NRT & NRT+ Pilot Preliminary Results

Gowri Shetty MS, MPH

Gita Bewtra MPH

Background

• Some sort of NRT benefit has been available to clients since 2003.

• In 2006, we offered a 50% discount on NRT and medications like Zyban

• An NRT workgroup was formed to address issues related to NRT and NRT+ coverage.

• Based on recommendations of the NRT workgroup, a pilot program was started in March 2008 where all clients received 12 week free NRT or NRT+ (including medications like Zyban, Welbutrin and Chantix)

• This pilot program was implemented for all clients enrolling in cessation services for the months of March and April 2008.

Background

• Funding– Pilot funded through Arizona tobacco tax,

received by ADHS-BTEP– Estimated billing between March 1, 2008 thru

April 30, 2008: ~$200K – 250K

Purpose of the Pilot Program

• To assess the impact of offering 12 week free NRT and NRT+ on Quitline service utilization and cessation outcomes

• Specifically we looked at:– How effective is offering free medication in

motivating people to call the quit line? – Do free medications impact someone’s ability to quit

for at least 7 days, 30 days or more? Does this vary by type of NRT/medication?

– Do people value the behavioral support offered through the Quitline, and is there a difference if they do?

Pilot Program Description

• All clients enrolled in cessation services were offered 12 week free NRT/NRT+

• NRT/NRT+ was mail ordered through BeBetter Networks Inc.

Methods

• Compared Quitline utilization for months before, during and after the pilot program

• All clients enrolled during the months of March and April 2008 were followed up at 4 months to assess their smoking status

• Criteria for follow-up– Complete the Client Intake Form (CIF)– Consent for follow up

• Up to 10 attempts were made to contact eligible callers

Demographics

• Age

• Gender

• Race/Ethnicity

• Insurance

AgeAge Range All Callers

N (%)

Callers reached for follow up N (%)

Mean 48.57 49.58

18 - <24 44 (2.2%) 18 (1.8%)

24 - <34 268 (13.%) 118 (11.5%)

34 - <44 399 (19.8%) 184 (17.9%)

44 - <54 569 (28.2%) 308 (30.0%)

54 - <64 472 (23.4%) 252 (24.5%)

64+ 558 (12.8%) 146 (14.2%)

Missing 5 (0.2%) 1 (0.1%)

Gender

Gender All Callers

N (%)

Callers reached for follow up

N (%)

Male 752 (37.3%) 393 (38.3%)

Female 1224 (60.7%) 619 ( 60.%)

Missing 39 (1.9%) 15 (1.5%)

Race/EthnicityRace/Ethnicity All Callers

N (%)

Callers reached for follow up

N (%)

White 1715 (85.1%) 896 (87.2%)

Latino 194 (9.6%) 74 (7.2%)

African American 57 (2.8%) 30 (2.9%)

American Indian/Alaskan Native

36 (1.8%) 17 (1.7%)

Asian 10 (0.5%) 6 (0.6%)

Other 129 (6.4%) 51 (5.0%)

Insurance

Insurance Coverage

All Callers

N (%)

Callers reached for follow up

N (%)

Yes 1173 (88.0%) 900 (87.6%)

AHCCCS 443 (22.0%) 210 (20.4%)

Results

• Call volume– 2015 calls

• Clients reached at follow up – 1027

Follow – up Clients

• Participants who enrolled in the free NRT program– 854 (83.2%)

• How important was the offer of the free quit medication in your decision to quit tobacco?– Almost 80% said it was important

Follow – up Clients

NRT/NRT+ Number of Clients

Chantix 543 (52.9%)

Bupropion 6 (0.6%)

Patch 65 (6.3%)

Gum 16 (1.6%)

Lozenge 19 (1.9%)

Did not use NRT 378 (36.8%)

Quit Rate Calculation

REACHED ONLY – Continuous quit

Number of participants who have not used tobacco since last call

Total number reached at call(1027)

REACHED ONLY – 24 hour quit

Number of participants who have not used tobacco in the past 24 hours

Total number reached at call(1027)

Follow – up ClientsNRT/NRT+

typeContinuous Quit

percentageContinuous Quit Rate

24 hour Quit percentage

24 Quit Rate

Chantix

(543)44.6% 23.6% 10.3% 5.5%

Bupropion*

(6)66.7%

Sample size too small

16.7%Sample size

too small

Patch

(65)38.5% 2.4% 16.9% 1.1%

Gum

(16)37.5%

Sample size too small

18.8%Sample size

too small

Lozenge

(19)31.6%

Sample size too small

15.8%Sample size

too small

Did Not Use NRT

(378)21.7% 8.0% 8.7% 3.2%

Follow – up Clients

NRT/NRT+ type

Continuous Quit percentage

Continuous Quit Rate

24 hour Quit Percentage

24 Hour Quit Rate

Chantix(543)

44.6% 23.6% 10.3% 5.5%

All Other(106)

38.7% 4.0% 17.0% 1.8%

Did Not Use NRT(378)

21.7% 8.0% 8.7% 3.2%

Follow – up Clients

• How important was the offer of quit coaching in your decision to quit tobacco?– Over 75% said it was important

• How helpful did you find the coaching in your efforts to quit tobacco?– Over 55% said it was helpful

• Overall, how satisfied were you with the service you received from the cessation quitline?– Over 67% said they were mostly or very satisfied

Next Steps

• Calculation of quit rates, based on new NAQC recommendations

• Recommendations for provision of NRT/NRT+

• Compare pilot data to before and after data

Questions?