The Emergency Department Action in Smoking Cessation (EDASC) trial: impact on delivery of smoking cessation counseling.
The Emergency Department Action in Smoking Cessation (EDASC) trial: impact on delivery of smoking cessation counseling.
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DOI：
10.1111/j.1553-2712.2012.01331.x
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发表时间：
2012-04
期刊：
影响因子：
--
通讯作者：
Titler M
中科院分区：
文献类型：
--
作者：
Katz DA;Vander Weg MW;Holman J;Nugent A;Baker L;Johnson S;Hillis SL;Titler M
对急诊护理的关注、时间压力和资源缺乏阻碍了急诊科（艾德）戒烟干预措施的实施。本研究的目的是1）确定基于5As框架（询问-建议-评估-协助-安排）的紧急护士发起的干预对提供戒烟咨询的效果，以及2）评估艾德护士和医生对戒烟咨询的看法。作者在789名成年吸烟者（每天5支或更多支烟）中进行了一项前后试验，这些吸烟者接受了两次ED。干预措施的重点是改善艾德护士和医生提供的5A，包括面对面的培训和在线教程，使用图表/提醒工具，传真转介动机吸烟者到国家戒烟热线进行积极的电话咨询，并向艾德工作人员提供小组反馈。为了评估艾德戒烟咨询的表现，在艾德访视后不久对受试者进行了电话访谈。以问卷调查法评估护士与医师自我效能感、角色满意度及对戒烟辅导的态度。使用多变量线性回归评估干预对5A性能的影响，同时调整关键协变量。在完成艾德术后访谈的650名吸烟者中，有更大比例的人被艾德护士问及吸烟问题（68% vs. 53%，调整后OR = 2.0，95% CI = 1.3 - 2.9），评估戒烟意愿（31% vs. 9%，调整OR= 4.9，95% CI = 2.9 - 7.9），协助戒烟（23% vs. 6%，调整后OR = 5.1，95% CI = 2.7 - 9.5），并安排了随访戒烟咨询（7% vs. 1%，调整后OR = 7.1，95% CI = 2.3 - 21）。急诊医生的人数也有类似的增加。干预后，艾德护士在戒烟咨询中的自我效能感和角色满意度显着提高;然而，艾德护士或医生对戒烟的“赞成”和“反对”态度没有变化。急诊科护士和医生可以有效地提供戒烟咨询吸烟者在一个时间效率的方式。这项试验还为专家建议提供了经验支持，这些建议要求护理人员在ED中提供公共卫生干预措施方面发挥更大的作用。
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. The authors conducted a pre-post trial in 789 adult smokers (five or more cigarettes/day) who presented to two EDs. The intervention focused on improving delivery of the 5As by ED nurses and physicians, and included face-to-face training and an online tutorial, use of a charting/reminder tool, fax referral of motivated smokers to the state tobacco quitline for proactive telephone counseling, and group feedback to ED staff. To assess ED performance of cessation counseling, a telephone interview of subjects was conducted shortly after the ED visit. Nurses’ and physicians’ self-efficacy, role satisfaction, and attitudes toward smoking cessation counseling were assessed by survey. Multivariable linear regression was used to assess the effect of the intervention on performance of the 5As, while adjusting for key covariates. Of 650 smokers who completed the post-ED interview, a greater proportion had been asked about smoking by an ED nurse (68% vs. 53%, adjusted OR = 2.0, 95% CI = 1.3 to 2.9), assessed for willingness to quit (31% vs. 9%, adjusted OR= 4.9, 95% CI = 2.9 to 7.9), assisted in quitting (23% vs. 6%, adjusted OR = 5.1, 95% CI = 2.7 to 9.5), and had arrangements for follow-up cessation counseling (7% vs. 1%, adjusted OR = 7.1, 95% CI = 2.3 to 21) during the intervention compared to the baseline period. A similar increase was observed for emergency physicians. ED nurses’ self-efficacy and role satisfaction in cessation counseling significantly improved following the intervention; however, there was no change in “pros” and “cons” attitudes toward smoking cessation in either ED nurses or physicians. 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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影响因子：
3.5
作者：
Bernstein, Steven L.;Boudreaux, Edwin D.;Rhodes, Karin V.
通讯作者：
Rhodes, Karin V.
影响因子：
4.7
作者：
Bock, Beth C.;Becker, Bruce M.;Trask, Peter
通讯作者：
Trask, Peter
影响因子：
4
作者：
Goldberg, D;Hoffman, A;A単el, D
通讯作者：
A単el, D
影响因子：
6.2
作者：
Bernstein, Steven L.;Boudreaux, Edwin D.;Kellermann, Arthur L.
通讯作者：
Kellermann, Arthur L.
影响因子：
3.8
作者：
Boudreaux, Edwin D.;Baumann, Brigitte M.;Ziedonis, Douglas
通讯作者：
Ziedonis, Douglas