Adoption of the AHCPR Clinical Practice Guideline for Smoking Cessation - A survey of California's HMOs

Objective: Our objective was to assess the degree to which health maintenan ce organizations (HMOs) and Medicaid managed care (MMC) plans in California have adopted the 1996 AHCPR Clinical Practice Guideline for Smoking Cessat ion. (AHCPR [U.S. Agency for Health Care Policy and Research] was renamed A HRQ [Agency for Healthcare Research and Quality] in 1999.) Methods: A fax survey of 13 licensed HMOs and 21 MMC plans operating in Cal ifornia in 1999 with up to 10 follow-up contacts by telephone, mail, fax, a nd/or electronic mail. Results: Awareness of the AHCPR guideline is widespread, and all HMOs in Ca lifornia in 1999 offered coverage for at least one treatment for smoking ce ssation. We found that 7% of the HMOs in California were aware of the AHCPR guideline, but less than half had used it to design benefits or distribute treatment guidelines to medical care providers in their networks. While on ly 23% of California HMOs covered the nicotine patch or gum, 69% covered at least one form of the pharmacotherapy and one type of counseling to treat tobacco dependence. In addition, a majority of the HMOs and MMC plans infor m their members about coverage for smoking cessation treatments and inform providers about their role in helping smokers to quit. Conclusion: Considerable progress has been made in increasing access to eff ective smoking cessation treatments in California's managed care organizati ons over the last 10 years. Future efforts and research must concentrate on : (1) adopting the 2000 Public Health Service Clinical Practice Guideline o n Treating Tobacco Use and Dependence, (2) increasing purchaser demand for coverage of tobacco dependence treatments, (3) increasing health plan docum entation and monitoring of member smoking status, and (4) increasing provid er provision of effective tobacco dependence treatments.