Arif, Faiza, BA

Aziz, Ali S, BS

Batchelor, Timothy, MD

Casey, Edward

Crowley, Lauren, BA

Doherty, Theodore, DO

Greco, Natalie M, MD

Greenberg, Marna R, DO, MPH, FACEP

Kruklitis, Robert, MD

Miller, Andrew H F, DO

Yee, Stephanie Z, BS

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works USF-LVHN SELECT Effects of Physician-Directed Smoking Cessation Intervention in the Emergency Department Faiza Arif BA Marna R. Greenberg DO, MPH, FACEP Natalie M. Greco MD Timothy Batchelor MD Andrew H F Miller DO See next page for additional authors Follow this and additional works at: https://scholarlyworks.lvhn.org/select-program  Part of the Medical Education Commons This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Authors Faiza Arif BA; Marna R. Greenberg DO, MPH, FACEP; Natalie M. Greco MD; Timothy Batchelor MD; Andrew H F Miller DO; Theodore Doherty DO; Ali S. Aziz BS; Stephanie Z. Yee BS; Lauren Crowley BA; Edward Casey; and Robert Kruklitis MD © 2018 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaWhat actions do smokers take after the ED SC motivational interviewing and STIR interventions to try to quit? We found that phone follow-up demonstrates that about one-fifth of the patients stopped smoking by 3-months post-intervention. About one-third of the patients adhered to the prescriptions for smoking cessation-related medications and greater than one-fifth participated in the referral follow-up. These findings support a willingness of patients to participate in STIR and the benefits of intervention in this setting. Effects of Physician-Directed Smoking Cessation Intervention in the Emergency DepartmentREFERENCES• This project relates to the Leadership, Values Based Patient-Centered Care, and Health Systems domains of SELECT. – The physicians incorporated motivational interviewing with Emergency Department (ED) patients who were smokers, this tool is a leadership tool that can be used to create a climate of change within the provider/patient relationship. – Due to the opt-out nature of this project, the patient was in full control of moving forward with the intervention or opting-out at any point, including phone follow-up. If the patient chose to continue the discussion of smoking cessation with provider then they were involved in shared decision making, brief STIR intervention, and phone follow-up. – Additionally, this project is a quality improvement project to evaluate the efficacy of an ED based intervention. The phone follow-up data demonstrate that STIR showed promising acceptability and effectiveness for helping patients quit smoking. If this result is replicated in larger study populations, quality of healthcare may be improved by incorporated physician-directed smoking cessation STIR intervention in the ED. Study Design and Setting• Prospective quality improvement pilot study in two Northeastern Pennsylvania Emergency Departments. • A standardized script adapted from D’Onofrio et al.9 and an electronic medical record template were derived to guide the patient interview and prescriptive interventions (STIR).• Residents and attending physicians that received training were able to conduct STIR.Selection of Participants• Prospective quality improvement study conducted from 5/7/2019 – 12/18/2019.• Inclusion criteria: currently smokes tobacco, English speaking, ≥18 years of age, discharged after their ED visit, able to participate in phone follow-up, and not critically ill, incapacitated, incarcerated, or known to be currently pregnant.Intervention• Physicians provided a brief motivational interview concerning smoking cessation which included a “readiness to change” inventory and recommendations to facilitate tobacco abstinence – both prescription(s) for use of smoking cessation-related medications and referral(s) for follow-up with a tobacco treatment program and/or primary care provider. • At approximately three months following their ED discharge, patients who did not opt out of the intervention and phone follow-up were contacted.Faiza ArifMarna Rayl Greenberg DO, MPH  Natalie M. Greco MD  Timothy J. Batchelor MD  Andrew H.F. Miller DO  Theodore Doherty DO  Ali S. Aziz BS  Stephanie Z. Yee BS Lauren M. Crowley BA  Edward W. Casey RPh, MBA  Robert J. Kruklitis MD, PhD1. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Aug 17].  https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/2. Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. American Journal of Preventive Medicine 2014;48(3):326–33 [accessed 2017 Nov 6]. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/index.htm3. Smith P. Tobacco Use Among Emergency Department Patients. Int. J. Environ. Res. Public Health. 2011;8:253-263.4. Boudreaux ED, Hunter GC, Bos K, Clark S, Camargo CA. Multicenter Study of Smoking, Nicotine Dependence, and Intention to Quitamong Emergency Department Patients and Visitors. Acad Emerg Med. 2004;11:548-549.5. Boudreaux ED, Kim S, Hohrmann JL, Clark S, Camargo CA. Interest in Smoking Cessation among Emergency Department Patients. Health Psychol. 2005;24:220-224.6. Lowenstein SR, Tomlinson D, Koziol-McLain J, Prochazka A. Smoking habits of emergency department patients: An opportunity for disease prevention. Acad Emerg Med. 1995;2:165-171.7. Lowenstein SR, Koziol-McLain J, Thompson M, et al. Behavioral risk factors in emergency department patients: a multisite study. AcadEmerg Med. 1998;5:781–7.8. Richman PB, Dinowitz S, Nashed A, Eskin B, Cody R. Prevalence of smokers and nicotine-addicted patients in a suburban emergency department. Acad Emerg Med. 1999;6:807-810.9. D'Onofrio G, Pantalon MV, Degutis LC, Fiellin DA, O'Connor PG. Development and implementation of an emergency practitioner–performed brief intervention for hazardous and harmful drinkers in the emergency department. Academic Emergency Medicine.2005;12(3):249-56. doi:10.1197/j.aem.2004.10.021Problem Statement• Tobacco use is the single most preventable cause of disease, disability, and death in the United States.1• Each year, over 480,000 people die prematurely from smoking or exposure to secondhand smoke and another 16 million live with a serious illness caused by smoking.1• The overall economic burden to the healthcare system is over $300 billion dollars each year, with approximately $170 billion attributed to direct medical care of adults.2• Over $156 billion is lost in productivity due to firsthand smoking, and $5.6 billion to secondhand  smoke exposure.1, 2 • The few studies that have reported rates of tobacco use in patients seeking care in the emergency department have shown great variability in prevalence (21-41%) and report that rates are greater than that of the general population.3-8• Using a physician directed, patient “opt-out” approach to prescriptive smoking cessation in the Emergency Department setting, we set out to describe patient actions as they related to smoking cessation behaviors. Outcomes studied include the phone follow-up data of the patients who did not opt out of the brief motivational interview in the Emergency Department. Does phone follow-up data show that the brief intervention in the Emergency Department using motivational interviewing and Screening, Treatment Initiation, Referral (STIR) counseling concepts results in patient actions towards smoking cessation?Greenberg, MR, Greco, NM, Batchelor, TJ, et al. Physician directed smoking cessation using patient “opt‐out” approach in the emergency department: A pilot program. JACEP Open. 2020; 1: 782–789. https://doi.org/10.1002/emp2.12176Greenberg, MR, Greco, NM, Batchelor, TJ, et al. Physician directed smoking cessation using patient “opt‐out” approach in the emergency department: A pilot program. JACEP Open. 2020; 1: 782– 789. https://doi.org/10.1002/emp2.12176Greenberg, MR, Greco, NM, Batchelor, TJ, et al. Physician directed smoking cessation using patient “opt‐out” approach in the emergency department: A pilot program. JACEP Open. 2020; 1: 782–789. https://doi.org/10.1002/emp2.12176

Effects of Physician-Directed Smoking Cessation Intervention in the Emergency Department

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1371&context=select-program

Effects of Physician-Directed Smoking Cessation Intervention in the Emergency Department

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