The Role of Health Plans in Tobacco Control

Manley, Marc W.; Griffin, Tom; Foldes, Steven S.; Link, Carolyn; Sechrist, Rebecca A.J.

doi:10.1146/annurev.publhealth.24.100901.140838

Cited by 19 publications

(15 citation statements)

References 56 publications

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“…With regard to insurance coverage, only 20% of employers include coverage of smoking cessation treatments in their primary plans, which tend not to be health maintenance organizations (7, 24). Manley et al's review challenges health plans to become more actively involved in tobacco control at both the clinical and community levels and proposes the 5Cs model (covering, counseling, capitalizing, collaborating, and counting) to facilitate their involvement (67).…”

Section: From Research To Practicementioning

confidence: 99%

“…Health care delivery systems are a critical component of tobacco cessation efforts (67). An estimated 70% of the 45 million adult smokers in the United States see a health care provider each year, representing over 31 million opportunities for brief intervention and treatment (25).…”

Section: Introductionmentioning

confidence: 99%

“…This review has two primary aims. The first is to review the current evidence base for the role of health care system supports in increasing tobacco cessation, with a particular emphasis on studies published since Manley et al's review on the role of health plans in tobacco control (67). The review draws on primary research, on published meta-analyses (e.g., Cochrane Collaboration reviews), and on recent reviews and syntheses of this literature (24,34,51).…”

Section: Introductionmentioning

confidence: 99%

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The Role of Health Care Systems in Increased Tobacco Cessation

Curry

Keller

Orleans

et al. 2008

Annu. Rev. Public Health

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Section: From Research To Practicementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Role of Health Care Systems in Increased Tobacco Cessation

Curry

Keller

Orleans

et al. 2008

Annu. Rev. Public Health

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“…A survey in 2000 showed that 43% of health plans required clinicians to record smoking status as part of patients' vital signs (blood pressure, temperature, and pulse rate). 10 Scientifi c evidence to support this recommendation was limited. The DHHS guideline based its recommendation on 3 studies [11][12][13] reporting increased counseling at practices that adopted the vital sign intervention, but these studies relied on before-and-after designs, were subject to confounding and limited generalizability, or both.…”

Section: Introductionmentioning

confidence: 99%

Effect on Cessation Counseling of Documenting Smoking Status as a Routine Vital Sign: An ACORN Study

Rothemich¹,

Woolf²,

Johnson³

et al. 2008

The Annals of Family Medicine

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PURPOSE Guidelines encourage primary care clinicians to document smoking status when obtaining patients' blood pressure, temperature, and pulse rate (vital signs), but whether this practice promotes cessation counseling is unclear. We examined whether the vital sign intervention infl uences patient-reported frequency and intensity of tobacco cessation counseling. METHODSThis study was a cluster-randomized, controlled trial conducted in the Virginia Ambulatory Care Outcomes Research Network (ACORN). At intervention practices, nurses and medical assistants were instructed to assess the tobacco use status of every adult patient and record it with the traditional vital signs. Control practices did not use any systematic tobacco screening or identifi cation system. Outcomes were the proportion of smokers reporting clinician counseling of any kind and the frequency of 2 counseling subcomponents: simple quit advice and more intensive discussion.RESULTS A total of 6,729 adult patients (1,149 smokers) at 18 primary care practices completed exit questionnaires during a 6-month comparison period. Among 561 smokers at intervention practices, 61.9% reported receiving any counseling, compared with 53.4% of the 588 smokers at control practices, for a difference of 8.6% (P = .04). The effect was largely restricted to simple advice, which was reported by 59.9% of intervention patients and 51.5% of control patients (P = .04). There was no signifi cant increase in more extensive discussion, with 32.5% and 29.3% of patients at intervention and control practices, respectively, reporting this type of counseling (P = .18). CONCLUSIONSThe vital sign intervention promotes tobacco counseling at primary care practices through a modest increase in simple advice to quit. When implemented as a stand-alone intervention, it does not appear to increase intensive counseling.

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“…Writing in the Annual Review of Public Health, Manley et al (2003) recently reviewed the issues and evidence pertaining to the multiple potential roles of MCOs in tobacco control, including provision of covered cessation services. Complementing that academic review is a practiceoriented review written for professionals within MCOs who may have interest in adding a smoking cessation benefit.…”

Section: Previous Researchmentioning

confidence: 99%

The Financial Implications of Coverage of Smoking Cessation Treatment by Managed Care Organizations

Warner

Méndez²,

Smith

2004

INQUIRY

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This paper presents results from a simulation of the financial impact and cost effectiveness of smoking cessation in a hypothetical managed care organization (MCO), using data from three large managed care organizations and from existing literature. With base-case assumptions and a market cost of capital, at five years, coverage of cessation services costs an MCO dollars .61 per member per month (PMPM). In a steady-state situation, net cost is dollars .41 PMPM. Both values include altered medical expenditures and MCO revenue patterns attributable to coverage-induced cessation. Quitters gain an average of 7.1 years of life, with a direct coverage cost of dollars 3,417 for each life-year saved. Coverage of cost-effective programs by MCOs should be strongly encouraged.

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The Role of Health Plans in Tobacco Control

Cited by 19 publications

References 56 publications

The Role of Health Care Systems in Increased Tobacco Cessation

The Role of Health Care Systems in Increased Tobacco Cessation

Effect on Cessation Counseling of Documenting Smoking Status as a Routine Vital Sign: An ACORN Study

The Financial Implications of Coverage of Smoking Cessation Treatment by Managed Care Organizations

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