in medical education was reported in 14 identified and four highlighted publications, with simulation being the most common technology studied. Five of the seven (71%) featured publications used a quasi-experimental or experimental design, one was observational, and one was qualitative. Practice management topics, including patient safety, efficiency, and revenue generation, were examined in seven reviewed studies. CONCLUSIONS Thirty-six medical education publications published in 2009 focusing on EM were identified. This critical appraisal reviews and highlights seven studies that met a priori quality indicators. Current trends are noted.
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Affiliation(s)
- Gloria J Kuhn
- Department of Emergency Medicine, Wayne State, University, Detroit, MI, USA.
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Johns TL, Lawrence E, Martini LE, Dunn GE, Thompson ZJ, Zwygart K. Smoking cessation in family medicine: effects of an area health education center training program. J Grad Med Educ 2010; 2:283-8. [PMID: 21975634 PMCID: PMC2930317 DOI: 10.4300/jgme-d-10-00043.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 03/23/2010] [Accepted: 04/29/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Many clinicians have not received adequate training in smoking cessation. We examined the effects of a tobacco training program on clinician behavior, attitudes, knowledge, and comfort related to smoking cessation. METHODS In a prospective cohort study, family medicine residents and faculty completed a pretest, followed by an educational intervention that encompassed presentations on smoking cessation resources, motivational interviewing, and the neurobiology of addiction and pharmacotherapy. After 3 months, participants completed a postintervention survey. Results were analyzed using chi-square tests to examine the effects of training. RESULTS Thirty-three residents and faculty completed the pretraining survey and 25 completed the posttraining survey. Following training, participants were more familiar and comfortable with Public Health Service Clinical Practice Guidelines (P < .0001). No significant differences were found in performance of the 5 As (Ask, Advise, Assess, Assist, and Arrange) or other behaviors, including providing assistance with counseling, cessation plans, resources, or pharmacotherapy. There were no improvements in knowledge of specific intervention plans or attitudes related to identifying and counseling smokers. CONCLUSION A multidisciplinary tobacco training program increases clinician familiarity and comfort with practice guidelines, and may contribute to improving care activities that promote a healthy lifestyle. Future research should explore other interventions that have the potential of changing practice patterns on a larger scale. Future studies should also assess the effect of training programs on patient-oriented outcomes.
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Affiliation(s)
- Tracy L. Johns
- Corresponding author: Tracy L. Johns, PharmD, University of South Florida Family Medicine Residency, Morton Plant Mease Health Care, Turley Family Health Center, 807 N Myrtle Avenue, Clearwater, FL 33755, 727.467.2512,
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Cunningham RM, Bernstein SL, Walton M, Broderick K, Vaca FE, Woolard R, Bernstein E, Blow F, D'Onofrio G. Alcohol, tobacco, and other drugs: future directions for screening and intervention in the emergency department. Acad Emerg Med 2009; 16:1078-88. [PMID: 20053226 DOI: 10.1111/j.1553-2712.2009.00552.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on "Public Health in the ED: Screening, Surveillance, and Intervention." The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening--develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention--conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups--conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies--a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and follow-up; and d) examine alternatives to specialized treatment referral. 5) Translation--conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice.
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Affiliation(s)
- Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, School of Public Health Injury Research Center, Ann Arbor, MI, USA.
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