opt-out, emergency department, motivational interviewing, referral and consultation, screening, treatment initiation, referral, smoking cessation agents, smoking cessation
Digital Object Identifier (DOI)
Objective: Using a physician-directed, patient “opt-out” approach to prescriptive smoking cessation in the emergency department (ED) setting, we set out to describe patient actions as they related to smoking cessation behaviors.
Methods: A convenience sample of smokers at 2 Pennsylvania hospital EDs who met inclusion/exclusion criteria were approached to participate in a brief intervention known as screening, treatment initiation, and referral (STIR) counseling that included phone follow-up. Demographic information, current smoking status, and specific physician prescription and follow-up recommendations were collected. Approximately 3 months later, patients were contacted to determine current smoking status and actions taken since their ED visit.
Results: One hundred six patients were approached and 7 (6.6%) opted out of the intervention. Patients who did not opt out were evaluated for appropriate use of smoking cessation-related medications; 35 (35.4%) opted out of the prescription(s) and 6 (6.1%) were not indicated. Twenty-one (21.2%) patients opted out of ambulatory referral follow-ups with primary care and/or tobacco treatment program; one (1.0%) was not indicated for referral. Nineteen (32.8%) patients who received prescription(s) for smoking cessation-related medications initially also followed the prescription(s). Seventeen (22.1%) patients participated in referral follow-up.
Conclusion: In this small ED pilot, using the STIR concepts in an opt-out method, few smokers opted out of the smoking cessation intervention. About one-third of the patients declined prescriptions for smoking cessation-related medications and less than one-quarter declined ambulatory referrals for follow-up. These findings support a willingness of patients to participate in STIR and the benefits of intervention in this setting.
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Citation / Publisher Attribution
Journal of the American College of Emergency Physicians Open, v. 1, issue 5, p. 782-789
Scholar Commons Citation
Greenberg, Marna Rayl; Greco, Natalie M.; Batchelor, Timothy J.; Miller, Andrew H.F.; Doherty, Theodore; Aziz, Ali S.; Yee, Stephanie Z.; Arif, Faiza; Crowley, Lauren M.; Casey, Edward W.; and Kruklitis, Robert J., "Physician-directed Smoking Cessation Using Patient “opt-out” Approach in the Emergency Department: A Pilot Program" (2020). Internal Medicine Faculty Publications. 248.