Quit outcomes among clients ineligible for cessation medication through the state quitline: A retrospective, observational study

Adrienne B. Lent, Patrick A. O'Connor, Ryan C. Reikowsky, Uma S. Nair, Melanie L Bell

Research output: Contribution to journalArticle

Abstract

Background: Distribution of tobacco cessation medications through state quitlines increases service utilization and quit outcomes. However, some state quitlines have moved to models in which callers are instructed to obtain quit medications through their health insurance pharmaceutical benefit. We aimed to investigate the impact of this policy on medication access and quit outcomes in the state quitline setting for clients who must obtain covered medications through the state Medicaid program. We hypothesized that clients with Medicaid who were referred by their healthcare provider would be more likely to report using quit medication and have higher quit rates compared to clients with Medicaid who engaged the quitline on their own. Methods: An observational, retrospective study was conducted using state quitline clients with Medicaid health insurance who were ineligible for quitline provided cessation medications. Clients were stratified by referral type: self-referred, passively referred, and proactively referred. Unadjusted and adjusted logistic regression was used to estimate the effect of referral type on both quit status and cessation medication use. Results: Proactively referred clients were less likely to use quit medication (53.6%) compared to self (56.9%) and passively referred clients (61.1%). Proactively referred clients had lower quit rates (31.4%), as compared to passively referred (36.0%) and self-referred (35.1%). In adjusted models, proactively referred clients were significantly less likely to be quit than passively referred clients (OR = 0.75, 95% CI: 0.56, 0.99). There were no statistically significant differences in medication use or number of coaching sessions among proactive, passive, and self-referred clients in adjusted models. Conclusions: In adjusted models, medication use did not significantly differ by mode of entry in this population of Medicaid beneficiaries. Psychosocial factors such as intention to quit in the next 30 days, social support for quitting, education level, race, and ethnicity impacted quit status and differed by mode of entry. Quitlines should use tailored strategies to increase engagement and reduce barriers among proactively referred clients.

Original languageEnglish (US)
Article number1001
JournalBMC Public Health
Volume18
Issue number1
DOIs
StatePublished - Aug 10 2018

Fingerprint

Medicaid
Observational Studies
Retrospective Studies
Health Insurance
Referral and Consultation
Tobacco Use Cessation
Ego
Insurance Benefits
Social Support
Health Personnel
Logistic Models
Psychology
Education
Pharmaceutical Preparations
Population

Keywords

  • Cessation medication
  • Medicaid
  • Quitline
  • Smoking
  • Telephone counseling
  • Tobacco

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Quit outcomes among clients ineligible for cessation medication through the state quitline : A retrospective, observational study. / Lent, Adrienne B.; O'Connor, Patrick A.; Reikowsky, Ryan C.; Nair, Uma S.; Bell, Melanie L.

In: BMC Public Health, Vol. 18, No. 1, 1001, 10.08.2018.

Research output: Contribution to journalArticle

Lent, Adrienne B. ; O'Connor, Patrick A. ; Reikowsky, Ryan C. ; Nair, Uma S. ; Bell, Melanie L. / Quit outcomes among clients ineligible for cessation medication through the state quitline : A retrospective, observational study. In: BMC Public Health. 2018 ; Vol. 18, No. 1.
@article{e9008984289a4c859e02089a07d3eb65,
title = "Quit outcomes among clients ineligible for cessation medication through the state quitline: A retrospective, observational study",
abstract = "Background: Distribution of tobacco cessation medications through state quitlines increases service utilization and quit outcomes. However, some state quitlines have moved to models in which callers are instructed to obtain quit medications through their health insurance pharmaceutical benefit. We aimed to investigate the impact of this policy on medication access and quit outcomes in the state quitline setting for clients who must obtain covered medications through the state Medicaid program. We hypothesized that clients with Medicaid who were referred by their healthcare provider would be more likely to report using quit medication and have higher quit rates compared to clients with Medicaid who engaged the quitline on their own. Methods: An observational, retrospective study was conducted using state quitline clients with Medicaid health insurance who were ineligible for quitline provided cessation medications. Clients were stratified by referral type: self-referred, passively referred, and proactively referred. Unadjusted and adjusted logistic regression was used to estimate the effect of referral type on both quit status and cessation medication use. Results: Proactively referred clients were less likely to use quit medication (53.6{\%}) compared to self (56.9{\%}) and passively referred clients (61.1{\%}). Proactively referred clients had lower quit rates (31.4{\%}), as compared to passively referred (36.0{\%}) and self-referred (35.1{\%}). In adjusted models, proactively referred clients were significantly less likely to be quit than passively referred clients (OR = 0.75, 95{\%} CI: 0.56, 0.99). There were no statistically significant differences in medication use or number of coaching sessions among proactive, passive, and self-referred clients in adjusted models. Conclusions: In adjusted models, medication use did not significantly differ by mode of entry in this population of Medicaid beneficiaries. Psychosocial factors such as intention to quit in the next 30 days, social support for quitting, education level, race, and ethnicity impacted quit status and differed by mode of entry. Quitlines should use tailored strategies to increase engagement and reduce barriers among proactively referred clients.",
keywords = "Cessation medication, Medicaid, Quitline, Smoking, Telephone counseling, Tobacco",
author = "Lent, {Adrienne B.} and O'Connor, {Patrick A.} and Reikowsky, {Ryan C.} and Nair, {Uma S.} and Bell, {Melanie L}",
year = "2018",
month = "8",
day = "10",
doi = "10.1186/s12889-018-5923-6",
language = "English (US)",
volume = "18",
journal = "BMC Public Health",
issn = "1471-2458",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Quit outcomes among clients ineligible for cessation medication through the state quitline

T2 - A retrospective, observational study

AU - Lent, Adrienne B.

AU - O'Connor, Patrick A.

AU - Reikowsky, Ryan C.

AU - Nair, Uma S.

AU - Bell, Melanie L

PY - 2018/8/10

Y1 - 2018/8/10

N2 - Background: Distribution of tobacco cessation medications through state quitlines increases service utilization and quit outcomes. However, some state quitlines have moved to models in which callers are instructed to obtain quit medications through their health insurance pharmaceutical benefit. We aimed to investigate the impact of this policy on medication access and quit outcomes in the state quitline setting for clients who must obtain covered medications through the state Medicaid program. We hypothesized that clients with Medicaid who were referred by their healthcare provider would be more likely to report using quit medication and have higher quit rates compared to clients with Medicaid who engaged the quitline on their own. Methods: An observational, retrospective study was conducted using state quitline clients with Medicaid health insurance who were ineligible for quitline provided cessation medications. Clients were stratified by referral type: self-referred, passively referred, and proactively referred. Unadjusted and adjusted logistic regression was used to estimate the effect of referral type on both quit status and cessation medication use. Results: Proactively referred clients were less likely to use quit medication (53.6%) compared to self (56.9%) and passively referred clients (61.1%). Proactively referred clients had lower quit rates (31.4%), as compared to passively referred (36.0%) and self-referred (35.1%). In adjusted models, proactively referred clients were significantly less likely to be quit than passively referred clients (OR = 0.75, 95% CI: 0.56, 0.99). There were no statistically significant differences in medication use or number of coaching sessions among proactive, passive, and self-referred clients in adjusted models. Conclusions: In adjusted models, medication use did not significantly differ by mode of entry in this population of Medicaid beneficiaries. Psychosocial factors such as intention to quit in the next 30 days, social support for quitting, education level, race, and ethnicity impacted quit status and differed by mode of entry. Quitlines should use tailored strategies to increase engagement and reduce barriers among proactively referred clients.

AB - Background: Distribution of tobacco cessation medications through state quitlines increases service utilization and quit outcomes. However, some state quitlines have moved to models in which callers are instructed to obtain quit medications through their health insurance pharmaceutical benefit. We aimed to investigate the impact of this policy on medication access and quit outcomes in the state quitline setting for clients who must obtain covered medications through the state Medicaid program. We hypothesized that clients with Medicaid who were referred by their healthcare provider would be more likely to report using quit medication and have higher quit rates compared to clients with Medicaid who engaged the quitline on their own. Methods: An observational, retrospective study was conducted using state quitline clients with Medicaid health insurance who were ineligible for quitline provided cessation medications. Clients were stratified by referral type: self-referred, passively referred, and proactively referred. Unadjusted and adjusted logistic regression was used to estimate the effect of referral type on both quit status and cessation medication use. Results: Proactively referred clients were less likely to use quit medication (53.6%) compared to self (56.9%) and passively referred clients (61.1%). Proactively referred clients had lower quit rates (31.4%), as compared to passively referred (36.0%) and self-referred (35.1%). In adjusted models, proactively referred clients were significantly less likely to be quit than passively referred clients (OR = 0.75, 95% CI: 0.56, 0.99). There were no statistically significant differences in medication use or number of coaching sessions among proactive, passive, and self-referred clients in adjusted models. Conclusions: In adjusted models, medication use did not significantly differ by mode of entry in this population of Medicaid beneficiaries. Psychosocial factors such as intention to quit in the next 30 days, social support for quitting, education level, race, and ethnicity impacted quit status and differed by mode of entry. Quitlines should use tailored strategies to increase engagement and reduce barriers among proactively referred clients.

KW - Cessation medication

KW - Medicaid

KW - Quitline

KW - Smoking

KW - Telephone counseling

KW - Tobacco

UR - http://www.scopus.com/inward/record.url?scp=85051250366&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85051250366&partnerID=8YFLogxK

U2 - 10.1186/s12889-018-5923-6

DO - 10.1186/s12889-018-5923-6

M3 - Article

AN - SCOPUS:85051250366

VL - 18

JO - BMC Public Health

JF - BMC Public Health

SN - 1471-2458

IS - 1

M1 - 1001

ER -