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Provider-delivered tobacco dependence treatment to Medicaid smokers.

INTRODUCTION
Smoking prevalence is 49% among Medicaid enrollees in Ohio. The objective of this pilot project was to test a comprehensive tobacco dependence treatment program targeting rural Medicaid-enrolled smokers for both physician-level and smoker-level outcomes.


METHODS
Using a group-randomized trial design, intervention group physicians (n = 4) were exposed to systems-level changes in their clinics, and smokers in these clinics were offered 12 weeks of telephone cessation counseling. Control group physicians (n = 4) were given the clinician's version of the U.S. Public Health Serivce (USPHS) Clinical Practice Guideline, and smokers in these clinics were given information about the Ohio Tobacco Quitline. Physician-level and smoker-level outcomes were assessed at 1 week and 3 months, respectively. Costs per quit were estimated.


RESULTS
A total of 214 Medicaid smokers were enrolled. At 1 week, there were no reported differences in rates of being asked about tobacco use (68% intervention, 58% control) or advised to quit (69% intervention, 63% control). However, 30% of intervention and 56% of control smokers reported receiving a prescription for pharmacotherapy (p < .01). At 3 months, there were no differences in quit attempts (58% intervention, 64% control), use of pharmacotherapy (34% intervention, 46% control), or abstinence (24% intervention, 16% control for self-reported abstinence; 11% intervention, 3.5% control for cotinine-confirmed abstinence). The intervention group proved more cost-effective at achieving confirmed quits ($6,800 vs. $9,700).


CONCLUSIONS
We found few differences in outcomes between physicians exposed to a brief intervention and physicians who were intensively trained. Future studies should examine how tobacco dependence treatment can be further expanded in Medicaid programs.