Health evaluation and referral assistant: a randomized controlled trial to improve smoking cessation among emergency department patients

Edwin D Boudreaux, Beau Abar, Brianna Haskins, Brigitte Bauman, Grant Grissom, Edwin D Boudreaux, Beau Abar, Brianna Haskins, Brigitte Bauman, Grant Grissom

Abstract

Background: Computer technologies hold promise for implementing tobacco screening, brief intervention, and referral to treatment (SBIRT). This study aims to evaluate a computerized tobacco SBIRT system called the Health Evaluation and Referral Assistant (HERA).

Methods: Smokers (n = 421) presenting to an emergency department were randomly assigned to the HERA or a minimal-treatment Control and were followed for 3 months. Analyses compared smoking cessation treatment provider contact, treatment initiation, treatment completion, and smoking behavior across condition using univariable comparisons, generalized estimating equations (GEE), and post hoc Chi square analyses.

Results: HERA participants were more likely to initiate contact with a treatment provider but did not differ on treatment initiation, quit attempts, or sustained abstinence. Subanalyses revealed HERA participants who accepted a faxed referral were more likely to initiate treatment but were not more likely to stop smoking.

Conclusions: The HERA promoted initial contact with a smoking cessation provider and the faxed referral further promoted treatment initiation, but it did not lead to improved abstinence.

Trial registration: ClinicalTrials.gov number NCT01153373.

Figures

Fig. 1
Fig. 1
Enrollment flow for the HERA RCT—tobacco

References

    1. Centers for disease control and prevention Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004. MMWR. 2008;57:1226–1228.
    1. Bernstein SL, Boudreaux ED, Cydulka RK, Rhodes KV, Lettman NA, Almeida SL, et al. American College of Emergency Physicians Task Force on Smoking Cessation. Tobacco control interventions in the emergency department: a joint statement of emergency medicine organizations. J Emerg Nurs. 2006;32(5):370–381. doi: 10.1016/j.jen.2006.06.006.
    1. Anders ME, Sheffer CE, Barone CP, Holmes TM, Simpson DD, Duncan AM. Emergency department-initiated tobacco dependence treatment. Am J Health Behav. 2011;35(5):546–556. doi: 10.5993/AJHB.35.5.4.
    1. Centers for disease control and prevention. Smoking is the leading preventable cause of death in the United States. 2014. . Accessed 17 April 2015.
    1. Sanjuan PM, Rice SL, Witkiewitz K, Mandler RN, Crandall C, Bogenschutz MP. Alcohol, tobacco, and drug use among emergency department patients. Drug Alcohol Depend. 2014;138:32–38. doi: 10.1016/j.drugalcdep.2014.01.025.
    1. Cunningham RM, Bernstein SL, Walton M, Broderick K, Vaca FE, Woolard R, et al. Alcohol, tobacco, and other drugs: future directions for screening and intervention in the emergency department. Acad Emerg Med. 2009;16:1078–1088. doi: 10.1111/j.1553-2712.2009.00552.x.
    1. Boudreaux ED, Baumann BM, Perry J, Marks D, Francies S, Camargo CA, et al. Emergency department initiated treatments for tobacco (EDITT): a pilot study. Ann Behav Med. 2008;36(3):314–325. doi: 10.1007/s12160-008-9066-3.
    1. Murphy MK, Bijur PE, Rosenbloom D, Bernstein SL, Gallagher EJ. Feasibility of a computer-assisted alcohol SBIRT program in an urban emergency department: patient and research staff perspectives. Addict Sci Clin Pract. 2013;8(1):1–10. doi: 10.1186/1940-0640-8-2.
    1. Bernstein SL, Boudreaux ED, Cabral L, Cydulka RK, Schwegman D, Larkin GL, et al. Efficacy of a brief intervention to improve emergency physicians’ smoking cessation counseling skills, knowledge, and attitudes. Subst Abus. 2009;30(2):158–181. doi: 10.1080/08897070902802117.
    1. Bernstein SL, Boudreaux ED, Cabral L, Cydulka RK, Schwegman D, Larkin GL, et al. Nicotine dependence, motivation to quit, and diagnosis among adult emergency department patients who smoke: a national survey. Nicotine Tob Res. 2008;10(8):1277–1282. doi: 10.1080/14622200802239272.
    1. Greenberg MR, Weinstock M, Fenimore DG, Siezega GM. Emergency department tobacco cessation program: staff participation and intervention success among patients. J Am Osteopath Assoc. 2008;108(8):391–396.
    1. Boudreaux ED, Bedek KL, Gilles D, Baumann BM, Hollenberg S, Lord SA, et al. The dynamic assessment and referral system for substance abuse (DARSSA): development, functionality, and end-user satisfaction. Drug Alcohol Depend. 2009;99(1):37–46. doi: 10.1016/j.drugalcdep.2008.06.015.
    1. Boudreaux ED, Abar B, Baumann BM, Grissom G. A randomized clinical trial of the health evaluation and referral assistant (HERA): research methods. Contemp Clin Trials. 2013;35(2):87–96. doi: 10.1016/j.cct.2013.04.010.
    1. Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, Robinson J. Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Br J Addict. 1989;84:791–800. doi: 10.1111/j.1360-0443.1989.tb03059.x.
    1. Kroenke K, Spitzer RL, Williams JB. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–1292. doi: 10.1097/01.MLR.0000093487.78664.3C.
    1. Miller WR, Rollnic S, Moyers TB. Motivational interviewing: helping people change. New York: Guilford Press; 2013.
    1. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol. 1992;47(9):1102–1114. doi: 10.1037/0003-066X.47.9.1102.
    1. Bernstein SL, Bernstein E, Boudreaux ED, Babcock-Irvin C, Mello MJ, Kapur AK, et al. Public health considerations in knowledge translation in the emergency department. Acad Emerg Med. 2007;14(11):1036–1041. doi: 10.1111/j.1553-2712.2007.tb02385.x.
    1. Willett JG, Hood NE, Burns EK, Swetlick JL, Wilson SM, Lang DA, et al. Clincial faxed referrals to a tobacco quitline: reach, enrollment, and participant characteristics. Am J Prev Med. 2009;36(4):337–340. doi: 10.1016/j.amepre.2008.12.004.
    1. Bernstein SL, Bijur P, Cooperman N, Jearld S, Arnsten JH, Moadel A, et al. Efficacy of an emergency department-based multicomponent intervention for smokers with substance use disorders. J Subst Abuse Treat. 2013;44(1):139–142. doi: 10.1016/j.jsat.2012.05.005.
    1. Velicer WF, Prochaska JO, Bellis JM, DiClemente CC, Rossi JS, Fava JL, et al. An expert system intervention for smoking cessation. Addict Behav. 1993;18(3):269–290. doi: 10.1016/0306-4603(93)90029-9.
    1. Prochaska JO, Velicer WF, Fava JL, Rossi JS, Tsoh JY. Evaluating a population-based recruitment approach and a stage-based expert system intervention for smoking cessation. Addict Behav. 2001;26(4):583–602. doi: 10.1016/S0306-4603(00)00151-9.
    1. Prochaska JO, Velicer WF, Fava JL, Ruggiero L, Laforge RG, Rossi JS, et al. Counselor and stimulus control enhancements of a stage-matched expert system intervention for smokers in a managed care setting. Prev Med. 2001;32(1):23–32. doi: 10.1006/pmed.2000.0767.
    1. Boudreaux ED, Abar B, O’Hea EL, Sullivan AF, Cydulka R, Bernstein SL, et al. Cognitive and affective predictors of smoking after a sentinel health event. Psychol Health Med. 2014;19(4):402–409. doi: 10.1080/13548506.2013.832781.
    1. Boudreaux ED, Baumann BM, Camargo CA, Jr, O’Hea EL, Ziedonis DM. Changes in smoking associated with an acute health event: theoretical and practical implications. Ann Behav Med. 2007;33:189–199. doi: 10.1007/BF02879900.
    1. Bock BC, Becker BM, Niaura RS, Partridge R, Fava JL, Trask P. Smoking cessation among patients in an emergency chest pain observation unit: outcomes of the chest pain smoking study (CPSS) Nicotine Tob Res. 2008;10(10):1523–1531. doi: 10.1080/14622200802326343.
    1. Ozhathil DK, Abar B, Baumann BM, Camargo CA, Jr, Ziedonis D, Boudreaux ED. The effect of removing cost as a barrier to treatment initiation with outpatient tobacco dependence clinics among emergency department patients. Acad Emerg Med. 2011;18(6):662–664. doi: 10.1111/j.1553-2712.2011.01048.x.

Source: PubMed

Подписаться