The Effectiveness of Smoking Cessation Guidelines in the Emergency Department

描述（由申请人提供）：尽管78%的吸烟者报告说健康专业人员以前曾建议他们戒烟，但大多数吸烟者在给定的急诊科就诊期间没有被建议戒烟或提供戒烟帮助。然而，急诊临床医生在常规实施戒烟指南方面存在多种障碍，需要严格执行临床试验来证明对急症患者进行常规筛查和咨询会增加戒烟率。为了确定在急诊科实施卫生保健研究与质量局（AHRQ）戒烟指南的可行性，我们将采用前后设计对974名到2个急诊科就诊的流动成年吸烟者进行临床试验。在3个月的基线期间，临床医生将履行其日常职责，但不会接受使用AHRQ指南的培训。基于慢性护理模式，3个月的干预期将包括：1)为急诊科护士和医生提供简短的戒烟咨询教程，2)使用包括推荐烟草咨询项目的急诊科算法，3)将有动机的吸烟者传真转介到爱荷华戒烟热线，进行主动电话咨询和免费尼古丁替代治疗，4)向急诊科工作人员提供团体和个人反馈。我们将对急诊科患者进行退出访谈，以评估急诊科工作人员对指南推荐行动的表现，并进行3个月和6个月的电话随访，以确定7天的点流行戒断（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对照期在指南推荐的行动表现和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基于指南的干预的接受程度，并将为计划在社区医院急诊科进行研究干预的全面多地点临床试验提供效应大小估计。

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.