A survey of managed care strategies for pregnant smokers

Objective-The purpose of this study was to measure the content and comprehe nsiveness of pregnancy specific smoking cessation strategies within managed care organisations (MCOs) responding affirmatively to the national 1997-98 addressing Tobacco in Managed Care (STR IC) survey. Design-This cross sectional follow up study consisted of a fax survey sent to medical directors and a 37 question telephone survey of program overseer s about the smoking cessation strategy. Subjects-147 MCOs identifying a pregnancy specific smoking cessation strate gy on the 1997-98 ATMC survey served as the initial sample; 88 MCOs of 128 eligible plans completed both components, with a response rate of 69%. Results-Pregnancy specific smoking cessation strategies varied. 40% of resp ondents used the Agency for Health Care Policy and Research guidelines for clinical smoking cessation to design their strategy. Strategies included se lf help materials, quit classes, telephone support and brief counselling by providers, linkages to quality improvement efforts, and use of patient dat abases for outreach. Only 42% offered a postpartum relapse prevention eleme nt. Lack of patient interest, competing clinic priorities, and the lack of a smoker identification system were the most problematic barriers to implem enting strategies, common to at least a quarter of respondents. A majority ranked best practice manuals and web site Linkages as the most useful form of technical assistance, followed by peer-to-peer counselling, regional wor kshops, newsletters, on-site assistance, and national conferences. Conclusions-The survey provides the first profile of prenatal tobacco treat ment strategies in managed care. While design limitations prevent generalis ation of these results to all MCOs, such information can help guide technic al assistance to plans interested in reducing smoking among pregnant women.