Patients are already in your hospital emergency department, waiting to get their smoking-exacerbated conditions addressed. As long as they're present and captive, why not help them kick the nasty habit?
Some 20 million smokers visit American EDs each year, many from low-income backgrounds, on Medicaid or lacking any insurance at all. Cigarette smoking is the leading cause of preventable death in the country, and the Affordable Care Act mandates Medicaid coverage of smoking cessation.
With that in mind, researchers at Yale University decided to provide aggressive smoking cessation treatments to those visiting an urban ED in Connecticut that has 90,000 visits a year to see if they might help to eradicate tobacco use. Three months later, the intervention seems to have done the trick, with some 12.2 percent of enrollees kicking the cancer stick versus just 4.9 percent in the control group, according to the study published recently in the Annals of Emergency Medicine.
Steven Bernstein, M.D., the lead author and professor at the Yale School of Medicine, says it's high time that EDs take ownership of smoking cessation and stop just letting patients return home with the same habits that keep them coming back.
"When I started working in emergency medicine over 25 years ago, I saw a whole lot of tobacco-related disease, like emphysema, or things like asthma that weren't caused by smoking but were made worse by it, and we weren't doing anything about it. We weren't even trained in it as emergency physicians in our residency," Bernstein told me by phone. “So, I thought there was a real gap there in our knowledge and in the services we were delivering. Why not use the ED as a place to identify smokers and initiate treatment?"
Nearly 800 low-income smokers were enrolled in the study, half of whom received Yale's multipronged intervention during their ED visit. That included a six-week dose of both nicotine gum and patches, an informational brochure, a motivational interview with a trained research assistant, a referral to the Connecticut quit-smoking hotline, and a nurse follow-up call three days later. Those in the control group, meanwhile, only received the brochure.
By the end of the study period, 12.9 percent of targeted patients self-reported that they'd stopped smoking — which researchers biochemically verified — compared with just 4.9 percent on the flip side. More than half of the Medicaid and uninsured patients involved in the study were nonwhite, and they represented all sexes, adult ages and ethnicities, yet still remained likelier to stay abstinent across that swatch when compared with the control group.
In the future, those involved with the study plan to take a deeper dive into whether such targeted smoking cessation efforts in the ED lead to reduced use of health care services. Also to be determined is whether the intervention is more affordable than standard care and if adding texting prompts or other mobile-related strategies to stop smoking might further move the needle.
Bernstein says, in the value-based, wellness-focused world of health care, hospitals need to keep finding creative ways to push outward and address such a pressing problem.
“Still about 18 percent of the U.S. population smokes. It’s still the No. 1 cause of preventable death and illness in this country," he says. “We have great treatment, but what we need to do better at is pushing that treatment out to all smokers everywhere so that every encounter with the medical care system is an opportunity to practice tobacco control. Emergency departments are just one piece of that more complex tapestry of care."