Emergency Department Initiated Treatments for Tobacco (EDITT): A Pilot Study
Emergency Department Initiated Treatments for Tobacco (EDITT): A Pilot Study
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DOI：
10.1007/s12160-008-9066-3
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发表时间：
2008-12-01
影响因子：
3.8
通讯作者：
Ziedonis, Douglas
中科院分区：
文献类型：
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作者：
Boudreaux, Edwin D.;Baumann, Brigitte M.;Ziedonis, Douglas
急诊科（ED）有很强的潜力，启动烟草干预措施与经济困难的population.We试点三个ED启动烟草干预措施，并得出参数估计为未来的trials.The研究纳入成人患者正在接受治疗的城市艾德谁是每日吸烟者。排除标准包括严重疾病或疼痛、隔离（传染）、精神状态改变、无法克服的语言障碍、临时居住和缺乏电话接入。床边+助推器组的受试者在床边接受了训练有素的顾问的动机咨询，最多三次电话会议后访问，和自助指南。传真转诊组中的受试者将他们的个人联系信息传真到医院的烟草依赖诊所，因此他们接受与床边+助推器组相同的治疗，但所有疗程都通过电话进行（即，没有床边咨询）。标准转诊组接受自助指南和转诊到医院的烟草依赖诊所。我们使用2：2：1的随机化时间表来最大限度地利用激励干预措施的经验。在1个月和3个月时评估结果。我们招募了90名受试者。在分配到床边+加强治疗条件的36名受试者中，31名（87%）完成了床边咨询和至少一次加强治疗，而22名（61%）完成了最多四次治疗。在37名被分配到传真转诊组的受试者中，28名（76%）至少完成了一次电话会议，而19名（51%）完成了最多四次会议。3个月内的戒烟尝试率从18%（标准转诊）到57%（传真转诊）不等。在3个月时，7天的戒烟率分别为8%（床边+助推器）、14%（传真转诊）和6%（标准转诊）。在艾德遇到最少医务人员参与的情况下，可以可行地启动动机性戒烟咨询。需要进行有说服力的试验来研究ED启动的干预措施，包括访视后随访。
Emergency departments (EDs) have strong potential to initiate tobacco interventions with economically disadvantaged populations.We piloted three ED-initiated tobacco interventions and derived parameter estimates for future trials.The study enrolled adult patients being treated in an urban ED who were daily smokers. Exclusion criteria included severe illness or pain, isolation (for contagion), altered mental status, an insurmountable language barrier, temporary residence, and lack of telephone access. Subjects in the Bedside + Booster group received motivational counseling by a trained counselor at the bedside, up to three telephone sessions post-visit, and a self-help guide. Subjects in the Faxed Referral group had their personal contact information faxed to the hospital's tobacco dependence clinic, whereupon they received identical treatment as the Bedside + Booster group, but all sessions occurred over the telephone (i.e., no bedside counseling). The Standard Referral group received the self-help guide and a referral to the hospital's tobacco dependence clinic. We used a 2:2:1 randomization schedule to maximize our experience with the motivational interventions. Outcomes were assessed at 1 and 3 months.We enrolled 90 subjects. Of the 36 subjects assigned to the Bedside + Booster condition, 31 (87%) completed bedside counseling and at least one booster session, while 22 (61%) completed the maximum four sessions. Of the 37 subjects assigned to the Faxed Referral group, 28 (76%) completed at least one telephone session, while 19 (51%) completed the maximum four sessions. Quit attempts over the 3 months ranged from 18% (Standard Referral) to 57% (Faxed Referral). Seven-day abstinence was attained by 8% (Bedside + Booster), 14% (Faxed Referral), and 6% (Standard Referral) at 3 months.Motivational cessation counseling can be feasibly initiated during the ED encounter with minimal medical staff involvement. Adequately powered trials are needed to study ED-initiated interventions that include post-visit follow-up.