Provider-Delivered Tobacco Dependence Treatment to Medicaid Smokers.
Wednesday, February 12, 2014
Posted by: Natalia Gromov
Tob Res. 2014 Jan 28. [Epub ahead of print]
Tobacco Dependence Treatment to Medicaid Smokers.
Ferketich AK, Pennell M,
Seiber EE, Wang L, Farietta T, Jin Y, Wewers ME
The smoking prevalence is 49% among Medicaid enrollees in Ohio. The objective
of this pilot project was to test a comprehensive tobacco dependence treatment
program targeting rural Medicaid-enrolled smokers for both physician-level and
smoker-level outcomes. METHODS: Using a group-randomized trial design,
intervention group physicians (n = 4) were exposed to systems-level changes in
their clinics and smokers in these clinics were offered 12 weeks of telephone
cessation counseling. Control group physicians (n = 4) were given the
clinician's version of the USPHS Clinical Practice Guideline and smokers in
these clinics were given information about the Ohio Tobacco Quitline.
Physician-level and smoker-level outcomes were assessed at 1 week and 3 months,
respectively. Costs per quit were estimated. RESULTS: A total of 214 Medicaid
smokers were enrolled. At 1 week, there were no reported differences in rates
of being asked about tobacco use (68% intervention, 58% control) or advised to
quit (69% intervention, 63% control). However, 30% of intervention and 56% of
control smokers reported receiving a prescription for pharmacotherapy (p <
.01). At 3 months, there were no differences in quit attempts (58%
intervention, 64% control), use of pharmacotherapy (34% intervention, 46%
control), or abstinence (24% intervention, 16% control for self-reported
abstinence; 11% intervention, 3.5% control for cotinine-confirmed abstinence).
The intervention group proved more cost effective at achieving confirmed quits
($6,800 vs. $9,700). CONCLUSIONS: We found few differences in outcomes between
physicians exposed to a brief intervention and physicians who were intensively
trained. Future studies should examine how tobacco dependence treatment can be
further expanded in Medicaid programs.