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Evaluation of Organizational Changes to Promote Smoking Cessation within
This evaluation grant examined the effects of comparative feedback on providers’ referral rates to a managed care organization’s tobacco cessation quitline. Eighty-seven practices and 308 providers within the Blue Cross Blue Shield of Michigan managed care system participated in the study. Baseline and follow-up data was gathered via patient exit interviews and provider surveys regarding referral rates and the delivery of the 5 A’s. Numbers of fax and phone referrals were tabulated by the quitline. Providers in the intervention arm received comparative feedback on their quarterly referrals to the quitline. In addition to receiving their referral rates, they received data on the average for their practice and the average for all practices. An achievable benchmark, based upon the top 10% of practices was also included to motivate providers to refer patients to the quitline. The control arm received general feedback in the form of quarterly reminders of the availability of quitline services. Practices also received a packet of information and tools from the managed care organization, including an audiotape continuing education program, fax referral forms, patient education materials, and other tools for the practice. Referral data was collected by the quitline. The intervention arm made significantly more fax referrals than the control arm during the study. Both groups made similar numbers of phone referrals (e.g., patients called the quitline on their own after receiving a brochure or card from the provider). Patients were more likely to enroll in quitline services by phone referral compared to fax referral. Phone enrollees were also more likely to set a quit date within 14 days than those referred by fax. However, providers in the intervention arm had more referrals overall and therefore had more estimated quits than providers in the control arm. According to patient exit surveys completed at baseline and after 30 months of intervention, providers in the intervention group had a significant increase in rates of asking about the smoking status of their patients compared to providers in the control group. Comparative feedback can enhance provider delivery of the 5 A’s. Feedback may also enhance the quit response of patients. A second study was conducted to determine if health care members who were receiving pharmacotherapy increased their participation in smoking quit-line services after receiving either proactive calls or postcards. Health plan members filing pharmacotherapy claims were identified weekly from health plan pharmacy claims data and randomized to one of three conditions: control, recruitment postcard, or recruitment telephone call by a nurse quit-line counselor. Enrollment of study members to the quit-line program was tracked for one month post-randomization. Over a five month time period, 625 total individuals were identified for participation in the study with the following enrollment to the program respectively: 0% control; 1% postcard; 21% telephone call (p<.0001). Although costs for the telephone intervention were most expensive, it was also the most cost-effective, given its success in enrolling members to the program. We conclude that proactive telephone calling by smoking cessation nurse counselors to smokers using pharmacotherapy may be an effective method of enrolling smokers into a cessation quit-line. Health plans should consider proactive telephone recruitment to improve utilization of quit-line services. Citations: Holtrop JS, Wadland WC, Vansen S, Weismantel D, Fadel H. Recruiting health plan members receiving pharmacotherapy into smoking cessation counseling. American Journal of Managed Care. 2005;11(8):501-507. Summers-Holtrop J, Wadland WC, Vansen S, Weismantel D, Fadel H. Recruiting Health Plan Members Receiving Pharmacotherapy Into Smoking Cessation Counseling. American Journal of Managed Care. 2005; 11:501-507. For more information, contact: William C. Wadland, MD, MS |
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