Implementing a referral to telephone tobacco cessation services in Louisiana community pharmacies: a pilot study.

BACKGROUND: With one of the highest rates of tobacco dependence in the nation, Louisiana has been searching for economical and effective methods for assisting patients in cessation efforts. Community pharmacists are in an excellent position to promote tobacco cessation due to their availability to patients. The "Ask-Advise-Refer" model is a short intervention in which patients desiring to quit smoking are referred to free tobacco cessation telephone counseling services. OBJECTIVE: To evaluate the implementation of the Ask-Advise-Refer model in a sample of Louisiana pharmacies and identify barriers experienced by pharmacists when identifying and referring appropriate patients. METHODS: Nine pharmacists from across the state implemented the Ask-Advise-Refer model in their community pharmacies. Each pharmacist submitted a weekly tally sheet consisting of number of patients asked about tobacco dependence, number of patients not ready to quit, number referred to tobacco cessation telephone counseling, number enrolled in study, and amount of time involved with interventions. Additionally, participating pharmacists completed a self-administered survey at the completion of the pilot study to determine opinions on barriers to widespread implementation of the program. RESULTS: Over a 6-month period, the 9 pharmacists asked 5429 patients about tobacco dependence. Of the 657 self-identified tobacco-dependent patients, 478 (72.8%) were not ready to quit, and 179 (27.2%) indicated that they were ready to quit tobacco in the next 30 days. Of the patients ready to quit, 169 (94.4%) were referred to telephone counseling services to assist in their cessation efforts. CONCLUSIONS: Louisiana community pharmacists have the ability to screen and identify tobacco-dependent patients ready to quit tobacco use, but barriers exist that prevent a large number of these patients from being referred to available, free cessation counseling.

Economic effect of an expansion of pharmacy benefits on total health care expenditures by a state Medicaid program.

OBJECTIVES: To evaluate the economic effect of a pharmacy benefit expansion on a population of Oklahoma Medicaid recipients and to determine whether recipients who routinely maximized their monthly prescription limit (cap) before the benefit expansion benefited more from the expansion than the remainder of the study population. DESIGN: Retrospective study. SETTING: Oklahoma Medicaid claims data from January 1, 2003, to December 31, 2004. PATIENTS: Data from 15,936 Oklahoma Medicaid recipients. INTERVENTION: Retrospective administrative analysis using the Oklahoma Health Care Authority pharmacy and medical claims databases. MAIN OUTCOME MEASURES: Total health care expenditures per recipient per year, total medical expenditures per recipient per year, and total pharmacy expenditures per recipient per year. RESULTS: Total health care expenditures increased 17% after the benefit expansion (P < 0.0001). Of this increase, 65% was attributed to pharmacy expenditures and 35% to medical expenditures. However, a subpopulation of recipients who routinely reached their prescription limit before the expansion had a statistically significant increase in total and pharmacy expenditures; a statistically significant increase in medical expenditures was not observed. CONCLUSION: Although total health care expenditures increased after a monthly pharmacy benefit in a Medicaid population was expanded, a subpopulation of recipients identified as high pharmacy users before the expansion did not have a statistically significant increase in medical expenditures, whereas those who were non-high users experienced a significant increase. Additionally, this subpopulation experienced a nonsignificant decrease in hospital expenditures. These results could suggest that this subpopulation was affected differently than the overall population by the expansion of the Medicaid pharmacy benefit.