A pragmatic, randomized, controlled study evaluating the impact of access to smoking cessation pharmacotherapy coverage on the proportion of successful quitters in a Canadian population of smokers motivated to quit (ACCESSATION)
| Autor: | Gerald Brosky, Carmen Arteaga, Peter Selby, Paul Oh, Suzanne Ranger, Vincent Raymond |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Pragmatic medicine.medical_specialty Canada Nicotine Randomization media_common.quotation_subject medicine.medical_treatment Medications Smoking cessation Health Services Accessibility law.invention chemistry.chemical_compound Randomized controlled trial law Internal medicine Quinoxalines Medicine Humans Nicotinic Agonists Varenicline Psychiatry Bupropion media_common Motivation Insurance Health business.industry Smoking Public Health Environmental and Occupational Health Pharmacotherapy coverage Odds ratio Tobacco Use Disorder Abstinence Benzazepines Middle Aged Confidence interval Tobacco Use Cessation Devices Reimbursement Clinical trial Treatment Outcome Policy chemistry Female business medicine.drug Research Article |
| Zdroj: | BMC Public Health |
| ISSN: | 1471-2458 |
| Popis: | Background Many smokers find the cost of smoking cessation medications a barrier. Financial coverage for these medications increases utilization of pharmacotherapies. This study assesses whether financial coverage increases the proportion of successful quitters. Methods A pragmatic, open-label, randomized, controlled trial was conducted in 58 Canadian sites between March 2009 and September 2010. Smokers (≥10 cigarettes/day) without insurance coverage who were motivated to quit within 14 days were randomized (1:1) in a blinded manner to receive either full coverage eligibility for 26 weeks or no coverage. Pharmacotherapies covered were varenicline, bupropion, or nicotine patches/gum. Investigators/subjects were unblinded to study group assignment after randomization and prior to choosing a smoking cessation method(s). All subjects received brief smoking cessation counseling. The primary outcome measure was self-reported 7-day point prevalence of abstinence (PPA) at week 26. Results Of the 1380 randomized subjects (coverage, 696; no coverage, 684), 682 (98.0%) and 435 (63.6%), respectively, were dispensed at least one smoking cessation medication dose. The 7-day PPA at week 26 was higher in the full coverage versus no coverage group: 20.8% (n = 145) and 13.9% (n = 95), respectively; odds ratio (OR) = 1.64, 95% confidence interval (CI) 1.23–2.18; p = 0.001. Urine cotinine-confirmed 7-day PPA at week 26 was 15.7% (n = 109) and 10.1% (n = 69), respectively; OR = 1.68, 95% CI 1.21–2.33; p = 0.002. After pharmacotherapy, coverage eligibility was withdrawn from the full coverage group, continuous abstinence between weeks 26 and 52 was 6.6% (n = 46) and 5.6% (n = 38), in the full coverage and no coverage groups, respectively; OR = 1.19, 95% CI 0.76–1.87; p = 0.439. Conclusions In this study, the adoption of a smoking cessation medication coverage drug policy was an effective intervention to improve 26-week quit rates in Canada. The advantages were lost once coverage was discontinued. Further study is required on the duration of coverage to prevent relapse to smoking. (clinicaltrials.gov identifier: NCT00818207; the study was sponsored by Pfizer Inc.). |
| Databáze: | OpenAIRE |
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