Treating Low-Income Smokers in the Hospital Emergency Department

在医院急诊室治疗低收入吸烟者

• 批准号: 8433997
• 负责人: Steven L Bernstein
• 金额: $ 56.4万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-16 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8433997
• 关键词: 18 year old; Abstinence; Accident and Emergency department; Adult; Age; Alcohol abuse; Alcohols; American; Asthma; Behavioral Risk Factor Surveillance System; Caring; Cessation of life; Cigarette; Connecticut; Control Groups; Cost-Benefit Analysis; Cotinine; Counseling; Dependence; Diagnosis; Dose; Economics; Effectiveness; Event; Feasibility Studies; Guidelines; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Individual; Institute of Medicine (U.S.); Intervention; Interview; Location; Low income; Measures; Mediation; Medical; Modeling; Nature; Nicotine; Nicotine Dependence; Nurses; Outcome Measure; Patient Preferences; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Population; Prevalence; Primary Health Care; Randomized; Randomized Controlled Trials; Relative (related person); Reporting; Research; Research Personnel; Salivary; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Societies; Substance Addiction; System; Telefacsimile; Telephone; Testing; Time; Tobacco; Tobacco Dependence; Training; United States; United States Public Health Service; Visit; Workplace; Writing; addiction; arm; base; brief intervention; cigarette smoking; comparative efficacy; control trial; cost; cost effective; cost effectiveness; design; economic cost; efficacy testing; experience; follow-up; health care service utilization; help-seeking behavior; high risk behavior; improved; innovation; interest; intervention program; motivational enhancement therapy; nicotine replacement; primary care setting; primary outcome; prospective; public health relevance; quitline; response; screening; screening and brief intervention; screening, brief intervention, referral, and treatment; secondary outcome; smoker brief intervention; smoking prevalence; standard care; success; tobacco abstinence; tobacco control; tobacco screening; treatment center

DESCRIPTION (provided by applicant): Of the nation's 45 million adult smokers, nearly 20 million visit hospital emergency departments (EDs) each year. ED patients, particularly smokers, are disproportionately low-income, with limited access to traditional primary care settings. Patients presenting to the ED with a tobacco-related trigger event, like an asthma attack, may be experiencing a "teachable moment." Thus, the ED may be an ideal location in which to identify smokers and initiate treatment for tobacco dependence. Initial pilot research by our group has demonstrated the feasibility of ED-based brief interventions for smokers. Based on our feasibility studies, the Institute of Medicine 2006 report on tobacco and the 2008 US Public Health Service guidelines now list EDs as appropriate loci for tobacco control efforts. This study aims to test the efficacy of an ED-initiated tobacco intervention which includes counseling and medication. The intervention-Screening, Brief Intervention, and Referral to Treatment (SBIRT)-uses a form of motivational interviewing known as the Brief Negotiation Interview (BNI). Our proposed intervention combines a BNI with initiation of nicotine replacement therapy (NRT) and a fax referral to the state Smokers' Quitline during the ED visit. A 6-week starter kit of NRT (patch and/or gum, tailored to level of addiction and patient preference) will be provided with written materials. The initial dose of NRT will be given in the ED. A trained nurse will administer the booster intervention via telephone 3 days post-visit. The SBIRT+NRT arm will be compared to standard care (SC), which consists of written materials only, in a controlled trial of 778 smokers age 18 years or older randomized in a 1:1 fashion. The primary hypothesis is that SBIRT+NRT will be superior to SC in reducing self-reported and biochemically verified 7-day tobacco abstinence at 3 months. Secondary hypotheses include: (1) Patients with a tobacco- related diagnosis for the ED visit will have a higher cessation rate than patients without a tobacco-related diagnosis, and (2) Patients who believe their ED visit is smoking-related will have a higher quit rate than others. We will conduct a cost benefit analysis of the interventions. Follow-up assessments at 1, 3 and 12 months will combine self-report with in-person salivary cotinine testing at 3 months for smokers who assert abstinence via phone. Expansions of the proposed project as compared to earlier studies include: 1) initiation of NRT during the ED visit; 2) provision of multiple forms of NRT; 3) a proactive referral made to the Quitline; 4) a credible control condition with minimal baseline assessment, to avoid the assessment reactivity seen in similar ED studies; and 5) an economic analysis of the tested interventions.

描述（由申请人提供）：在全国 4500 万成年吸烟者中，每年有近 2000 万人到医院急诊科 (ED) 就诊。急诊科患者，尤其是吸烟者，收入极低，获得传统初级保健机构的机会有限。因烟草相关触发事件（例如哮喘发作）而向急诊科就诊的患者可能正在经历“受教育的时刻”。因此，急诊室可能是识别吸烟者并开始治疗烟草依赖的理想场所。我们小组的初步试点研究证明了对吸烟者进行基于急诊科的短暂干预的可行性。根据我们的可行性研究，医学研究所 2006 年烟草报告和 2008 年美国公共卫生服务指南现已将 ED 列为烟草控制工作的适当场所。本研究旨在测试急诊科发起的烟草干预措施（包括咨询和药物治疗）的有效性。干预措施——筛查、简短干预和转介治疗 (SBIRT)——使用一种称为简短谈判访谈 (BNI) 的动机访谈形式。我们提议的干预措施将 BNI 与开始尼古丁替代疗法 (NRT) 以及在急诊就诊期间传真转介至州吸烟者戒烟热线相结合。将提供为期 6 周的 NRT 入门套件（贴剂和/或口香糖，根据成瘾程度和患者偏好定制）以及书面材料。 NRT 的初始剂量将在急诊室给予。经过培训的护士将在就诊后 3 天通过电话进行加强干预。 SBIRT+NRT 组将与仅由书面材料组成的标准治疗 (SC) 进行比较，该试验以 1:1 的方式随机对 778 名 18 岁或以上吸烟者进行。主要假设是，SBIRT+NRT 在减少 3 个月时自我报告和生化验证的 7 天戒烟方面优于 SC。次要假设包括：(1) 急诊就诊时诊断为烟草相关的患者比没有诊断为烟草相关的患者具有更高的戒烟率；(2) 认为急诊就诊与吸烟有关的患者比其他患者有更高的戒烟率。我们将对干预措施进行成本效益分析。对于通过电话断言戒烟的吸烟者，第 1、3 和 12 个月的后续评估将结合自我报告和 3 个月当面唾液可替宁测试。与早期研究相比，拟议项目的扩展包括：1）在急诊就诊期间开始 NRT； 2) 提供多种形式的NRT； 3) 主动转介至戒烟热线； 4) 具有最小基线评估的可靠控制条件，以避免类似 ED 研究中出现的评估反应； 5) 对测试的干预措施进行经济分析。