The association of smoking with medical treatment adherence in the workforce of a large employer.
OBJECTIVE
Prior descriptive epidemiology studies have shown that smokers have lower compliance rates with preventive care services and lower chronic medication adherence rates for preventive care services in separate studies. The goal of this study was to perform a more detailed analysis to validate both of these findings for current smokers versus nonsmokers within the benefit-covered population of a large US employer.


METHODS
This study involved the analysis of incurred medical and pharmacy claims for employee and spouse health plan enrollees of a single US-based employer during 2010. Multivariate regression models were used to compare data by active or never-smoker status for preventive care services and medication adherence for chronic conditions. Analysis controlled for demographic variables, chronic condition prevalence, and depression.


RESULTS
Controlling for demographic variables and comorbid conditions, smokers had significantly lower cancer screening rates, with absolute reductions of 6%-13%. Adherence to chronic medication use for hypertension was also significantly lower among smokers, with nearly 7% fewer smokers having a medication possession ratio of ≥80%. Smokers were less adherent to depression medications (relative risk =0.79) than nonsmokers (P=0.10). While not statistically significant, smokers were consistently less adherent to all other medications than nonsmokers.


CONCLUSIONS
Current smokers are less compliant with recommended preventive care and medication use than nonsmokers, likely contributing to smoking-related employer costs. Awareness of these care gaps among smokers and direct management should be considered as part of a comprehensive population health-management strategy.
Employers Health Coalition, Inc., Canton, OH, USA ; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA ; Sherman Consulting Services, LLC, Burlington, MA, USA.
Bruce W
BW
Sherman
Lynch Consulting, Ltd, Steamboat Springs, CO, USA ; Altarum Institute, Ann Arbor, MI, USA.
Wendy D
WD
Lynch
chronic condition management; disease management; employer health benefits; health care utilization and costs; tobacco