Reducing barriers to smoking cessation in a Medicaid population: The Medicaid Stop Smoking Intervention Study (MEDASSIST)

• Main Author: Murphy, Jill M
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2003
• Subjects: Intervention; Medicaid; Public health; Smoking cessation
• ISBN: 0496499629; 9780496499625

Objectives. Study objectives were to: (1) assess the awareness of a pharmacotherapy benefit among Medicaid clients who were current smokers, and (2) evaluate the effectiveness of an intensive case management intervention designed to reduce barriers to accessing pharmacotherapies and (a) increase use of pharmacotherapy, (b) promote smoking cessation, and (c) improve efforts toward cessation. Methods. The study population included 1,174 English-speaking Medicaid clients aged 18–64 years, who currently smoked and volunteered to be interviewed while attending an appointment at the Erie County Department of Social Services from March–July, 2002. Subjects (n = 608) who met eligibility criteria (≥10 cigarettes per day, a desire to stop smoking, not currently pregnant, had a telephone) and agreed to participate in the follow-up study were then randomized to one of three intervention groups: Minimal (verbally informed of Medicaid benefit), Self Help (verbally informed + reading materials), or Case Management (verbally informed, reading materials + economic/personal assistance of case manager). Participants were contacted three months later and completed a telephone survey. Outcomes. The primary outcomes were awareness of the Medicaid benefit for smokers and use of a stop smoking medication during the three-month follow-up period. Secondary outcomes included three month quit ratios and improved smoking cessation efforts. Results. Awareness of the Medicaid pharmacotherapy benefits was variable: 9.5% for nicotine nasal spray, 19.8% for Zyban, and 29.5% for the nicotine patch. Among all subjects enrolled into the intervention study, 14.6% reported using a stop smoking medication and staying off cigarettes for 24 hours, 4.6% self-reported being smoke-free at three months, and 1.8% were bioverified as smoke-free (breath CO ≤8 ppm). There were no significant differences by intervention group for use of a stop smoking medication or smoking cessation at three months. Overall, Case Management participants (52.5%) were more likely to report increased efforts to stop smoking, compared to the Self Help (39.1%) and Minimal Intervention (35.1%) groups (p = 0.002). Conclusion. The majority of Medicaid clients were unaware of the pharmacotherapy benefit for cessation. An intensive intervention designed to increase awareness of the benefit and reduce economic barriers to accessing the benefit was no more effective than less intensive interventions, although it did appear to motivate enhanced efforts toward cessation.