Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South St, MS035, Waltham, MA 02454, USA.
Prev Chronic Dis. 2011 Jan;8(1):A14. Epub 2010 Dec 15.
The US Public Health Service urges providers to screen patients for smoking and advise smokers to quit. Yet, these practices are not widely implemented in clinical practice. This study provides national estimates of systems-level strategies used by private health insurance plans to influence provider delivery of smoking cessation activities.
Data are from a nationally representative survey of health plans for benefit year 2003, across product types offered by insurers, including health maintenance organizations (HMOs), preferred provider organizations, and point-of-service products, regarding alcohol, tobacco, drug, and mental health services. Executive directors of 368 health plans responded to the administrative module (83% response rate). Medical directors of 347 of those health plans, representing 771 products, completed the clinical module in which health plan respondents were asked about screening for smoking, guideline distribution, and incentives for guideline adherence.
Only 9% of products require, and 12% verify, that primary care providers (PCPs) screen for smoking. HMOs are more likely than other product types to require screening. Only 17% of products distribute smoking cessation guidelines to PCPs, and HMOs are more likely to do this. Feedback to PCPs was most frequently used to encourage guideline adherence; financial incentives were rarely used. Furthermore, health plans that did require screening often conducted other cessation activities.
Few private health plans have adopted techniques to encourage the use of smoking cessation activities by their providers. Increasing health plan involvement is necessary to reduce tobacco use and concomitant disease in the United States.
美国公共卫生署敦促医疗服务提供者为患者筛查吸烟状况，并建议吸烟者戒烟。然而，这些做法在临床实践中并未得到广泛实施。本研究提供了美国私人健康保险计划用于影响提供者提供戒烟活动的系统层面策略的全国性估计。
数据来自于一项针对 2003 年医保年度的、涵盖各类保险产品的全国性健康计划调查，包括健康维护组织（HMO）、优选提供者组织和服务点产品，调查内容涉及酒精、烟草、药物和精神健康服务。368 家健康计划的执行主管对行政模块做出回应（回应率为 83%）。其中 347 家健康计划的医疗主任完成了临床模块，该模块询问了健康计划参与者有关吸烟筛查、指南分发以及遵医嘱激励的情况。
仅有 9%的产品要求初级保健提供者（PCP）筛查吸烟状况，而 12%的产品会核实 PCP 是否进行了筛查。HMO 比其他产品类型更有可能要求进行筛查。只有 17%的产品向 PCP 分发戒烟指南，HMO 更有可能这样做。向 PCP 提供反馈最常用于鼓励遵医嘱；很少使用经济激励措施。此外，确实要求筛查的健康计划通常会开展其他戒烟活动。
很少有私人健康计划采用鼓励其提供者使用戒烟活动的技术。为了减少美国的烟草使用和相关疾病，有必要增加健康计划的参与度。
