Leveling the Playing Field: Mailing Pharmacotherapy to Medicaid Members who Smoke.
Thursday, November 17, 2022
Posted by: Natalia Gromov
McQueen A, Wartts JG, Garg
R, Carpenter KM, Kreuter MW.
Leveling the Playing
Field: Mailing Pharmacotherapy to Medicaid Members who Smoke.
[published online ahead of print, 2022 Nov 2]. Am J Prev Med.
2022;S0749-3797(22)00465-2. doi:10.1016/j.amepre.2022.09.008
Introduction. Smoking
rates differ by insurance type; rates are often double for Medicaid and
uninsured compared with that for Medicare or privately insured. State-funded
tobacco quitlines' provision of free nicotine replacement therapy varies. In
some states, Medicaid beneficiaries must obtain nicotine replacement therapy
from a physician, whereas others get nicotine replacement therapy mailed to
them.
Methods. This
secondary analysis examined the differences in the source and use of cessation
treatment by insurance type and their impacts on cessation. The parent trial
excluded people who were pregnant, had private insurance, or were not ready to
quit. From June 1, 2017 to November 15, 2020, a total of 1,944 low-income
people who smoke daily completed a baseline survey and were enrolled in a
quitline program; 1,380 (71%) completed a 3-month follow-up. Analyses were
completed in August 2022. Participants were classified as Medicaid/dual (55%),
Medicare/Veterans Affairs (14%), or uninsured (31%). Nine months into the
trial, owing to a system error, the quitline provided nicotine replacement
therapy to all study participants regardless of insurance type.
Results. Before
error versus after error, Medicaid participants reported lower nicotine
replacement therapy receipt (3.2% vs 50.8%) and use (32.4% vs 52.6%). The odds
of quitting (7-day point prevalence) by 3 months increased for people who smoke
who completed more quitline calls and used any (36% quit) versus used no (20%
quit) pharmacotherapy, but quitting did not differ by insurance classifications
(27%-29%). Getting and using nicotine replacement therapy from the quitline
produced the highest quit rates (38%).
Conclusions. Results
illustrate the benefit of receiving nicotine replacement therapy from the
quitline on cessation. Mailing nicotine replacement therapy to all people who
smoke should be standard practice to reduce smoking disparities.
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