The Effectiveness of Smoking Cessation Guidelines in the Emergency Department

NCT ID: NCT00756704

Last Updated: 2011-11-04

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 789 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2008-09-30
• Study Completion Date: 2011-06-30

Brief Summary

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 Quitline Iowa 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.

Conditions

Cigarette Smoking

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Baseline Period

Group Type: NO_INTERVENTION

No interventions assigned to this group

Intervention Period

Group Type: EXPERIMENTAL

Smoking cessation guideline implementation

Intervention Type: BEHAVIORAL

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 Quitline Iowa for proactive telephone counseling plus free nicotine replacement therapy

4. group feedback to ED staff

Interventions

Smoking cessation guideline implementation

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 Quitline Iowa for proactive telephone counseling plus free nicotine replacement therapy

4. group feedback to ED staff

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Presentation to the Emergency Department by private vehicle or on a walk-in basis
• Current cigarette smoker (5 or more cigarettes per day)

Exclusion Criteria

• Acute medical decompensation (e.g., acute respiratory failure requiring intubation, cardiac arrest, cardiogenic or septic shock)
• Life-threatening trauma
• Altered mental status
• Dementia
• Language barrier
• Incarceration
• Transfer to another ED
• Departure from the ED prior to evaluation
• Inability to be contacted by telephone
• ED presentation for sexual assault
• ED presentation for acute psychiatric crisis (e.g., suicidal ideation)
• Participation in a smoking cessation program in the past 3 months

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

National Institute on Drug Abuse (NIDA)

NIH

Sponsor Role: collaborator

University of Iowa

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

David A Katz, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

The Univesity of Iowa College of Medicine

Locations

Iowa Methodist Medical Center

Des Moines, Iowa, United States

The University of Iowa Hospitals and Clinics Emergency Treatment Center

Iowa City, Iowa, United States

Countries

United States

References

Katz D, Vander Weg M, Nugent A, Kim R, Graham M, Holman J, Hillis S, Titler M. Adherence to smoking cessation guidelines in the emergency department. J Gen Intern Med 2009; 24 (Suppl 1): S15.

Reference Type: RESULT

Katz DA, Paez MW, Reisinger HS, Gillette MT, Weg MW, Titler MG, Nugent AS, Baker LJ, Holman JE, Ono SS. Implementation of smoking cessation guidelines in the emergency department: a qualitative study of staff perceptions. Addict Sci Clin Pract. 2014 Jan 24;9(1):1. doi: 10.1186/1940-0640-9-1.

Reference Type: DERIVED

PMID: 24460974 (View on PubMed)

Katz DA, Holman JE, Nugent AS, Baker LJ, Johnson SR, Hillis SL, Tinkelman DG, Titler MG, Vander Weg MW. The emergency department action in smoking cessation (EDASC) trial: impact on cessation outcomes. Nicotine Tob Res. 2013 Jun;15(6):1032-43. doi: 10.1093/ntr/nts219. Epub 2012 Nov 2.

Reference Type: DERIVED

PMID: 23125437 (View on PubMed)

Other Identifiers

R21DA021607

Identifier Type: NIH

Identifier Source: secondary_id

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R21DA021607

Identifier Type: NIH

Identifier Source: org_study_id

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