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

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

doi:10.1186/s13722-015-0045-2

Abstract

BackgroundComputer 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).MethodsSmokers (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.ResultsHERA 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.ConclusionsThe 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

Highlights

Computer technologies hold promise for implementing tobacco screening, brief intervention, and referral to treatment (SBIRT)
With over 130 million visits annually, emergency department (ED) originated tobacco control efforts have the potential for substantial impact on public health by effecting change in hard to reach populations [7, 8]. This potential was recognized by the Robert Wood Johnson Foundation which recommended implementation of routine screening, brief intervention, and referral to treatment (SBIRT) for tobacco in the ED setting, Boudreaux et al Addict Sci Clin Pract (2015) 10:24 and strongly encouraged research to develop tobacco interventions specific to the needs of EDs [7]
There were no differences between the two conditions on demographics, mental health diagnoses, Heavy Smoking Index (HSI), pack years, or readiness to change (p values >0.10) (Table 2)

Summary

Introduction

Computer technologies hold promise for implementing tobacco screening, brief intervention, and referral to treatment (SBIRT). While much attention has focused on primary care as a setting to promote smoking cessation, hospital emergency departments (EDs) are uniquely positioned This potential was recognized by the Robert Wood Johnson Foundation which recommended implementation of routine screening, brief intervention, and referral to treatment (SBIRT) for tobacco in the ED setting, Boudreaux et al Addict Sci Clin Pract (2015) 10:24 and strongly encouraged research to develop tobacco interventions specific to the needs of EDs [7]. They proposed using a brief Ask, Advise, Refer model, which consists of Asking about tobacco use, Advising patients to quit, and Referring patients to specialized treatment for tobacco use [2, 3]. The Ask, Advise, Refer model has since been adopted by researchers in their work to refine an effective ED-appropriate strategy for tobacco SBIRT [9, 10]

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