Background

1. An Emergency Department Intervention For Tobacco Cessation Among Patients and Visitors Utilizing Pre-Health Professional Students As Research Associates Keith Bradley, MD*; Frank Illuzzi, MD, FACEP;** Ryan Trowbridge, BA*; Ryan Byun, BS*; Roberto Castillo, MS, MS 2*; Katherine Lee., MS, MPH, MS 1* *Research Associates Program **Department of Emergency Medicine, St. Vincent’s Medical Center, Bridgeport, CT Research Associates Program Discern, Qualify, and Develop for the health professions through clinical research in the Emergency Department Background Methods Results Context There is potential for public health interventions for patients and visitors in the emergency department. Clinical ED personnel focused on care of the patient’s emergency problem cannot be expected to provide such additional services. However, pre-health professional students looking for clinical experience may offer a willing work force who could accomplish this value-added activity to an ED visit. Research Associates (RAs) are college students and post-bacs considering a career in the health professions. They volunteer a minimum of one 4-hour shift per week during each of the three academic semesters. They are trained over a two-day, sixteen hour orientation on the basics of clinical research, ethical issues such as confidentiality and informed consent, HIPAA and OSHA standards, and the details of the particular studies and service to be provided in that semester. They identify and enroll study subjects in studies and provide service based on the results of prior completed studies. The RA Program began at Lincoln Medical and Mental Health Center, South Bronx, NY, and now works with the Department of Emergency Medicine at St. Vincent’s Medical Center in Bridgeport, CT. RAs in the Program are recruited from local colleges during the school year and nationally for the summer semester. RAs have enrolled ≈ 25K subjects in various clinical research, of which > 10K have been in studies on cancer-related screening referrals from the ED at St. Vincent’s. Study Objectives:Using pre-health professional students as Research Associates (RAs), 1. To assess tobacco use among adult non-emergent ED patients and visitors To determine rate of referrals to a telephone-based tobacco cessation service Design: Prospective, observation and intervention, convenience sample. Setting: Urban, community teaching hospital ED with an inner-city and suburban catchment area. Type of participants: Non-emergent patients and their visitors Protocol: RAs approached as many non-emergent patients and their visitors 18 years of age or older as possible. After obtaining informed consent, they used a scripted format to get demographic information and a detailed tobacco history. If a subject used tobacco products for > 30 days at any time in their lives, the RA offered them a referral to the Connecticut Quitline, a free service provided by the CT Department of Public Health. Those who indicated an interest in stopping tobacco use or to have help maintaining their tobacco cessation had a referral request and contact information sent to Free and Clear, Inc., the agency responsible for implementing Connecticut Quitline’s treatment program. Free and Clear, Inc. provides a validated, free, telephone-based tobacco cessation program, funded by monies from the tobacco companies’ settlement. • Over 21 weeks during the spring and summer semesters of 2008, 63 RAs approached 4613 potential subjects. 893 (19%) refused enrollment. • RAs successfully enrolled 3125 (67%) to study completion, 53% patients and 47% visitors. • Among our subjects, 1682 (54%) used tobacco for > one month at some time in their lives; 1615 (96%) used cigarettes. • The average age of those using tobacco products was 17 years (range 5 – 54) when they started smoking, and the average duration of tobacco use was 22 years (range < 1 - 76). 681 (22%) subjects had used tobacco within the last 30 days. • Of those subjects who used tobacco for > one month in their lives, 299 (18%) accepted a CT Quitline referral. For those who used tobacco within the last 30 days, 261 (38%) were referred. • Over the duration of the study, the 299 referrals represented > 40% of all referrals received by the Quitline from the entire state of CT. (O. Kordahi; Free and Clear, Inc.; oral communication; April 2009.) • Three numbers demonstrate the potential: • > 50% • More than half the U.S. population go to EDs as a patient or visitor each year 1 • 3.3 hours • Duration of average ED visit 2 • > 500 K • Estimate of “pre-meds” each year • If service like “RA” was a prerequisite for medical school application, • → 60 million “free” hrs/yr for the public health • In addition to their work on active studies, RAs now also incorporate tobacco cessation along with screenings from previous studies such as Pap tests, mammograms, PSA and digital rectal exams as service to subjects and other ED patients and visitors • Always more “pre-meds” in the pipeline • = sustainability. • Cost = time, letters of evaluation, zero$ • Conclusion • Among ED patients and visitors, RAs identified tobacco users and arranged referrals to a free tobacco cessation service for a large number of them. This study demonstrates the potential for a substantial public health intervention in the emergency department setting with minimal impact on clinical and financial resources. References Nawar, EW, Niska, RW, Xu, J. National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Adv Data. 2007 Jun 29;(386):1. http://www.cdc.gov/nchs/data/ad/ad386.pdf. Accessed September 23, 2009. Ibid. Watch “ER” on TV and guess what it’s like; be a Research Associate in the Emergency Department and know the reality. www.RAProgram.org Printed by