Outcome of an emergency department intervention on tobacco cessation among emergency department patients and visitors: a validation study
Authors: Delgado J, Illuzzi F, Jablow R, King R, Carro-Kowalcyk S, Molloy M, Bradley K
Background: Pilot work at St. Vincent’s Medical Center demonstrated the potential for public health interventions, such as referral to tobacco cessation programs. To validate this model, two other institutions in Connecticut, Hartford Hospital and Lawrence and Memorial Hospital joined St. Vincent’s
Objectives: Using pre-health professional students as Research Associates (RAs), 1. To assess tobacco use among adult non-emergent ED patients and visitors 2. To determine rate of referrals to a telephone-based tobacco cessation service
Methods: Design: prospective, observation and intervention, convenience sample. Setting: an urban, community teaching hospital ED with an inner-city and suburban catchment area, a major academic medical center and a community hospital. Type of participants: non-emergent patients and visitors; RAs, volunteer college and post-baccalaureate students interested in a career in the health professions, trained in clinical research methods and the study protocol.
During weekly four-hour shifts, RAs approached as many non-emergent patients and visitors 18 years of age or older as possible. After obtaining informed consent, they used a scripted format to get demographic information and a detailed tobacco history. If a participant had used tobacco products for > 30 days at any time in their lives, they were offered a referral to the Connecticut Quitline, a service provided by the CT Department of Public Health. Those who indicated an interest in stopping tobacco use or to have help maintaining their tobacco cessation had a referral request and contact information sent to Free and Clear, Inc., the agency responsible for implementing Connecticut Quitline’s treatment program. Free and Clear, Inc. provides a validated, free, telephone-based tobacco cessation program, funded by monies from the tobacco companies’ settlement.
Results: Over 20 weeks during the spring and summer semesters of 2011, RAs served 1530 shifts of four hours each. They approached 10,324 potential participants, identified 8558 as eligible and successfully enrolled 6750 (79%) and guided 6333, 74% of eligible and 94% of eligible, to study completion. Among our participants, 3640 (58%) used tobacco for > one month at some time in their lives. 1640 participants (26% of enrolled and 45% of those who used tobacco ever) had used tobacco within the last 30 days. Of those participants who used tobacco for > one month in their lives, 1118 (17% of enrolled and 31% of tobacco users) accepted a CT Quitline referral. For those who used tobacco within the last 30 days, 52% were referred.
Conclusion: In this validation study, RAs were able to arrange referrals to a free tobacco cessation service for a large number of tobacco users among ED patients and visitors. This study demonstrates the potential for a substantial public health intervention in the emergency department setting with minimal financial impact in a variety of ED settings.
