The Effectiveness of Smoking Cessation Guidelines in the Emergency Department

描述(由申请人提供)：虽然78%的吸烟者报告说健康专业人员曾建议他们戒烟，但大多数吸烟者在特定的急诊科就诊期间并未被建议戒烟或提供戒烟帮助。然而，急诊临床医生常规实施戒烟指南存在多种障碍，需要进行严格的临床试验，以证明对ED患者的常规筛查和咨询会增加戒烟率。为了确定在急诊室实施医疗研究与质量署(AHRQ)戒烟指南的可行性，我们将采用事后设计，对974名在两个急诊科就诊的成年非卧床吸烟者进行临床试验。在3个月的基线期间，临床医生将履行他们的日常职责，但不会接受使用AHRQ指南的培训。根据慢性护理模式，为期3个月的干预期将包括：1)为急诊科护士和医生提供简短戒烟咨询教程；2)使用包括推荐烟草咨询项目的戒烟算法；3)将有动机的吸烟者传真至爱荷华州Quitline，接受积极的电话咨询和免费的尼古丁替代疗法；以及4)向急诊科工作人员提供小组和个人反馈。我们将对ED患者进行离职访谈，以评估ED工作人员根据指南建议的行动的表现，并进行为期3个月和6个月的电话随访，以确定7天点戒毒盛行率(并在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验干预期和控制期在指南推荐行动的执行和6个月戒烟率方面的对比，使用分层Logistic回归来调整潜在混淆患者变量的基线差异。在二次分析中，我们将评估急诊科护士和医生对戒烟咨询态度的变化。这项可行性研究将确定患者和急诊科工作人员对以指南为基础的干预措施的接受程度，并将为规划社区医院急诊室研究干预的全面多地点临床试验提供效果大小的估计。

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.