Affordable Care Act Medicaid expansion and access to primary-care based smoking cessation assistance among cancer survivors: an observational cohort study.
Affordable Care Act Medicaid expansion and access to primary-care based smoking cessation assistance among cancer survivors: an observational cohort study.
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DOI：
10.1186/s12913-022-07860-3
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发表时间：
2022-04-12
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
--
作者：
癌症幸存者吸烟会增加癌症复发的风险，降低治疗效果，降低生活质量。与有健康保险的癌症幸存者相比，没有健康保险的癌症幸存者的吸烟率更高，戒烟的可能性更低。本研究探讨了《平价医疗法案》（ACA）医疗补助保险扩展与戒烟援助和社区卫生中心（CHCs）癌症幸存者戒烟之间的关系。利用来自扩大医疗补助资格的12个州的337个初级保健社区卫生中心和未扩大医疗补助资格的8个州的273个CHCs的电子健康记录数据，我们确定了2014年ACA扩大前6个月内有吸烟状况的成年癌症幸存者，并在扩大后24个月内评估了吸烟状况。采用观察性队列倾向评分加权方法和logistic广义估计方程回归，我们比较了医疗补助扩大和非医疗补助扩大州的癌症幸存者在扩大后期间戒烟、服用戒烟药物和就诊≥6次的几率。扩展状态的癌症幸存者接受戒烟药物治疗的几率高于非扩展状态的癌症幸存者（调整优势比[aOR] = 2.54, 95%CI = 1.61-4.03），就诊6次以上的几率高于非扩展状态的癌症幸存者（aOR = 1.82, 95%CI = 1.22-2.73）。在医疗补助扩大州和未扩大州的患者中，戒烟的几率没有显著差异。与未扩大医疗补助计划的州相比，扩大医疗补助计划的州的癌症幸存者获得戒烟药物订单的几率增加，这证明了健康保险覆盖在CHCs内获得循证烟草治疗方面的重要性。需要继续的研究来理解为什么在医疗补助扩大的州，尽管有戒烟药物处方的几率增加，但与没有扩大的州相比，癌症幸存者的戒烟几率并没有显著提高。
Smoking among cancer survivors can increase the risk of cancer reoccurrence, reduce treatment effectiveness and decrease quality of life. Cancer survivors without health insurance have higher rates of smoking and decreased probability of quitting smoking than cancer survivors with health insurance. This study examines the associations of the Affordable Care Act (ACA) Medicaid insurance expansion with smoking cessation assistance and quitting smoking among cancer survivors seen in community health centers (CHCs). Using electronic health record data from 337 primary care community health centers in 12 states that expanded Medicaid eligibility and 273 CHCs in 8 states that did not expand, we identified adult cancer survivors with a smoking status indicating current smoking within 6 months prior to ACA expansion in 2014 and ≥ 1 visit with smoking status assessed within 24-months post-expansion. Using an observational cohort propensity score weighted approach and logistic generalized estimating equation regression, we compared odds of quitting smoking, having a cessation medication ordered, and having ≥6 visits within the post-expansion period among cancer survivors in Medicaid expansion versus non-expansion states. Cancer survivors in expansion states had higher odds of having a smoking cessation medication order (adjusted odds ratio [aOR] = 2.54, 95%CI = 1.61-4.03) and higher odds of having ≥6 office visits than those in non-expansion states (aOR = 1.82, 95%CI = 1.22-2.73). Odds of quitting smoking did not differ significantly between patients in Medicaid expansion versus non-expansion states. The increased odds of having a smoking cessation medication order among cancer survivors seen in Medicaid expansion states compared with those seen in non-expansion states provides evidence of the importance of health insurance coverage in accessing evidence-based tobacco treatment within CHCs. Continued research is needed to understand why, despite increased odds of having a cessation medication prescribed, odds of quitting smoking were not significantly higher among cancer survivors in Medicaid expansion states compared to non-expansion states.
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影响因子：
5.5
作者：
Flocke SA;Hoffman R;Eberth JM;Park H;Birkby G;Trapl E;Zeliadt S
通讯作者：
Zeliadt S
DOI：
10.1007/s11764-015-0446-y
发表时间：
2016-02
期刊：
Journal of cancer survivorship : research and practice
影响因子：
--
作者：
Burcu M;Steinberger EK;Sorkin JD
通讯作者：
Sorkin JD
影响因子：
3.8
作者：
Guimond, Anne-Josee;Croteau, Virginie A.;Savard, Josee
通讯作者：
Savard, Josee
影响因子：
2.7
作者：
Bailey, Steffani R.;Stevens, Victor J.;Hazlehurst, Brian
通讯作者：
Hazlehurst, Brian
影响因子：
5.5
作者：
Donahoe, J. Travis;Norton, Edward C.;Fleischer, Nancy L.
通讯作者：
Fleischer, Nancy L.