To evaluate the impact of their ongoing work, the HCP conducted a baseline survey of Arizona Healthcare systems to understand their policies, knowledge of and compliance with the PHS Guideline, and tobacco cessation services. Eighty-three percent (n=33) of Arizona healthcare systems responded (7 Commercial Managed Care Organizations (MCOs), 7 Medicare MCOs, 10 AHCCCS (Arizona Health Care Cost Containment System) MCOs, 3 Veterans Affairs, 6 Indian Health Service).

Methods

The Tobacco Control in Healthcare Systems Survey was conducted to assess existing tobacco control policies, guidelines, and services available within Arizona's healthcare systems. The survey was mailed to the Commercial, Medicare and AHCCCS MCOs, the VAHCS, and the IHS. Non-respondents were contacted by telephone. An 83% (33/40) response rate was achieved.
Data was cross-tabulated by health plan type (i.e., Commercial, Medicare, AHCCCS MCOs, VAHCS, and IHS) for most questions. A correlation analysis was performed to assess relationship of health plan type and healthcare delivery model (i.e., staff, network) with guideline implementation and coverage for tobacco interventions.

Outcomes

Some of the major conclusions of the Tobacco Control in Healthcare Systems Survey are listed below:

• All health plans reported the existence of tobacco-free workplace policies for employees, but only one-third of plans stated protocols/policies were in place for enrollees.
  
  
• Fifty-five percent of plans indicated that there was full or partial implementation of tobacco cessation and prevention practice guidelines.
  
  
• Respondents from 70% of plans reported coverage for at least one form of counseling and 12% of plans reported that self-help material only were available.
  
  
• Respondents from 49% reported that nicotine replacement or bupropion was fully or partially covered for general or group enrollment.
  
  
• Lack of requests from health plan purchasers, insufficient staff, and cost of implementing guidelines were ranked as the top three barriers for implementation of guidelines or policies.

Conclusions & Recommendations

The survey data will be used in activity planning for the Healthcare Partnership. Recommendations by the Healthcare Partnership based on the results of the Tobacco Control in Healthcare Systems Survey include:

• It is appropriate to link tobacco control activities with health plan accreditation and HEDIS (Health Plan Employer Data and Information Set) reporting.
  
  
• Although healthcare systems indicate there are workplace policies in place for employees, there is a need to increase protocols and policies for tobacco cessation for enrollees.
  
  
• There is an opportunity to increase the number of health plans using tobacco cessation and prevention guidelines.
  
  
• Systems and resource barriers continue to exist for guideline implementation.
  
  
• Arizona healthcare systems are aware of and refer to the Arizona Smokers' Helpline and ADHS-TEPP (Arizona Department of Health Services - Tobacco Education and Prevention Program) Community-based Projects, which demonstrates the success of these programs. These relationships may be strengthened for some healthcare systems.
  
  
• Most healthcare systems provide behavioral interventions for tobacco cessation. There appear to be some differences in provision of behavioral services by type of health plan and delivery model.
  
  
• Less than half of the health plans provide medications for tobacco cessation. There are significant differences in provision of medications by type of health plan.
  
  
• There is a strong positive association between medication coverage and behavioral interventions.
  
  
• Barriers to provision of behavioral interventions and medications for tobacco cessation exist and should be explored.
  
  
• Disease Management and Health Promotion programs offer a venue for tobacco cessation activities within healthcare systems.