Enlisting Tobacco Users to Prompt their Physicians to Follow Tobacco Use and Dependence Guidelines

The goals of this study were to first identify potential incentives that would encourage adult tobacco users enrolled in a managed care organization (MCO) to initiate tobacco use discussions with their primary care providers (PCP) and then to evaluate the impact of patient self-identification in intervention quality and frequency as well as its impact on patients’ cessation attempts and successes. 

The study was divided into two parts. Investigators first conducted a focus group with three smokers enrolled in QualChoice of North Carolina. The focus group indicated that patients expect to be asked about smoking by their PCP and feel that their PCP knows their smoking status; they do not object to tobacco-related discussions with their PCP provided the PCP does not lecture them; they are indifferent to giving a tobacco-use identifier to their PCP; they thought a monetary incentive might mitigate this indifference; and they were concerned that they would forget to bring the stickers to their appointment.

Investigators then enrolled 60 adult tobacco users from one non-academic care practice and randomly assigned subjects into one of three groups: Group A, the control, received a letter from their MCO and PCP encouraging them to discuss tobacco use at their next visit; Group B received the letter along with tobacco use stickers to bring to their next visit; and Group C received the letter, the stickers and a $10 incentive to bring them to their next visit. Medical chart reviews indicated that Groups B and C were more likely than the controls to engage in a tobacco-use discussion with their PCP; they were also more likely to receive quit advice and a quit prescription. Endpoint patient surveys supported these findings.

Although this study was limited by small sample size and short duration, preliminary evidence indicates that MCO patients can be motivated to actively request tobacco dependence treatment during visits to their PCP.

For more information, contact:

Stuart J. Cohen, EdD
Canyon Ranch Endowed Chair
Professor of Public Health and Medicine
Associate Dean for Research
Mel & Enid Zuckerman College of Public Health
University of Arizona
P.O. Box 245163
Tucson, AZ 85724-5163

| Home | Meetings | Researcher Tools | Provider Tools | Research Findings | Literature Review | Links |

Page Updated: August 13, 2008

Center for Tobacco Research and Intervention 
University of Wisconsin School of Medicine and Public Health
1930 Monroe St., Suite 200
Madison, WI 53711-2027

Commonly Used Acronyms
Robert Wood Johnson Foundation (RWJF)
Addressing Tobacco in Healthcare (ATHC)
Addressing Tobacco in Managed Care (ATMC)