Relationship Between Tobacco Control Policies and the Delivery of Smoking Cessation Services in Nonprofit HMOs

Kaiser Permanente Center for Health Research Northwest, 3800 N. Interstate Ave., Portland, OR 97227, USA.
JNCI Monographs 02/2005; 2005(35):75-80. DOI: 10.1093/jncimonographs/lgi042
Source: PubMed


This project examined tobacco policies and delivery of cessation services in nonprofit HMOs that collectively provide comprehensive medical care to more than 8 million members.
Three annual surveys with health plan managers showed that all of these health plans had written tobacco control guidelines that became more comprehensive over the span of this study. We also surveyed a random sample of 4207 current smokers who had attended a primary care visit in the past year (399-528 at each of nine health plans).
Of these smokers, 71% reported advice to quit, 56% were asked about their willingness to quit, 49% were provided some assistance in quitting (mostly self-help material or information about classes or counseling), and 9% were offered some kind of follow-up. Smokers receiving assistance in quitting reported higher satisfaction with their care.
In general, health plans with the most comprehensive policies also showed higher rates of implementing tobacco treatment programs in primary care. Compared with tobacco control efforts of a decade or more ago, considerable progress has been made. However, there is still room for improvement in the proportion of smokers who receive the most effective forms of assistance in quitting.

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Available from: Jane Zapka, Oct 12, 2015
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    • "As quitlines and websites have proliferated, "Refer," as part of the Assist agenda, has been increasingly emphasized [25]. In practice, rates of referral to cessation resources have been measured to be as high as 28% at the VA [26] and 37% in managed care [27] and as low as 10% in community-based practices [28]. Providers do refer some patients to quitlines. "
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    ABSTRACT: Although screening for tobacco use is increasing with electronic health records and standard protocols, other tobacco-control activities, such as referral of patients to cessation resources, is quite low. In the QUIT-PRIMO study, an online referral portal will allow providers to enter smokers' email addresses into the system. Upon returning home, the smokers will receive automated emails providing education about tobacco cessation and encouragement to use the patient smoking cessation website (with interactive tools, educational resources, motivational email messages, secure messaging with a tobacco treatment specialist, and online support group). The informatics system will be evaluated in a comparative effectiveness trial of 160 community-based primary care practices, cluster-randomized at the practice level. In the QUIT-PRIMO intervention, patients will be provided a paper information-prescription referral and then "e-referred" to the system. In the comparison group, patients will receive only the paper-based information-prescription referral with the website address. Once patients go to the website, they are subsequently randomized within practices to either a standard patient smoking cessation website or an augmented version with access to a tobacco treatment specialist online, motivational emails, and an online support group. We will compare intervention and control practice participation (referral rates) and patient participation (proportion referred who go to the website). We will then compare the effectiveness of the standard and augmented patient websites. Our goal is to evaluate an integrated informatics solution to increase access to web-delivered smoking cessation support. We will analyze the impact of this integrated system in terms of process (provider e-referral and patient login) and patient outcomes (six-month smoking cessation). Web-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628.
    Implementation Science 11/2010; 5(1):87. DOI:10.1186/1748-5908-5-87 · 4.12 Impact Factor
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    • "Despite these reasons why smokers may be reluctant to use smoking cessation services, a majority of primary care patients have said they would participate in cessation programs if offered the opportunity (Fiore et al. 2004b). Studies have shown that high proportions of smokers would like their physicians to address smoking often (Stevens et al. 2005) and would be interested in participating in a smoking cessation treatment program (especially when it is free) (Fiore et al. 2004b). Free coverage of cessation services—and informing smokers about the effectiveness of treatments and of the existence of their coverage—could go a long way toward improving acceptance of treatment (McMenamin, Halpin, and Bellows 2006). "
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    ABSTRACT: Counseling smokers to quit smoking and providing them with pharmaceutical cessation aides are among the most beneficial and cost-effective interventions that clinicians can offer patients. Yet assistance with quitting is not universally covered by health plans or offered by all clinicians. Analysis of stakeholders' perspectives and interests can identify the barriers to more widespread provision of cessation services and suggest strategies for the public policy agenda to advance smoking cessation. Review of literature and discussions with representatives of stakeholders. All stakeholders-health plans, employers, clinicians, smokers, and the government-face barriers to broader smoking cessation activities. These range from health plans' perceiving that covering counseling and pharmacotherapy will increase costs without producing commensurate health care savings, to clinicians' feeling unprepared and uncompensated for counseling. Like other preventive measures aimed at behavior, efforts directed at smoking cessation have marginal status among health care interventions. State governments can help correct this status by increasing Medicaid coverage of treatment and expanding coverage for state employees. The federal government can promote the adoption of six initiatives recommended by a government subcommittee on cessation: set up a national quit line, develop a media campaign to encourage cessation, include cessation benefits in all federally funded insurance plans, create a research infrastructure to improve cessation rates, develop a clinician training agenda, and create a fund to increase cessation activities through a new $2 per pack cigarette excise tax. Both the federal and state governments can increase cessation by adopting policies such as the higher cigarette tax and laws prohibiting smoking in workplaces and public places. Public policy efforts should assume greater social responsibility for smoking cessation, including more aggressive leadership at the state and federal levels, as well as through advocacy, public health, and clinician organizations.
    Milbank Quarterly 01/2009; 86(4):601-27. DOI:10.1111/j.1468-0009.2008.00536.x · 3.38 Impact Factor
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