Referrals for emergency department patients to a telephone-based tobacco cessation program using college research associates as screeners.
Authors: Bradley K, Illuzzi F, Lee K, Castillo R, Trowbridge R, Byun R.
Presented at American College of Emergency Physicians meeting, Boston, October, 2009
Background: There is potential for public health interventions, such as referral to tobacco cessation programs, for the estimated more than half the U.S. population coming to an emergency department (ED) as a patient or visitor each year. Clinical ED personnel focused on care of the emergency problem cannot be expected to provide such additional services. However, the pre-health professional students looking for clinical experience may offer a willing work force who could accomplish this work.
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: urban, community teaching hospital ED with an inner-city and suburban catchment area. Type of participants: nonemergent 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 subject 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 21 weeks during the spring and summer semesters of 2008, 63 RAs approached 4613 potential subjects. 893 (19%) refused enrollment. RAs successfully enrolled 3125 (67%) to study completion, 53% patients and 47% visitors. Among our subjects, 1682 (54%) used tobacco for > one month at some time in their lives and 1615 (96%) used cigarettes. The average age of those using tobacco products was 17 years (range 5 – 54) when they started smoking, and the average duration of tobacco use was 22 years (range < 1 76). 681 (22%) subjects had used tobacco within the last 30 days. Of those subjects who used tobacco for > one month in their lives, 299 (18%) accepted a CT Quitline referral. For those who used tobacco within the last 30 days, 261 (38%) were referred.
Conclusion: 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.
