title: The effectiveness of covering smoking cessation services for medicare beneficiaries.
abstract: OBJECTIVE
  To examine whether reimbursement for Provider Counseling, Pharmacotherapies, and a telephone Quitline increase smoking cessation relative to Usual Care.
  
  
  METHODS
  Randomized comparison trial testing the effectiveness of four smoking cessation benefits.
  
  
  METHODS
  Seven states that best represented the national population in terms of the proportion of those > or = 65 years of age and smoking rate.
  
  
  METHODS
  There were 7,354 seniors voluntarily enrolled in the Medicare Stop Smoking Program and they were followed-up for 12 months.
  
  
  METHODS
  (1) Usual Care, (2) reimbursement for Provider Counseling, (3) reimbursement for Provider Counseling with Pharmacotherapy, and (4) telephone counseling Quitline with nicotine patch.
  
  
  METHODS
  Seven-day self-reported cessation at 6- and 12-month follow-ups.
  
  
  RESULTS
  Unadjusted quit rates assuming missing data=smoking were 10.2 percent (9.0-11.5), 14.1 percent (11.7-16.5), 15.8 percent (14.4-17.2), and 19.3 percent (17.4-21.2) at 12 months for the Usual Care, Provider Counseling, Provider Counseling + Pharmacotherapy, and Quitline arms, respectively. Results were robust to sociodemographics, smoking history, motivation, health status, and survey nonresponse. The additional cost per quitter (relative to Usual Care) ranged from several hundred dollars to $6,450.
  
  
  CONCLUSIONS
  A telephone Quitline in conjunction with low-cost Pharmacotherapy was the most effective means of reducing smoking in the elderly.
authors.affiliation: RAND, 1776 Main Street, Santa Monica, CA 90407-2138, USA. gjoyce@rand.org
authors.forename: Geoffrey F
authors.initials: GF
authors.lastname: Joyce
authors.forename: Raymond
authors.initials: R
authors.lastname: Niaura
authors.forename: Margaret
authors.initials: M
authors.lastname: Maglione
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mongoven
authors.forename: Carrie
authors.initials: C
authors.lastname: Larson-Rotter
authors.forename: James
authors.initials: J
authors.lastname: Coan
authors.forename: Pauline
authors.initials: P
authors.lastname: Lapin
authors.forename: Sally
authors.initials: S
authors.lastname: Morton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003376:Counseling; D004358:Drug Therapy; D005260:Female; D019538:Health Care Surveys; D006296:Health Services; D006801:Humans; D019458:Insurance Coverage; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D015397:Program Evaluation; D016540:Smoking Cessation / Q000379:methods*; D014481:United States
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