260075 Uptake of Smoking Cessation Codes by Family Physicians in Ontario, Canada

Tuesday, October 30, 2012

Alexey Babayan, PhD , Dalla Lana School of Public Health, University of Toronto, Ontario Tobacco Research Unit, Toronto, ON, Canada
Anne Philipneri, MPH , Dalla Lana School of Public Health, University of Toronto, Ontario Tobacco Research Unit, Toronto, ON, Canada
Robert Schwartz, PhD , Dalla Lana School of Public Health, University of Toronto, Ontario Tobacco Research Unit, Toronto, ON, Canada
Susan Bondy, PhD , Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Peter Selby, MD , Addictions Program, Center for Addiction and Mental Health, Toronto, ON, Canada
Background: In 2006 the Ontario government introduced new fee codes (for initial and follow-up counselling) to promote smoking cessation intervention by family physicians (FPs). In 2008 incentive payments were increased and criteria loosened to be inclusive of all FPs. This study examines trends in fee code utilization.   Methods: Descriptive analysis and regression models, using 2006-2010 Ontario Health Insurance Program (OHIP) administrative data. Canadian Tobacco Use Monitoring Survey, 2006-2010 data to contextualize OHIP estimates. Qualitative interviews with provincial stakeholders (n=6) and FPs (n=21) to support the interpretation of the findings.   Result: A substantial proportion of Ontario smokers report receiving advice from physicians to quit smoking (50%, 2006 to 59%, 2010) However, physicians billed for only a fraction of smokers (8%, 2006 to 16%, 2010). Only a small proportion of smokers receiving initial counselling were followed up (10%, 2006 to 22%, 2010). While male smokers received more initial counselling, females had higher odds of receiving the follow-up (OR: 1.17; 95% CI: 1.16-1.18). Physician engagement (ratio of services per physician) increased after the modification of fee codes in 2008, but has declined afterward (2009: OR=0.88; 95% CI: 0.85-0.90 and 2010: OR=0.85; 95% CI: 0.82-0.88). Identified barriers from interviews included time constraints, insufficient incentives, and too much paper work.   Conclusion: The smoking cessation fee codes do not provide physicians sufficient incentive to engage smokers, particularly for providing follow-up

Learning Areas:
Provision of health care to the public
Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
1. Demonstrate the effects of incentive payments in improving physicians’ engagement in smoking cessation. 2. Describe patient demographic characteristics for receipt of smoking cessation counselling by family physicians. 3. Identify avenues for improvement for physician led smoking cessation counselling.

Keywords: Smoking Cessation, Tobacco Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am research officer at the Ontario Tobacco Research Unit and PhD candidate in the program of health research methodology. My professional interests are in epidemiology and biostatistics. My research interests are in monitoring and surveillance of tobacco use.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4157.0: System Advances in Tobacco Cessation