Medicaid Coverage of Smoking Cessation Counseling and Medication Is Underutilized for Pregnant Women
Medicaid Coverage of Smoking Cessation Counseling and Medication Is Underutilized for Pregnant Women
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DOI：
10.1093/ntr/ntw263
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发表时间：
2017-05-01
影响因子：
4.7
通讯作者：
Shireman, Theresa I.
中科院分区：
文献类型：
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作者：
Scheuermann, Taneisha S.;Richter, Kimber P.;Shireman, Theresa I.
简介：促进医疗补助保险孕妇戒烟的政策有可能帮助很大一部分怀孕吸烟者。 2010 年，堪萨斯州医疗补助计划开始为怀孕吸烟者提供戒烟咨询服务。我们的目的是评估因堪萨斯州医疗补助政策变更而向孕妇提供的戒烟福利的使用情况，政策变更为医生提供的戒烟咨询提供报销。方法：我们检查了堪萨斯州医疗补助索赔数据，以估计 2010 财年至 2013 财年堪萨斯州医疗补助保险孕妇接受戒烟治疗的比率。我们分析了接受医生提供的戒烟咨询的孕妇人数门诊管理护理就诊和按服务收费索赔数据中的程序账单代码（即 G0436 和 G0437）和药物（即尼古丁替代疗法、安非他酮或伐尼克兰）指示的咨询。我们利用该人群中的全国吸烟率 (14%) 和堪萨斯州报告的活产数量来估算受医疗补助保险的怀孕吸烟者的数量。结果：从 2010 年到 2013 年，每年约有 27.2%-31.6% 的怀孕吸烟者要求接受尼古丁替代疗法、安非他酮或伐尼克兰。不包括安非他酮（一种常用于治疗抑郁症的药物）的索赔，索赔率在 9.3% 至 11.1% 之间。在实施戒烟咨询医疗补助覆盖后，预计只有不到 1% 的吸烟者要求接受咨询。结论：如此低的索赔率表明，仅仅改变政策不足以确保使用新实施的福利，而且戒烟治疗可能仍存在重大差距。意义：本研究评估了堪萨斯州低收入孕妇使用医疗补助报销戒烟咨询的情况。我们描述了医生为孕妇提供的戒烟咨询的医疗补助索赔率，这是一种基于证据且普遍推荐的针对该人群的戒烟治疗方法。我们的研究结果表明，即使在实施支持提供戒烟援助的政策变化之后，该人群的戒烟福利索赔率也非常低。需要进行更多研究来确定报销是否按预期发挥作用，并确定政策与基于证据的戒烟治疗实施之间的潜在差距。
Introduction: Policies to promote smoking cessation among Medicaid-insured pregnant women have the potential to assist a significant proportion of pregnant smokers. In 2010, Kansas Medicaid began covering smoking cessation counseling for pregnant smokers. Our aim was to evaluate the use of smoking cessation benefits provided to pregnant women as a result of the Kansas Medicaid policy change that provided reimbursement for physician-provided smoking cessation counseling.Methods: We examined Kansas Medicaid claims data to estimate rates of delivery of smoking cessation treatment to Medicaid-insured pregnant women in Kansas from fiscal year 2010 through 2013. We analyzed the number of pregnant women who received physician-provided smoking cessation counseling indicated by procedure billing codes (ie, G0436 and G0437) and medication (ie, nicotine replacement therapy, bupropion, or varenicline) located in outpatient managed care encounter and fee-for-service claims data. We estimated the number of Medicaid-insured pregnant smokers using the national smoking prevalence (14%) in this population and the number of live births reported in Kansas.Results: Annually from 2010 to 2013, approximately 27.2%-31.6% of pregnant smokers had claims for nicotine replacement therapy, bupropion, or varenicline. Excluding claims for bupropion, a medication commonly prescribed to treat depression, claims ranged from 9.3% to 11.1%. Following implementation of Medicaid coverage for smoking cessation counseling, less than 1% of estimated smokers had claims for counseling.Conclusions: This low claims rate suggests that simply changing policy is not sufficient to ensure use of newly implemented benefits, and that there probably remain critical gaps in smoking cessation treatment.Implications: This study evaluates the use of Medicaid reimbursement for smoking cessation counseling among low-income pregnant women in Kansas. We describe the Medicaid claims rates of physician-provided smoking cessation counseling for pregnant women, an evidence-based and universally recommended treatment approach for smoking cessation in this population. Our findings show that claims rates for smoking cessation benefits in this population are very low, even after policy changes to support provision of cessation assistance were implemented. Additional studies are needed to determine whether reimbursement is functioning as intended and identify potential gaps between policy and implementation of evidence-based smoking cessation treatment.