New York State Department of Health, Albany, NY.
Nicotine Tob Res. 2018 Nov 15;20(12):1467-1473. doi: 10.1093/ntr/ntx250.
Pharmacotherapy and counseling for tobacco cessation are evidence-based methods that increase successful smoking cessation attempts. Medicaid programs are required to provide coverage for smoking cessation services. Monitoring utilization is desirable for program evaluation and quality improvement. Various methodologies have been used to study utilization. Many factors can influence results, perhaps none more than how smokers are identified. This study evaluated the utilization of smoking cessation services using various methods to estimate the number of smokers within New York State's (NYS's) Medicaid program in 2015.
Estimates of utilization were generated based on Medicaid claims and encounters and four sources of smoking prevalence: two population surveys, one Medicaid enrollee survey, and diagnosis codes. We compared the percentage of (estimated) smokers utilizing cessation services, and the average number of services used, across fee-for-service and managed care populations, and by cessation service category.
Statewide, smoking prevalence estimates ranged from 10.9% to 31.5%. Diagnosis codes identified less than 45% of smokers estimated by surveys. A similar number of cessation counseling (199106) and pharmacotherapy services (197728) were used, yet more members utilized counseling (126839) than pharmacotherapy (91433). The estimated percentage of smokers who used smoking cessation services ranged from 15.1% to 43.4%, and the estimated average number of cessation services used ranged from 0.31 to 0.90 per smoker.
Smoking prevalence estimates obtained through surveys greatly exceed prevalence observed in diagnosis codes in NYS's Medicaid data. Use of diagnosis codes in the analysis of smoking cessation benefit utilization may result in overestimates.
Selection of a smoking prevalence data source for similar analyses should ultimately be based on completeness of the data and applicability to the population of interest. Evaluation of smoking cessation benefit utilization and the effectiveness of tobacco control campaigns aimed to increase utilization requires a well-defined methodology which ensures reliable baseline data. Comparing utilization estimates across populations or state lines can be misleading, as differences in how estimations were generated can greatly bias observed results.
药物治疗和咨询戒烟是增加成功戒烟尝试的循证方法。医疗补助计划必须提供戒烟服务。监测利用率是方案评估和质量改进的理想选择。已经使用了各种方法来研究利用率。许多因素可能会影响结果，也许没有比如何识别吸烟者更重要的了。本研究使用各种方法评估了 2015 年纽约州（NYS）医疗补助计划中戒烟服务的利用情况，以估算该州医疗补助计划中吸烟者的数量。
根据医疗补助索赔和就诊情况以及四种吸烟流行率来源（两项人口调查、一项医疗补助受保人调查和诊断代码）生成利用率估计数。我们比较了（估计）吸烟者使用戒烟服务的百分比和平均使用服务数量，比较了按服务付费和管理式医疗人群以及按戒烟服务类别进行的比较。
全州范围内，吸烟流行率估计数从 10.9%到 31.5%不等。诊断代码确定的吸烟者人数不到调查估计数的 45%。戒烟咨询（199106 次）和药物治疗（197728 次）的使用量相似，但接受咨询（126839 人）的人数多于药物治疗（91433 人）。使用戒烟服务的吸烟者估计百分比从 15.1%到 43.4%不等，每个吸烟者平均使用的戒烟服务数量从 0.31 到 0.90 不等。
通过调查获得的吸烟流行率估计值远远超过了 NYS 医疗补助数据中诊断代码观察到的流行率。在分析戒烟福利利用率时使用诊断代码可能会导致高估。
类似分析中应最终根据数据的完整性和对目标人群的适用性来选择吸烟流行率数据来源。评估戒烟福利的利用情况以及旨在提高利用率的烟草控制运动的有效性需要一种定义明确的方法，该方法可以确保可靠的基线数据。比较不同人群或州之间的利用率估计值可能会产生误导，因为估计方法的差异可能会极大地影响观察到的结果。
