Smoking Interventions in the ED Could Yield Important Benefits
Smoking Interventions in the ED Could Yield Important Benefits
This viewpoint offers commentary on important clinical research.
Bernstein S.L., Boudreau E.D., Cydulka R.K., et al
Ann Emerg Med. 2006;48;e417-e426
Smoking contributes to significant morbidity and mortality in the United States. It is considered a leading cause of preventable death, with nearly 20% of all US deaths related to tobacco use. Despite the knowledge that the effects of smoking are catastrophic, people continue to smoke. The nicotine in tobacco is addictive, and breaking the cycle of this addiction can be difficult.
National practice guidelines offer specific recommendations to help clinicians and healthcare systems help fight tobacco use. However, the authors of this study note, the guidelines fail to target actions for the hospital emergency department (ED). Because a large number of patients passes through EDs each year (more than 115 million), targeting tobacco interventions at this level has the potential to affect a large population.
A task force representing major emergency medicine professional organizations sought to test the feasibility of ED-based tobacco control, review the evidence, and propose a research and education agenda for tobacco intervention in the ED setting. The literature review indicated that tobacco use among ED patients exceeds that of the general population, indicating that interventions in this population could reach a significant number of smokers. Studies have shown that ED physicians are likely to inquire about a patient's smoking status but are unlikely to assess the patient's interest in quitting or broach tobacco cessation.
Barriers to ED-based tobacco control were identified:
However, even if an ED-based tobacco control program was not highly efficacious, it still could reach a large number of smokers, if delivered to a large population. For example, about 85 million of the annual ED visits include adults and children 15 years of age and older. If one-third of these individuals smoke, that would translate to a significant number of smoker ED visits per year (rounded down by the authors to 20 million).
The task force estimated that, even with a low efficacy program, 1% of these smokers could be persuaded to quit. The result: an additional 200,000 quitters per year who may not have been reached by any other tobacco intervention program.
The Task Force put forth several recommendations:
Smoking cessation remains a timely topic, and efforts to curb tobacco use are widely discussed in the medical literature. Incorporating tobacco interventions into routine ED practices has the potential to reach patients who do not have a primary care physician and who use the ED as their primary means of healthcare. It would be interesting to determine whether the interventions reduce overall ED use for those patients, and whether a reduction in total healthcare spending would be achieved.
While not specifically addressed by this task force, pharmacists are often part of the ED medical team. Interventions could utilize pharmacists by calling on them to help educate patients about available smoking cessation products. The costs of these aids likely would be a concern for patients without healthcare coverage. Studies on how to make smoking cessation aids affordable should be included in the research agenda.
Abstract
Tobacco Control Interventions in the Emergency Department: A Joint Statement of Emergency Medicine Organizations
This viewpoint offers commentary on important clinical research.
Bernstein S.L., Boudreau E.D., Cydulka R.K., et al
Ann Emerg Med. 2006;48;e417-e426
Study Summary
Smoking contributes to significant morbidity and mortality in the United States. It is considered a leading cause of preventable death, with nearly 20% of all US deaths related to tobacco use. Despite the knowledge that the effects of smoking are catastrophic, people continue to smoke. The nicotine in tobacco is addictive, and breaking the cycle of this addiction can be difficult.
National practice guidelines offer specific recommendations to help clinicians and healthcare systems help fight tobacco use. However, the authors of this study note, the guidelines fail to target actions for the hospital emergency department (ED). Because a large number of patients passes through EDs each year (more than 115 million), targeting tobacco interventions at this level has the potential to affect a large population.
A task force representing major emergency medicine professional organizations sought to test the feasibility of ED-based tobacco control, review the evidence, and propose a research and education agenda for tobacco intervention in the ED setting. The literature review indicated that tobacco use among ED patients exceeds that of the general population, indicating that interventions in this population could reach a significant number of smokers. Studies have shown that ED physicians are likely to inquire about a patient's smoking status but are unlikely to assess the patient's interest in quitting or broach tobacco cessation.
Barriers to ED-based tobacco control were identified:
Insufficient time with the patient;
Perceived lack of interest on the part of patients;
The belief that the ED is an inappropriate setting for preventive health services;
Perceived ineffectiveness of counseling;
Lack of training in tobacco cessation techniques;
Difficulties with follow up;
Lack of reimbursement for screening and referral; and
Administrative burden of screening if smoking is not perceived to be the cause of the ED visit.
However, even if an ED-based tobacco control program was not highly efficacious, it still could reach a large number of smokers, if delivered to a large population. For example, about 85 million of the annual ED visits include adults and children 15 years of age and older. If one-third of these individuals smoke, that would translate to a significant number of smoker ED visits per year (rounded down by the authors to 20 million).
The task force estimated that, even with a low efficacy program, 1% of these smokers could be persuaded to quit. The result: an additional 200,000 quitters per year who may not have been reached by any other tobacco intervention program.
The Task Force put forth several recommendations:
Educate all faculty and emergency medicine residents about the burden of smoking and the potential for ED cessation programs;
Identify the most effective ED-based strategies for urban, suburban, and rural EDs, and assist in adopting them;
Conduct research on novel approaches to ED-based smoking cessation; and
Identify funds to encourage ED-based research and demonstration projects on smoking cessation.
Viewpoint
Smoking cessation remains a timely topic, and efforts to curb tobacco use are widely discussed in the medical literature. Incorporating tobacco interventions into routine ED practices has the potential to reach patients who do not have a primary care physician and who use the ED as their primary means of healthcare. It would be interesting to determine whether the interventions reduce overall ED use for those patients, and whether a reduction in total healthcare spending would be achieved.
While not specifically addressed by this task force, pharmacists are often part of the ED medical team. Interventions could utilize pharmacists by calling on them to help educate patients about available smoking cessation products. The costs of these aids likely would be a concern for patients without healthcare coverage. Studies on how to make smoking cessation aids affordable should be included in the research agenda.
Abstract
