Katz David A, Holman John E, Nugent Andrew S, Baker Laurence J, Johnson Skyler R, Hillis Stephen L, Tinkelman David G, Titler Marita G, Vander Weg Mark W
Department of Medicine, University of Iowa, Iowa City, IA, USA.
Nicotine Tob Res. 2013 Jun;15(6):1032-43. doi: 10.1093/ntr/nts219. Epub 2012 Nov 2.
The focus on acute care, time pressure, and lack of resources hamper the implementation of smoking cessation guidelines in the emergency department (ED). The purpose of this study was to determine whether an emergency nurse- initiated intervention based on the 5A's (Ask-Advise-Assess-Assist-Arrange) framework improves quit rates.
We conducted a pre-post implementation trial in 789 adult smokers who presented to two EDs in Iowa between August 13, 2008 and August 4, 2010. The intervention focused on improving delivery of the 5A's by ED nurses and physicians using academic detailing, charting/reminder tools, and group feedback. Performance of ED cessation counseling was measured using a 5A's composite score (ranging from 0 to 5). Smoking status was assessed by telephone interview at 3- and 6-month follow-up (with biochemical confirmation in those participants who reported abstinence at 6-month follow-up).
Based on data from 650 smokers who completed the post-ED interview, there was a significant improvement in the mean 5A's composite score for emergency nurses during the intervention period at both hospitals combined (1.51 vs. 0.88, difference = 0.63, 95% confidence interval [CI] [0.41, 0.85]). At 6-month follow-up, 7-day point prevalence abstinence (PPA) was 6.8 and 5.1% in intervention and preintervention periods, respectively (adjusted odds ratio [OR] = 1.7, 95% CI [0.99, 2.9]).
It is feasible to improve the delivery of brief smoking cessation counseling by ED staff. The observed improvements in performance of cessation counseling, however, did not translate into statistically significant improvements in cessation rates. Further improvements in the effectiveness of ED cessation interventions are needed.
对急性护理的关注、时间压力以及资源匮乏阻碍了戒烟指南在急诊科（ED）的实施。本研究的目的是确定基于5A's（询问-建议-评估-协助-安排）框架的急诊护士发起的干预措施是否能提高戒烟率。
我们在2008年8月13日至2010年8月4日期间对爱荷华州两家急诊科的789名成年吸烟者进行了实施前-后的试验。干预措施侧重于通过学术详述、图表/提醒工具和小组反馈来改善急诊科护士和医生对5A's的提供。使用5A's综合评分（范围从0到5）来衡量急诊科戒烟咨询的表现。在3个月和6个月随访时通过电话访谈评估吸烟状况（对那些在6个月随访时报告戒烟的参与者进行生化确认）。
基于650名完成急诊科后访谈的吸烟者的数据，两家医院合并后的干预期间，急诊护士的平均5A's综合评分有显著提高（1.51对0.88，差异 = 0.63，95%置信区间[CI][0.41, 0.85]）。在6个月随访时，干预期和干预前期的7天点患病率戒烟率（PPA）分别为6.8%和5.1%（调整优势比[OR] = 1.7，95% CI[0.99, 2.9]）。
急诊科工作人员改善简短戒烟咨询的提供是可行的。然而，观察到的戒烟咨询表现的改善并未转化为戒烟率的统计学显著提高。需要进一步提高急诊科戒烟干预措施的有效性。
