A Randomized Trial of a Multicomponent Cessation Strategy for Emergency Department Smokers
A Randomized Trial of a Multicomponent Cessation Strategy for Emergency Department Smokers
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DOI：
10.1111/j.1553-2712.2011.01097.x
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发表时间：
2011-06-01
影响因子：
4.4
通讯作者：
Gallagher, E. John
中科院分区：
文献类型：
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作者：
Bernstein, Steven L.;Bijur, Polly;Gallagher, E. John
目的：目的是确定基于急诊科 (ED) 的戒烟干预措施的有效性。方法：本研究是一项随机试验，于 2006 年 1 月至 2007 年 9 月在城市急诊科进行，每年治疗 90,000 名成年人。每天至少吸 10 支烟的出院成人被随机分配到 1) 常规护理，收到戒烟手册；或 2) 加强护理，收到小册子、动机访谈 (MI)、尼古丁贴片以及 3 天的电话。干预措施由接受过烟草治疗培训的同伴教育者进行。 3个月时进行盲法随访。结果：共有338名受试者入组，平均（+/-SD）年龄为40.2（+/-12.0）岁，51.8%为女性，56.5%为自费或医疗补助。组间人口统计学和临床变量具有可比性。加强护理组和常规护理组在 3 个月时的戒烟率相似（分别为 14.7% 和 13.2%）。尝试戒烟的受试者比例（69.2% vs. 66.5%）和每日吸烟量减少（5 vs. 1；所有 p > 0.05）也相似。在逻辑模型中，与戒烟相关的因素包括任何与烟草相关的国际疾病分类第九次修订版 (ICD-9)、急诊就诊代码（比值比 [OR] = 3.42，95% 置信区间 [CI] = 1.61 至 7.26）或受试者认为 Ell 就诊与烟草相关（OR = 2.47，95% CI = 1.17 至 5.21）。相反，报告患有烟草相关疾病的受试者戒烟的可能性较小（OR = 0.22，95% CI = 0.10 至 0.50）。 结论：主要终点为阴性，反映出对照组的戒烟率高于预期。根据医生的诊断或受试者的看法，急诊就诊与烟草相关的受试者戒烟的可能性是其两倍多。这些数据表明，即使是低强度的筛查和转诊也可能促使大量 ED 吸烟者戒烟或尝试戒烟。学术急诊医学2011； 18:575-583 (C) 2011 由学术急诊医学学会
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 Ell 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. ACADEMIC EMERGENCY MEDICINE 2011; 18:575-583 (C) 2011 by the Society for Academic Emergency Medicine