Effectiveness of the 5-As Tobacco Cessation Treatments in Nine HMOs
- 257 Downloads
Smoking remains the leading cause of preventable mortality in the US. The national clinical guideline recommends an intervention for tobacco use known as the 5-As (Ask, Advise, Assess, Assist, and Arrange). Little is known about the model’s effectiveness outside the research setting.
To assess the effectiveness of tobacco treatments in HMOs.
Smokers identified from primary care visits in nine nonprofit health plans.
Smokers were surveyed at baseline and at 12-month follow-up to assess smoking status and tobacco treatments offered by clinicians and used by smokers.
Analyses include the 80% of respondents who reported having had a visit in the previous year with their clinician when they were smoking (n = 2,325). Smokers were more often offered Advice (77%) than the more effective Assist treatments–classes/counseling (41%) and pharmacotherapy (33%). One third of smokers reported using pharmacotherapy, but only 16% used classes or counseling. At follow-up, 8.9% were abstinent for >30 days. Smokers who reported being offered pharmacotherapy were more likely to quit than those who did not (adjusted OR = 1.73, CI = 1.22–2.45). Compared with smokers who didn’t use classes/counseling or pharmacotherapy, those who did use these services were more likely to quit (adjusted OR = 1.82, CI = 1.16–2.86 and OR = 2.23, CI = 1.56–3.20, respectively).
Smokers were more likely to report quitting if they were offered cessation medications or if they used either medications or counseling. Results are similar to findings from clinical trials and highlight the need for clinicians and health plans to provide more than just advice to quit.
KEY WORDSsmoking HMOs 5-As tobacco cessation treatment
- 1.US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.Google Scholar
- 2.Centers for Disease Control and Prevention. Cigarette smoking among adults–United States, 2006. MMWR Morb Mortal Wkly Rep. 2007;56(44):1157–61. November 9.Google Scholar
- 3.Best Practices for Comprehensive Tobacco Control Programs October 2007 Report. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2007 Oct 10.Google Scholar
- 6.Centers for Disease Control and Prevention. Smoking cessation during previous year among adults–United States, 1990 and 1991. MMWR Morb Mortal Wkly Rep. 1993:42:(26)504–7. July 9.Google Scholar
- 7.Fiore MC, Bailey WC, Cohen SJ, et al. Treating tobacco use and dependence: an evidence-based clinical practice guideline for tobacco cessation. US Department of Health and Human Services, Public Health Service; 2000.Google Scholar
- 8.Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. US Department of Health and Human Services-Public Health Service; 2008.Google Scholar
- 11.Centers for Disease Control and Prevention. Prevention and managed care: opportunities for managed care organizations, purchasers of health care, and public health agencies. MMWR Morb Mortal Wkly Rep. 1995;RR-14(44):1–12. November 17.Google Scholar
- 13.National Committee for Quality Assurance 2. The state of health care quality 2007. Washington, DC: 2007.Google Scholar
- 14.Hollis JF. Population impact of clinician efforts to reduce tobacco use. In: Population based smoking cessation proceedings of a conference on what works to influence cessation in the general population. National Institutes of Health 2000 November 1;129–54.Google Scholar
- 19.Dillman DA. Mail and telephone surveys: the total design method. New York: John Wiley & Sons Inc; 1978.Google Scholar
- 27.US Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. 2000. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.Google Scholar
- 28.National Institutes of Health State of the Science Panel. National Institutes of Health State-of-the-Science conference statement: tobacco use: prevention, cessation, and control. Ann Intern Med. 2006;14511839–44. December 5.Google Scholar
- 29.National Cancer Institute. Greater than the sum: Systems thinking in tobacco control. Bethesda, MD: National Institute of Health; 2007.Google Scholar
- 31.Centers for Disease Control and Prevention. Cigarette smoking among adults–United States, 1993. MMWR Morb Mortal Wkly Rep. 1994;43(50):925–30. December 23.Google Scholar
- 33.Quinn VP, Stevens VJ, Smith KS, Ritzwoller D. Documentation of Tobacco Services in the Medical Record: Promoting Treatment and Quality of Care. Oral Presentation, 10th Annual HMO Research Network Conference, Dearborn: MI, May 2004.Google Scholar