The results of a randomized controlled trial show that smokers visiting the emergency department (ED) are more than twice as likely to quit if counseling, nicotine replacement therapy, and relevant referrals are provided during the visit.
For the study, the research team enrolled 778 adult smokers who made a visit to an urban teaching ED and were either self-pay or had Medicaid insurance. Participants were randomly assigned to intervention and control groups.
Smokers in the intervention group received a motivational interview by a trained research assistant, a faxed referral to the state smokers’ quit line, 6 weeks of nicotine patches and gum started in the ED, a booster call, and a brochure that included quit line information. The control group in the study received only the brochure.
The results of the trial reveal that 3 months after their visit, the rate of biochemically confirmed smoking abstinence was 12.2% in the intervention group compared with 4.9% in the control group, according to a Medscape news report. In a multivariate analysis, participants in the intervention group were still 2.72 times more likely to be abstinent than those in the control group.
Additionally, an exploratory analysis showed that the abstinence rate remained higher in the intervention group at 1 year. The intervention group was also more likely to have made a 24-hour quit attempt since their ED visit (68.4% vs 55.9%) and had a greater reduction in the mean number of cigarettes smoked daily (9.1 vs 5.9 fewer cigarettes), as noted on the Medscape news report.
Steven L. Bernstein, MD, along with colleagues, says ED visits may be an ideal opportunity for smoking cessation interventions. The researchers explain, “Smokers are disproportionately from low-income households and commonly receive care in hospital EDs either for medical consequences of smoking or for comorbid medical and psychiatric conditions. These patients often have limited access to primary care providers, who tend to undertreat tobacco use.”
Bernstein and colleagues also write, “This intervention may offer a new approach for treating the difficult-to-reach population of low-income smokers. With continued implementation of the Patient Protection and Affordable Care Act… initiation of tobacco dependence treatment in the ED and linkage to aftercare may be particularly timely.”
Bernstein comments, “While a busy emergency department may not welcome the additional responsibility of tobacco-cessation counseling, sometimes we have to meet our patients where they are.”