Pharmacists help with ED smoking cessation efforts
Pharmacists help with ED smoking cessation efforts
Many smokers seek primary care in EDs
Smoking cessation is a timely topic and efforts to curb tobacco use are widely discussed in the medical literature. MLC Solutions principals Charlotte Kenreigh, Pharm.D., and Linda Timm Wagner, Pharm.D., wrote in a Viewpoint column at the Medscape pharmacist web page that emergency department smoking interventions could make use of pharmacists by calling on them to help educate patients about available smoking cessation products.
Kenreigh and Wagner commented on a report in the Annals of Emergency Medicine that provided a joint statement of emergency medicine organizations on tobacco control interventions in the emergency department. The statement reported that smoking is considered a leading cause of preventable death, with nearly 20% of all U.S. deaths related to tobacco use. Despite the knowledge that the effects of smoking are catastrophic, it said, people continue to smoke. The nicotine in tobacco is addictive, and breaking the cycle of this addiction can be difficult.
While national practice guidelines offer specific recommendations to help clinicians and healthcare systems fight tobacco use, the study authors noted the guidelines fail to target actions for hospital emergency departments. Because more than 115 million patients pass through emergency departments each year, targeting tobacco interventions at that level has the potential to affect a large population.
A task force representing major emergency medicine professional organizations sought to test feasibility of emergency department based tobacco control, review the evidence, and propose a research and educational agenda for tobacco intervention in the emergency department setting. A literature review indicated that tobacco use among emergency department patients exceeds that of the general population, indicating that interventions in the emergency department population could reach a significant number of smokers. Studies have shown that emergency department physicians are likely to inquire about a patient's smoking status, but are not likely to assess patients' interest in quitting or raise the possibility of tobacco cessation.
Barriers to emergency department tobacco control that were identified include insufficient time with patients, perceived lack of interest on the part of patients, the belief that the emergency department is an inappropriate setting for preventive health services, perceived ineffectiveness of counseling, lack of training in tobacco cessation techniques, difficulties with followup, lack of reimbursement for screening and referral, and the administrative burden of screening if smoking is not perceived to be the cause of the emergency department visit.
Large potential effect
Kenreigh and Wagner say that even if an emergency department based tobacco control program were not highly efficacious, it still could reach a large number of smokers if delivered to a large population.
For example, about 85 million of the annual emergency department visits include adults and children age 15 and older. If one-third of those individuals smoke, that would translate to an estimated 20 million smoker emergency department visits per year. The task force estimated that even with a low-efficacy program, 1% of the smokers could be persuaded to quit, meaning there would be an additional 200,000 people who quit smoking each year who might not have been reached by any other tobacco intervention program.
The task force provided several recommendations, including:
- Educate all faculty and emergency medicine residents about the burden of smoking and the potential for emergency department cessation programs.
- Identify the most effective emergency department based strategies for urban, suburban, and rural emergency departments, and assist in adopting them.
- Conduct research on novel approaches to emergency department based smoking cessation.
- Identify funds to encourage emergency department-based research and demonstration projects on smoking cessation.
Kenreigh and Wagner said that while pharmacists could be useful in educating patients about smoking cessation products, the costs of the aids would likely be a concern for patients without healthcare coverage and studies on how to make smoking cessation aids affordable should be included in the research agenda.
Smoking cessation is a timely topic and efforts to curb tobacco use are widely discussed in the medical literature. MLC Solutions principals Charlotte Kenreigh, Pharm.D., and Linda Timm Wagner, Pharm.D., wrote in a Viewpoint column at the Medscape pharmacist web page that emergency department smoking interventions could make use of pharmacists by calling on them to help educate patients about available smoking cessation products.Subscribe Now for Access
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