Financial Incentives Spur Smoking Cessation

March 14, 2009

Financial incentives offered by employers significantly increased rates of smoking cessation, according to results of a study published in the February 12 issue of the New England Journal of Medicine. The study, one of the largest of its kind, was funded by the CDC and the Pennsylvania Department of Health. The CDC reports that smoking costs employers about $3400 per employee annually, or about $7.18 per pack of cigarettes smoked, in health care costs, presenteeism (lost productivity), and absenteeism.

Financial incentives offered by employers significantly increased rates of smoking cessation, according to results of a study published in the February 12 issue of the New England Journal of Medicine. The study, one of the largest of its kind, was funded by the CDC and the Pennsylvania Department of Health. The CDC reports that smoking costs employers about $3400 per employee annually, or about $7.18 per pack of cigarettes smoked, in health care costs, presenteeism (lost productivity), and absenteeism.

Kevin G. Volpp, MD, PhD, core investigator at the Center for Health Equity Research and Promotion and attending physician at the Philadelphia Veterans Affairs Medical Center, and colleagues randomly assigned 878 employees of General Electric Company from 85 US facilities who smoked an average of 1 pack of cigarettes a day to receive information about smoking cessation programs (n = 442) or to receive this information along with offers of financial incentives (n = 436). Employees who completed a smoking cessation program were awarded $100; those who stopped smoking within 6 months of study enrollment, as confirmed by a biochemical test, were awarded $250; and those who continued to abstain from smoking for an additional 6 months after quitting, as confirmed by a biochemical test, were awarded $400.

The researchers found that the financial-incentive group had much higher rates of smoking cessation than the information-only group 9 or 12 months after enrollment (14.7% vs 5.0%; P < .001) and 15 or 18 months after enrollment (9.4% vs 3.6%; P < .001) (Figure). Employees in the financial-incentive group, compared with those in the information-only group, also were much more likely to enroll in a smoking cessation program (15.4% vs 5.4%; P < .001), complete such a program (10.8% vs 2.5%; P < .001), and stop smoking within the first 6 months after enrollment (20.9% vs 11.8%; P < .001).

Pharmacist Follow-up Cuts Hospital Readmissions, ED Use
Researchers at the Boston University School of Medicine (BUSM) found that a comprehensive patient discharge plan that included follow-up by a pharmacist significantly reduced subsequent hospitalizations and emergency department (ED) visits. Findings of the study, which was funded by the Agency for Healthcare Research and Quality and the National Heart, Lung, and Blood Institute, were published in the February 3 issue of the Annals of Internal Medicine.

The study, conducted by Brian W. Jack, MD, associate professor, department of family medicine, BUSM, and colleagues, included 749 adults (mean age, 49.9 years) who had been admitted to Boston Medical Center in 2006 and 2007. Half of the patients received usual care and half were enrolled in an intervention, called the reengineered hospital discharge (RED) program. Patients in the RED group worked with discharge advocates-specially trained nurses whose duties included educating patients about their diagnoses, coordinated their care within the hospital, and confirmed their medication and postdischarge plans. The discharge advocates counseled patients on their written postdischarge plan, which contained a calendar of scheduled appointments and tests and a medication list that indicated where to obtain each drug as well as described how and when to take it.

Between 2 and 4 days after discharge, a clinical pharmacist contacted each patient in the RED group to review and reinforce the postdischarge plan. The pharmacist followed a script that included asking the patients to bring their medications to the telephone in order to review them and communicated any problems to a patient’s discharge advocate or physician. The study design specified that the pharmacist should make at least 3 attempts to contact each patient. The pharmacist reached 228 patients and completed the medication review for 195 patients. The researchers also reported that 126 patients in the RED group had at least 1 medication problem identified during the review and that 103 of those problems required the pharmacist to take corrective action.

When the researchers reviewed the hospital’s electronic medical record data, they found that 116 hospitalizations or ED visits were recorded within 30 days after initial discharge in the RED group compared with 166 hospitalizations or ED visits in the usual-care group. In addition to this 30% decrease, the researchers found that the RED intervention resulted in an estimated savings of $150,000 on ED, hospital, and primary care visits, or $412 per patient.

Migraines: Headache for Employers
Results of a survey conducted by the Midwest Business Group on Health (MBGH), Chicago, indicated that while a vast majority (91%) of 34 large employers recognize that migraine headaches adversely affect worker productivity, more than three-fourths (76%) do not track the direct and/or indirect costs of migraine. More employers involved in manufacturing than those in other industries consider the financial impact of migraine to be a costly and serious problem, with 44% expressing concern. About half (47%) of employers are interested in tools to measure migraine-related costs.

The survey also showed that most employers offer migraine resources and wellness programs, with 38% providing health coaches and nurse phone lines and 24% providing migraine materials and Web site information and onsite clinics. Employers indicated that health coaches and nurse phone lines provide the most valuable support. While employers rely on their health insurance plans and wellness vendors to manage worker productivity and costs associated with migraine, they often do not know how effective these programs are.

The report noted that the National Headache Foundation estimates that US employers lose $50 billion annually because of migraine-related absenteeism, presenteeism, and medical costs and that nearly 30 million US adults, or 1 in 8 workers, have migraines.