Pilot study of enhanced tobacco-cessation services coverage for low-income smokers

Abstract

This study explored the feasibility of covering nicotine replacement therapy (NRT) and paying for pharmacist-delivered smoking cessation counseling at the time of NRT pick-up for low-income, managed Medicaid and Basic Health Plan (a state insurance program) enrollees. A prospective pilot intervention was used at two community health centers (CHCs) and two community pharmacies. Participants were adult managed-Medicaid or Basic Health Plan enrollees who attended the pilot CHCs and smoked. An innovative insurance benefit that included coverage for NRT and $15 payment to the pharmacist to deliver cessation counseling with each prescription fill. Proportion of eligible patients who used the cessation benefit and patient and pharmacist satisfaction with the intervention. During the 9-month intervention, 32 patients at the pilot clinics were referred for NRT and pharmacist-delivered counseling. This number represented roughly 5% of eligible smokers. Of these, 26 received NRT with concomitant pharmacist-delivered cessation counseling at least once. Recipients reported a high level of satisfaction with this intervention. Pharmacists indicated they would continue providing counseling if reimbursement remained adequate and if counseling lasted no longer than 5-10 min. However, 12 (38%) who were referred were no longer insured by the sponsoring plan by the end of the 9-month pilot period. Pharmacist-delivered cessation counseling may be feasible and merits further study. More importantly, this pilot reveals two key obstacles in our low-income, culturally diverse setting: low participation and rapid turnover of insureds. Future interventions will need to address these barriers.

Improving clinic- and neighborhood-based smoking cessation services within federally qualified health centers serving low-income, minority neighborhoods

“…System approaches to improving smoking cessation services in clinical settings have included (a) training of physicians (Cornuz et al, 1997;Richmond, Mendelsohn, & Kehoe, 1998;Swartz, Cowan, DePue, & Goldstein, 2002), (b) including smoking status as a vital sign (Fiore et al, 1995;Robinson, Laurent, & Little, 1995), (c) staff training and educational materials (Lancaster, Silagy, & Fowler, 2004;Pine, Sullivan, Sauser, & David, 1997;Solberg, Maxwell, Kottke, Gepner, & Brekke, 1990), (d) assignment of smoking cessation interventions to job descriptions of professionals other than physicians or to teams (Hollis et al, 2000;Hollis, Lichtenstein, Vogt, Stevens, & Biglan, 1993), (e) chart reminders used alone (Chang, Zimmerman, & Beck, 1995) or with other strategies such as free nicotine replacement (Cohen et al, 1987), and (f) reduced or reimbursed costs for smoking cessation services Curry, Grothaus, McAfee, & Pabiniak, 1998;Doescher et al, 2002;. A multicomponent approach that included prioritization of prevention objectives, quality management techniques, and attention to influences on service delivery at the practice, organizational, and community levels was effective (Thompson et al, 1995).…”

Tobacco Interventions Delivered by Pharmacists: A Summary and Systematic Review

“…For heavy smokers (≥ 20 cigarettes/day), it was 11% for the treatment group and 4% for the placebo group (p<0.05). At 6 months in 35 To assess effectiveness of a smoking-15 pharmacists from 7 chain 48 smokers, self-referred or cessation program in chain pharmacies 36 pharmacies in Richmond, Virginia referred by primary care provider…”

“…In a second U.S. study, 32 self-referred patients participated in a pharmacist-delivered smokingcessation program at two community health centers and two community pharmacies. 35 This 36 1 C A S R 8 (4/50) 37 Same 12 TOI PP SR 41.5 (54/130) 38 36. 39 17.2 (34/198) 6 wks CA SR ITT = intent-to-treat; CA = continuous abstinence; CO = exhaled carbon monoxide test; PP = point prevalence; TOI = time-of-interview; SR = self-report.…”

An evaluation of a rural community pharmacy-based smoking-cessation counselling and nicotine replacement therapy initiative

“…One controlled trial was identified and evaluated NRT and counselling in a pharmacy-based smoking-cessation programme in Glasgow (Dickson 2000). 24 Four cohort studies were identified: in Sydney Australia (Carroll 2000), 25 Washington DC (Doescher 2001), 26 Virginia USA (Kennedy 2002, 27 and Iowa USA (Zillich 2002). 28 A summary of the methods used to evaluate the studies is shown in Table 4.…”