Use of Pharmacotherapy in Conjunction with Quitlines

Tim McAfeeTracey Strader (OK)Paula Celestino (NY)Heidi Grossman (OR)Susan Swartz (ME)Mary Hartman (BCBS-MN)

Even Mount St. Helens Relapsed….

Format Overview of Issues and Opportunities Detailed studies from Oklahoma,

New York, Oregon, and Maine Case reports from other states &

health systems Discussion & share experiences

Issues & Opportunities Briefly review evidence base Pros & cons of NRT with quit lines NRT as alternative or adjunct to media Discuss operations & quality issues Explore challenges, controversy &

uncertainty Mature the science/business together

NRT Evidence Base Many large, well-designed randomized trials

showing 1.5 x 2 – fold increase in quit rates Improved outcomes with counseling Uncertainty around low-intervention

effectiveness (i.e. OTC with NO counseling) Several trials show phone adds Quit Rate

value to pharmacotherapy, but still early.. Swan et al – Group Health bupropion Hollis et al – Oregon quitline

Pros for Inclusion of NRT into QL services May increase effectiveness May increase popularity May increase volume cost-effectively May increase health provider interest

Synergistic effects around 5-A adoption may create population quit attempts beyond callers

May recruit people for counseling who otherwise would not use

Cons for Inclusion of NRT into QL services Full course of therapy is expensive May divert $$$ and attention from

counseling May divert $$$ from paid media

Which may decrease synergistic quit attempts by non-callers who saw ads

Some liability issues Full course to all WILL dis-incent healthplan

coverage

Issues Around NRT RoleShould QLs function as fulfillment houses (i.e. connect people with patches?)

-- OR --

Should NRT be incorporated as an adjunctive aid and/or inducement to accept and use behavioral support?

Operational Issues What to offer and how long Eligibility and screening How to deliver medication

Voucher vs. direct mail ‘Full course’ vs. split dose delivery How to integrate with counseling What about prescription meds?

Safety & Quality Issues Decision-making on type of Rx

Participant decision input? Appropriate dosing protocols

FDA # of cigarettes sufficient? ‘Right’ level of screening

Medical oversight/over-ride role? Exclusions/over-ride (i.e. pregnancy, CAD)

Continuing education of counselors

How much? 8 weeks is a lot How much do people really use? Will people buy more if we get them

started? If 1-2 weeks works for promotion effect,

why send more? Different approaches to insured vs.

uninsured?

How to hold back the sea? Awareness of free NRT via media

creates tsunamis of call volume Can we:

Handle the volume so as not to lose the promotional impact

Learn to create predictable, sustained increased demand leveraging NRT

Healthcare system integration Targeted outreach