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RESEARCH |
Kate E. Pickett is with the Department of Health Studies, University of Chicago, Chicago, Ill. Barbara Abrams and Amy Kalkbrenner are with the Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley. Helen Halpin Schauffler is with the Center for Health and Public Policy Studies, School of Public Health, University of California, Berkeley. Janet Savage is with the Center for Public Health Practice, School of Public Health, University of California, Berkeley. Peggy Brandt and Amy Kalkbrenner are with the Public Health Nutrition Program, School of Public Health, University of California, Berkeley. Susan A. Chapman is with the Center for Health Professions, University of California, San Francisco.
Correspondence: Requests for reprints should be sent to Kate E. Pickett, PhD, Department of Health Studies, University of Chicago, 5841 South Maryland Ave, MC 2007, Chicago, IL 60637 (e-mail: kpickett{at}health.bsd.uchicago.edu).
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INTRODUCTION |
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 TOP INTRODUCTION References |
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We surveyed coverage of prenatal tobacco dependence treatments in health maintenance organizations (HMOs) in California to assess the availability, accessibility, use, and effectiveness of services offered to pregnant smokers. The survey addressed the following services: individual, group, and telephone counseling and self-help kits. The eligible sample included 39 full-service HMOs, all of which responded to the survey. For each HMO, we identified the most knowledgeable staff member to answer the survey.
Only 3 HMOs (8%) covered all 4 services. Thirty-six HMOs (92%) covered at least 1 treatment, whereas 3 (8%) covered no tobacco dependence treatments for pregnant women. Seventeen HMOs (44%) reported covering at least 1 additional smoking cessation service, such as nicotine replacement therapy, for pregnant women beyond those about which we asked. Coverage ranged from a low of 44% for self-help kits and individual counseling to a high of 56% for telephone counseling (Figure 1
).
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Of the HMOs covering services, only 67% monitored utilization (e.g., keeping lists of participants). Only 28% of these HMOs monitored quit rates among pregnant smokers. Thirty-two of the 39 HMOs (82%) reported that their providers screen all pregnant women for smoking, whereas 7 HMOs (18%) did not know whether screening took place.
Medi-Cal managed care plans were more likely to provide coverage for face-to-face services (individual and group counseling) compared with commercial HMOs (Figure 1
). In California, members of Medi-Cal managed care plans may have better access to the most effective, clinically intensive tobacco dependence treatment services, because providers of Medi-Cal managed care are mandated to identify and intervene on risk conditions identified during pregnancy.
Our findings suggest that in 1997, most California HMOs were not covering the extended or augmented psychosocial interventions that have been recommended for all pregnant smokers by the US Public Health Service.9,15 Although managed care offers the potential for increasing the availability and accessibility of such services for plan members, this survey suggests that that potential is not being realized. In addition, many California HMOs are unable to judge the use or effectiveness of these services and can neither track the costs and benefits of existing programs nor determine the need for additional services.
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Acknowledgments |
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Footnotes |
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K. E. Pickett wrote the paper and conducted analyses. B. Abrams was the principal investigator and conceived the study. B. Abrams, H. H. Schauffler, J. Savage, P. Brandt, and S. A. Chapman designed the survey. P. Brandt conducted the survey. A. Kalkbrenner conducted analyses. All authors contributed to the writing and revision of several drafts.
Accepted for publication January 10, 2001.
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References |
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TOPINTRODUCTIONReferences |
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