Capsule Commentary on Huskamp et al., Effects of Global Payment and Accountable Care on Tobacco Cessation Service Use: An Observational Study
J Gen Intern Med
Capsule Commentary on Huskamp et al., Effects of Global Payment and Accountable Care on Tobacco Cessation Service Use: An Observational Study
Jeffrey L. Jackson
M.D. M.P.H.
Zablocki VAMC
Milwaukee
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T disability in the US. Unfortunately, despite decades of
obacco use is the leading cause of preventable death and
smoking cessation effort, 18% of US adults smoke.1 In this
study, Huskamp and colleagues2 found that an Alternative
Quality Contract, in which accountable care organizations
receive incentives for improving care performance on 64
measures, reduced smoking (from 2.02 to 1.87%). This is
despite the fact that tobacco cessation was not 1 of the 64
measures of care. The authors posit that a multi-year global
payment contract incentivizes tobacco cessation as an
intervention that can potentially lower future disease burden. The
authors also suggest that including tobacco cessation as a
specific metric could create even stronger incentives.
There are a number of approaches that have been shown to
reduce smoking. Patients are more likely to quit smoking
when it is recommended by their primary care provider.
Unfortunately, the percentage of patients receiving this advice
from their providers is low, only about 27%. Interventions that
incentivize the primary care provider to increase smoking
cessation efforts might reduce smoking, though this is
unproven. Interventions that combine pharmacotherapy and
behavioral support have been shown to reduce smoking more than
minimal interventions or usual care.3 This would suggest that
beyond merely advising patients to quit, primary care
providers are going to be most effective in settings in which they
deliver both pharmacotherapy and behavioral support. In
addition, direct financial incentives to patients also improve rates
of smoking cessation, at least for as long as the incentives are
in place.4 These incentives are typically provided by either the
employer or the patient?s health insurance carrier. Other
studies have found that gaining insurance coverage leads to
reduced rates of smoking.5 This would suggest that providing
insurance to the uninsured, bundling into the insurance
coverage incentives for both providers and patients to reduce
smoking and paying for both pharmacologic and behavioral
interventions may optimize tobacco cessation. Future studies
need to examine the impact of combining these interventions.
It could be that they are additive, multiplicative or there is no
additional benefit.
Compliance with ethical standards:
Conflict of Interest: The author has no conflicts of interest with this
article.
1. King BA , Dube SR , Tynan MA . Current tobacco use among adults in the United States: Findings from the National Adult Tobacco Survey . Am J Public Health . 2012 ; 102 ( 11 ): e93 - e100 .
2. Huskamp HA , Greenfield SF , Stuart EA , Donohue JM , Duckworth K , Kouri EM , Song Z , Chernew ME , Barry CL . Effects of global payment and accountable care on tobacco cessation service use: An observational study . J Gen Intern Med . 2016 . doi: 10 .1007/s11606-016-3718-y.
3. Stead LF , Koilpillai P , Fanshawe TR , Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation . Cochrane Database Syst Rev . 2016 ; 3, CD008286 . doi: 10 .1002/14651858.CD008286. pub3 .
4. Cahill K , Hartmann-Boyce J , Perera R . Incentives for smoking cessation . Cochrane Database Syst Rev . 2015 ; (5):CD004307.
5. Bailey SR , Hoopes MJ , Marino M , Heintzman J , O'Malley JP , Hatch B , Angier H , Fortmann SP , DeVoe JE . Effect of gaining insurance coverage on smoking cessation in community health centers: A cohort study . J Gen Intern Med . 2016 . doi: 10 .1007/s11606-016-3781-4. (...truncated)