The Effectiveness of Smoking Cessation Guidelines in the Emergency Department

急诊科戒烟指南的有效性

• 批准号: 7380300
• 负责人: DAVID A KATZ
• 金额: $ 30万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-15 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7380300
• 关键词: Abstinence; Accident and Emergency department; Adherence; Adult; Algorithms; Attitude; Biochemical; Caring; Clinical Trials; Community Hospitals; Counseling; Couples; Effectiveness; Elements; Emergency Situation; Enrollment; Feasibility Studies; Feedback; Guidelines; Health Professional; Individual; Intervention; Intervention Studies; Interview; Iowa; Logistic Regressions; Modality; Multi-Institutional Clinical Trial; Nurses; Outcome; Patient Self-Report; Patients; Performance; Pharmaceutical Preparations; Physicians; Pilot Projects; Prevalence; Preventive; Primary Health Care; Rate; Reporting; Research; Research Design; Screening procedure; Services; Site; Smoker; Smoking Cessation Intervention; Telefacsimile; Telephone; Tobacco; Training; Translating; United States Agency for Healthcare Research and Quality; University Hospitals; Visit; alcohol abuse prevention; base; chronic care model; community based care; day; design; desire; evidence based guidelines; experience; follow-up; nicotine replacement; quitline; size; smoking cessation; success

DESCRIPTION (provided by applicant): Although 78% of smokers report that a health professional has previously advised them to quit smoking, most smokers are not advised to stop smoking or offered assistance with smoking cessation during a given ED visit. There are multiple barriers to routine implementation of smoking cessation guidelines by emergency clinicians, however, and rigorously performed clinical trials are needed to demonstrate that routine screening and counseling of ED patients results in increased quit rates. To determine the feasibility of implementing the Agency for Healthcare Research and Quality (AHRQ) Smoking Cessation Guideline in the ED, we will conduct a clinical trial in 974 ambulatory adult smokers who present to 2 emergency departments, using a pre-post design. During the 3-month baseline period, clinicians will perform their usual duties but will not receive training in use of the AHRQ Guideline. Based on the Chronic Care Model, the 3-month intervention period will include: 1) a tutorial on brief cessation counseling for ED nurses and physicians, 2) use of an ED algorithm that includes recommended tobacco counseling items, 3) fax referral of motivated smokers to the Iowa Quitline for proactive telephone counseling plus free nicotine replacement therapy, and 4) group and individual feedback to ED staff. We will conduct exit interviews of ED patients to assess performance of guideline-recommended actions by ED staff and 3- and 6-month telephone follow-up to determine 7-day point-prevalence abstinence (with biochemical confirmation of self-reported quitters at 6 months). Our main analyses will examine the contrast between the intervention and control periods in the performance of guideline- recommended actions and in 6-month quit rates, using hierarchical logistic regression to adjust for baseline differences in potentially confounding patient variables. In secondary analyses, we will assess the change in attitudes of ED nurses and physicians toward smoking cessation counseling. This feasibility study will determine the receptivity of patients and ED staff to the guideline-based intervention and will provide estimates of effect size in planning a full scale multi-site clinical trial of the study intervention in community hospital EDs.

描述（由申请人提供）：尽管78%的吸烟者报告说，医疗专业人员之前曾建议他们戒烟，但在特定的艾德访视期间，大多数吸烟者未被建议戒烟或提供戒烟帮助。然而，急诊医生常规实施戒烟指南存在多种障碍，需要严格进行临床试验以证明对艾德患者进行常规筛查和咨询可提高戒烟率。为了确定在艾德实施医疗保健研究和质量局（AHRQ）戒烟指南的可行性，我们将在974名前往2个急诊室的非卧床成年吸烟者中进行一项临床试验，采用前后设计。在3个月的基线期内，临床医生将履行其日常职责，但不会接受使用AHRQ指南的培训。根据慢性病护理模式，3个月的干预期将包括：1）为艾德护士和医生提供简短戒烟咨询的教程，2）使用包括推荐烟草咨询项目的艾德算法，3）传真将有动机的吸烟者转诊至爱荷华州戒烟热线，进行主动电话咨询和免费尼古丁替代治疗，以及4）向艾德工作人员提供小组和个人反馈。我们将对艾德患者进行离职面谈，以评估艾德工作人员对指南建议措施的执行情况，并进行3个月和6个月的电话随访，以确定7天时点戒烟率（6个月时对自我报告的戒烟者进行生化确认）。我们的主要分析将检查干预期和对照期之间在指南推荐的行为表现和6个月戒烟率方面的对比，使用分层逻辑回归来调整潜在混淆患者变量的基线差异。在二次分析中，我们将评估艾德护士和医生对戒烟咨询态度的变化。本可行性研究将确定患者和艾德工作人员对基于指南的干预措施的接受程度，并将为计划在社区医院ED中进行研究干预措施的全规模多中心临床试验提供效应量估计值。