title: Focusing on the five A's: a comparison of homeless and housed patients' access to and use of pharmacist-provided smoking cessation treatment.
abstract: BACKGROUND
  The prevalence of smoking remains high among the medically underserved and could be related to disparities in access to and use of smoking cessation treatments.
  
  
  METHODS
  This study implemented and tracked providers' use of the 5 A's intervention for tobacco use (Ask, Assess, Advise, Assist, Arrange) with homeless (n = 260) and housed (n = 226) adults attending a free medical clinic, including referrals to and use of an on-site pharmacist-led smoking cessation service.
  
  
  RESULTS
  Among patients whose tobacco use was Asked about and Assessed (97%), homeless (vs. housed) patients were more likely to smoke (59% vs. 39%; P = 0.008). Among current smokers, there were no homeless-housed disparities in receipt of Advice to quit smoking (84% vs. 78%; P = 0.22) or Arrangement of treatment (36% vs. 31%; P = 0.46). Overall, among patients for whom treatment was Arranged, homeless patients were less likely than housed patients to attend the smoking cessation program (25% vs. 48%; P = 0.04). However, among those that attended any treatment (i.e., were Assisted to quit), homeless and housed patients attended similar numbers of sessions and used pharmacotherapy at similar rates.
  
  
  CONCLUSIONS
  Providers may reduce homeless-housed disparities in smoking by offering special Assist(ance) to homeless smokers that reduces barriers to initially accessing treatment services.
authors.affiliation: Department of Pharmacy and Therapeutics, University of Pittsburgh, USA. Electronic address: sconnor@pitt.edu.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Connor
authors.affiliation: Department of Psychiatry, University of Pittsburgh, USA; RAND Corporation, Pittsburgh, PA, USA.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Scharf
authors.affiliation: Department of Pharmacy and Therapeutics, University of Pittsburgh, USA.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Jonkman
authors.affiliation: Division of General Internal Medicine, UPMC Montefiore Hospital, USA.
authors.forename: Mary I
authors.initials: MI
authors.lastname: Herbert
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D005260:Female; D006297:Health Services Accessibility; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010595:Pharmacists; D016540:Smoking Cessation
keywords: Free clinic; Homeless; Medically underserved; Pharmacist services; Smoking cessation