Use of Pharmacotherapy in Conjunction with Quitlines Tim McAfee Tracey 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 Role Should 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