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This planning project was a prospective
pilot study that tested the feasibility of covering nicotine
replacement therapy and reimbursing pharmacists for smoking
cessation counseling they delivered when the prescription
was filled. Two federally funded community health centers
and two community pharmacies participated in the study. The
study population consisted of low-income, managed Medicaid
and Basic Health Plan (a state insurance program) enrollees
who received care at these health centers. Outcome measures
were the proportion of eligible patients who used the new
benefit, patient satisfaction with the intervention, and pharmacist
satisfaction with the intervention.
During the nine-month intervention, 32 patients
were referred for nicotine replacement therapy and counseling,
representing approximately 5% of eligible smokers. Of these,
26 filled the prescription and received counseling at least
once. Patients who completed a follow-up survey reported a
high level of satisfaction with the service. Pharmacists reported,
via telephone follow-up, that they would continue providing
counseling if counseling sessions lasted no longer than 5-10
minutes and if reimbursement was adequate. Further research
is needed to ascertain the feasibility of pharmacist-delivered
cessation counseling.
One challenge noted in the study was rapid
turnover among this population of managed Medicaid and Basic
Health Plan enrollees - 12 (38%) of the smokers referred for
nicotine replacement therapy and counseling were no longer
insured by the Community Health Plan of Washington at the
end of the intervention period. This could prove to be a disincentive
for a single plan to offer cessation coverage and may warrant
a broader policy level intervention to foster tobacco dependence
treatment (e.g. a policy mandate from the state stating that
all insurers who provide coverage for Medicaid enrollees shall
offer the same cessation benefit to enrollees).
Citations:
Doescher MP, Whinston MA, Goo A, Cummings D, Huntington J,
Saver BG. Pilot study of enhanced tobacco-cessation services
coverage for low-income smokers. Nicotine Tob Res 2002 Feb;4
Suppl 1:19-24.
For more information, contact:
Mark Doescher, MD, MSPH
Department of Family Medicine
University of Washington School of Medicine
4225 Roosevelt Way NE, Suite 308
Seattle, WA 98105-6099
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