Learning Objectives: Describe delivery of tobacco services based on national recommendations (the 5As) in non-profit HMOs, characteristics of smokers who receive them and the effect on member satisfaction.
Abstract: Cost-effective tobacco treatment strategies described by the USPHS clinical guideline's 5As (Ask, Advise, Assess, Assist, Arrange) have been developed for primary care. All 9 HMOs participating in the HIT (HMOs Investigating Tobacco) study have adopted tobacco guidelines and give substantial system support for their implementation. These HMOs are members of the NCI-funded Cancer Research Network and provide comprehensive medical care to 8½ million members including 30% minority enrollment.
To assess the delivery of tobacco services and explore the impact on members' satisfaction, we identified 4,245 smokers from a survey of primary care patients. We found 75% had been Asked and Advised about smoking in the past year, 60% were Assessed about their interest in quitting, 35% were provided any Assistance (referred to classes/counseling, offered pharmacotherapy, given self-help materials) and follow-up contact was Arranged for 10%. Bivariate associations with receipt of the 5As include male gender, white race, older age, lower education, poorer health, greater outpatient utilization, heavier smoking, greater number of years smoking, plans for quitting, and asking for help. Of note, while providers often cite smokers' attitudes as barriers to addressing tobacco, we found smokers who received tobacco services were more satisfied in general with their HMO and rated tobacco services more highly. Results show these HMOs have made important progress regarding the first 3As. To help health plans fully implement national recommendations, we will present results of a multivariate model that identifies those smokers least likely to receive assistance. Implications for quality improvement will be discussed.
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