Provider-delivered tobacco dependence treatment to Medicaid smokers.
BACKGROUND
Smoking prevalence is 49% among Medicaid enrollees in Ohio. The objective of this pilot project was to test a comprehensive tobacco dependence treatment program targeting rural Medicaid-enrolled smokers for both physician-level and smoker-level outcomes.


METHODS
Using a group-randomized trial design, intervention group physicians (n = 4) were exposed to systems-level changes in their clinics, and smokers in these clinics were offered 12 weeks of telephone cessation counseling. Control group physicians (n = 4) were given the clinician's version of the U.S. Public Health Serivce (USPHS) Clinical Practice Guideline, and smokers in these clinics were given information about the Ohio Tobacco Quitline. Physician-level and smoker-level outcomes were assessed at 1 week and 3 months, respectively. Costs per quit were estimated.


RESULTS
A total of 214 Medicaid smokers were enrolled. At 1 week, there were no reported differences in rates of being asked about tobacco use (68% intervention, 58% control) or advised to quit (69% intervention, 63% control). However, 30% of intervention and 56% of control smokers reported receiving a prescription for pharmacotherapy (p < .01). At 3 months, there were no differences in quit attempts (58% intervention, 64% control), use of pharmacotherapy (34% intervention, 46% control), or abstinence (24% intervention, 16% control for self-reported abstinence; 11% intervention, 3.5% control for cotinine-confirmed abstinence). The intervention group proved more cost-effective at achieving confirmed quits ($6,800 vs. $9,700).


CONCLUSIONS
We found few differences in outcomes between physicians exposed to a brief intervention and physicians who were intensively trained. Future studies should examine how tobacco dependence treatment can be further expanded in Medicaid programs.
Division of Epidemiology, Ohio State University College of Public Health, Columbus, OH;
Amy K
AK
Ferketich
Michael
M
Pennell
Eric E
EE
Seiber
Ling
L
Wang
Thalia
T
Farietta
Yue
Y
Jin
Mary Ellen
ME
Wewers
D000328:Adult; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009820:Ohio; D058007:Physicians, Primary Care; D010865:Pilot Projects; D012424:Rural Population; D016540:Smoking Cessation / Q000191:economics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013689:Telephone; D014029:Tobacco Use Disorder / Q000191:economics / Q000628:therapy*; D014481:United States