RESEARCH PAPER
How does reimbursement status affect smoking cessation interventions? A real-life experience from the Eastern Black Sea region of Turkey
 
More details
Hide details
1
Department of Chest Diseases, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
2
Department of Public Health, School of Medicine, Süleyman Demirel University, Isparta, Turkey
3
Department of Psychiatric Nursing, School of Health Science, Çoruh University, Artvin, Turkey
Publish date: 2019-01-22
 
Tob. Induc. Dis. 2019;17(January):5
KEYWORDS:
TOPICS:
ABSTRACT:
Introduction:
In the last decade, outpatient smoking cessation clinics (SCCs) in Turkey have been extended countrywide. Initially, only counseling was covered under health insurance. In 2011 and 2015, free varenicline and bupropion preparations were distributed to SCCs, periodically. In the current study we aimed to compare outcomes between the free and paid medication periods.

Methods:
Patients applied to the local SCC in a secondary health care unit between June 2014 and June 2017. They were evaluated for SC interventions and had phone visits after their third month; these records were included in the study. Patients were grouped and evaluated according to medication’s reimbursement status: free medication period (FP) and paid medication period (PMP).

Results:
In total, 733 patients applied to the SCC, 77.7% of them had applied during the FP. Analyses were made involving 417 patients who had records of third-month phone visit. Mean age of the patients was 44.0±13.7 years with the majority of patients (65%) being male. Sociodemographic characteristics of patients in both groups were not statistically different, while the percentage of patients with comorbid diseases was lower in the FP group (p<0.05). Treatment choices were different— the bupropion-prescribed group’s rate was similar in both periods (53.5% in PMP vs 52.0% in FP), however varenicline was mostly prescribed in the FP (35.8% vs 14.1%) while nicotine replacement therapy was mostly prescribed in the PMP (32.4% vs 12.1%) (p<0.05). Patients who used the advised treatment for at least 30 days (treatment adherent) and the rate of quitters at the third month were higher in FP (p<0.05) from univariate analysis, however these differences were not statistically significant when a multivariate analysis was performed.

Conclusions:
Our study showed that the free medication period increased the quit attempts but the increased in treatment adherence and quit success of the participating smokers was not obvious.

CORRESPONDING AUTHOR:
Dilek Karadoğan   
Department of Chest Diseases, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
 
REFERENCES (26):
1. Public Health Institution of Turkey. Global Adult Tobacco Survey Turkey 2012. http://www.who.int/tobacco/sur.... Accessed October 9, 2018.
2. American Psychiatric Association. Diagnostice and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
3. 2008 PHS Guideline Update Panel, Liaisons, and Staff. Treating tobacco use and dependence: 2008 update U.S. Public Health Service Clinical Practice Guideline executive summary. Respir Care. 2008;53(9):1217-1222.
4. Zhu S, Melcer T, Sun J, Rosbrook B, Pierce JP. Smoking cessation with and without assistance: a population-based analysis. Am J Prev Med. 2000;18(4):305-311. doi:10.1016/s0749-3797(00)00124-0
5. Patnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;163(8):608-621. doi:10.7326/M15-0171
6. Türk Torak Derneği Tütün Kontrolü Çalışma Grubu. Sigara Bırakma Tanı ve Tedavi Uzlaşı Raporu, 2014. [Turkish Thorasic Society Tobacco Control Assembly. Smoking cessation diagnosis and Treatment Guidance, 2014]. http://www.toraks.org.tr/book..... Accessed October 9, 2018.
7. Kunt Uzaslan E, Örsel O, Demir T. Türkiye’de Sigara Bıraktırma Poliklinikleri. [Smoking cessation outpatient clinics in Turkey]. http://www.toraks.org.tr/userf.... Accessed October 9, 2018.
8. Elbek O, Kılınç O, Aytemur ZA, et al. Tobacco Control in Turkey. Turk Thorac J. 2015;16(3):141-50. doi:10.5152/ttd.2014.3898
9. Salepci B, Fidan A, Çağlayan B, et al. Can a Computer-Based Prescription of Free Medication Increase Smoking Cessation Rates Efficiently? Turk Thorac J. 2016;17(1):15-21. doi:10.5578/ttj.17.1.003.
10. McAfee T, Babb S, McNabb S, Fiore MC. Helping smokers quit--opportunities created by the Affordable Care Act. N Engl J Med. 2015;372(1):5-7. doi:10.1056/NEJMp1411437.
11. Cadier B, Durand-Zaleski I, Thomas D, Chevreul K. Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases. PLoS One. 2016;11(2):e0148750. doi:10.1371/journal.pone.0148750.
12. Trapero-Bertran M, Muñoz C, Coyle K, et al. Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD. Addiction. 2018;113:65. doi:10.1111/add.14090.
13. White CM, Rynard VL, Reid JL, Ahmed R, Burkhalter R, Hammond D. Stop-Smoking Medication Use, Subsidization Policies, and Cessation in Canada. Am J Prev Med. 2015. 49(2):188-198. doi:10.1016/j.amepre.2015.03.001
14. van den Brand FA, Nagelhout GE, Reda AA, Winkens B, Evers SMAA, Kotz D, van Schayck OC. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database Syst Rev. 2017;9:CD004305. doi:10.1002/14651858.CD004305.pub5.
15. Çelik İ, Yüce D, Hayran M, et al. Nationwide Smoking Cessation Treatment Support Program-Turkey project. Health Policy. 2015;119(1):50-56. doi:10.1016/j.healthpol.2014.11.017.
16. Willemsen MC, Segaar D, van Schayck OC. Population impact of reimbursement for smoking cessation: a natural experiment in The Netherlands. Addiction. 2012;108(3):602-604. doi:10.1111/j.1360-0443.2012.04089.x.
17. Balmford J, Borland R, Hammond D, Cummings KM. Adherence to and reasons for premature discontinuation from stop-smoking medications: data from the ITC Four-Country Survey. Nicotine Tob Res. 2011;13(2):94-102. doi:10.1093/ntr/ntq215.
18. Heydari G. Is Cost of Medication for Quit Smoking Important for Smokers, Experience of Using Champix in Iranian Smoking Cessation Program 2016. Int J Prev Med. 2017;8(1):63. doi:10.4103/ijpvm.ijpvm_375_16
19. Ku L, Brantley E, Bysshe T, Steinmetz E, Bruen BK. How Medicaid and Other Public Policies Affect Use of Tobacco Cessation Therapy, United States, 2010-2014. Prev Chronic Dis. 2016;27(13):E150. doi:10.5888/pcd13.160234
20. Benli AR, Erturhan S, Oruc MA, Kalpakci P, Sunay D, Demirel Y. A comparison of the efficacy of varenicline and bupropion and an evaluation of the effect of the medications in the context of the smoking cessation programme. Tob Induc Dis. 2017;15(February). doi:10.1186/s12971-017-0116-0.
21. Önür ST, Uysal MA, İliaz S, et al. Does Short Message Service Increase Adherence to Smoking Cessation Clinic Appointments and Quitting Smoking? Balkan Med J. 2016;33(5):525-531. doi:10.5152/balkanmedj.2016.151610
22. West R, Eden Evins A, Benowitz NL, et al. Factors associated with the efficacy of smoking cessation treatments and predictors of smoking abstinence in EAGLES. Addiction. 2018 ;113(8):1507-1516. doi:10.1111/add.14208
23. Tara Mansoursadeghi-Gilan. Thesis: Evaluating the Real-World Effectiveness of Bupropion Versus Varenicline for Smoking Cessation: Exploring the Role of Nicotine Metabolism and Medication Adherence. Degree of Master of Science Graduate Department of Pharmacology and Toxicology University of Toronto Tara Mansoursadeghi-Gilan (2015). https://tspace.library.utoront.... Accessed October 9, 2018.
24. Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994;84(7):1086-1093. doi:10.2105/ajph.84.7.1086
25. Wilson JS, Elborn JS, Fitzsimons D, McCrum-Gardner E. Do smokers with chronic obstructive pulmonary disease report their smoking status reliably? A comparison of self-report and bio-chemical validation. Int J Nurs Stud. 2011;48(7):856-862. doi:10.1016/j.ijnurstu.2011.01.002.
26. Studts JL, Ghate SR, Gill JL, et al. Validity of self-reported smoking status among participants in a lung cancer screening trial. Cancer Epidemiol Biomarkers Prev. 2006;15(10):1825-1828. doi:10.1158/1055-9965.epi-06-0393.
eISSN:1617-9625