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Relationship Between Tobacco Control Policies and the Delivery of Smoking Cessation Services in Nonprofit HMOs
Affiliations of authors: Kaiser Permanente Center for Health Research Northwest, Portland, OR (VJS, JAH, KSS); HealthPartners Research Foundation, Minneapolis, MN (LIS, RGB); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (VPQ); Harvard Medical School and Massachusetts General Hospital, Boston, MA (NAR); University of Massachusetts Medical School, Worcester, MA (JGZ); Kaiser Permanente Colorado, CO (EF); Kaiser Permanente Center for Health Research Hawaii, Honolulu, HI (TV); Division of Research, Kaiser Permanente Northern California, Oakland, CA (NG); Group Health Cooperative Center for Health Studies, Seattle, WA (PF)
Correspondence to: Victor J. Stevens, PhD, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227 (e-mail: victor.j.stevens{at}kpchr.org).
Background: This project examined tobacco policies and delivery of cessation services in nonprofit HMOs that collectively provide comprehensive medical care to more than 8 million members. Methods: Three annual surveys with health plan managers showed that all of these health plans had written tobacco control guidelines that became more comprehensive over the span of this study. We also surveyed a random sample of 4207 current smokers who had attended a primary care visit in the past year (399–528 at each of nine health plans). Results: Of these smokers, 71% reported advice to quit, 56% were asked about their willingness to quit, 49% were provided some assistance in quitting (mostly self-help material or information about classes or counseling), and 9% were offered some kind of follow-up. Smokers receiving assistance in quitting reported higher satisfaction with their care. Conclusions: In general, health plans with the most comprehensive policies also showed higher rates of implementing tobacco treatment programs in primary care. Compared with tobacco control efforts of a decade or more ago, considerable progress has been made. However, there is still room for improvement in the proportion of smokers who receive the most effective forms of assistance in quitting.
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