Brake For Health A SMOKING CESSATION PROGRAM

1
A SMOKING CESSATION PROGRAM
Chris Monteith - General Motors of Canada
Limited Jim Beaudry - CAW Sal Cimino - Green
Shield Canada
2
PERSPECTIVE

• Plan Sponsor
• Labour
• Plan Administrator

3
PERSPECTIVE

• Plan Sponsor
• Labour
• Plan Administrator

4
Plan Sponsors Perspective

• GMCL/CAW Health and Wellness Program known today
  as Motoring to Wellness launched new smoking
  cessation program September 2006
• Designed for GMCL employees, retirees and their
  family members
• In partnership with Durham Region Health
  Department and Green Shield Canada

5
Plan Sponsors Perspective

• Theme of Fall 2006 campaign
• Program very timely as the Smoke Free Ontario Act
  came into effect May 31, 2006
• Key Campaign Messages
• Increase awareness of health effects of tobacco
  use
• Increase awareness of health effects of 2nd hand
  smoke
• Provide supports to those who wish to quit
  smoking

6
Plan Sponsors Perspective

• Health Wellness Employee Survey conducted
  Spring 2006 revealed
• 18.4 GMCL employees were current smokers
• 50.5 were considering quitting in the next 6
  months (contemplation) or committed to quitting
  in next 30 days (preparation)
• 38.3 were not considering quitting

7
Plan Sponsors Perspective

• Unique program design included combination of
  motivation, education and support
• Intervention support through pharmacists trained
  in clinical tobacco intervention (CTI)
• Participants accessing pharmacists support
  provided benefit coverage for all NRT
• Support material including
• Self-help resources (e.g. websites, phone lines)
• CTI trained pharmacist listing

8
Plan Sponsors Perspective

• Combination of pharmacotherapy and professional
  support considered to be programs key to improve
  quit rate
• GMCL committed to helping participants be
  successful
• GMCL covered related pharmacist cognitive fees in
  addition to NRT costs

9
Plan Sponsors Perspective

• 180 individuals registered
• Approximately 50 of those registered took
  advantage of the CTI trained pharmacist/NRT
  coverage offering
• Outcomes of that 50 signified success of Program
• Health Canada has approved funding support for
  2008 Program

10
PERSPECTIVE

• Plan Sponsor
• Labour
• Plan Administrator

11
LaboursPerspective

• CAW behind initiative 100
• Program excellent example for other sectors of
  our Union
• Demonstrates value of working closely with
  benefit providers to achieve Wellness Program
  success
• Improved quality of life for our members

12
PERSPECTIVE

• Plan Sponsor
• Labour
• Plan Administrator

13
Plan Administrators Perspective

1. Eligible vs Ineligible benefits
2. Trained Pharmacists
3. Electronic Adjudication
4. Communication
5. Data Mining

14
Plan Administrators Perspective

• Eligible vs Ineligible Benefits
• Oral smoking cessation products (e.g., Champix,
  Zyban) full benefit of the drug plan
• Nicotine replacement therapy (NRTe.g. patches,
  gum) removed from the plan in 2001 due to
  unscheduled status
• Programming to include the NRT

15
Plan Administrators Perspective

• Trained Pharmacists
• The intervention was associated with increased
  and more highly rated counselling, and a trend
  toward higher smoking cessation rates, indicating
  that community pharmacy personnel have the
  potential to make a significant contribution to
  national smoking cessation targets.
• Sinclair HK et al. Training pharmacists and
  pharmacy assistants in the state-of-change model
  of smoking cessation a randomised controlled
  trial in Scotland. Tob Control 1998
  Autumn7(3)253-61

16
Plan Administrators Perspective

• Trained Pharmacists
• About 1,000 CTI trained pharmacists in Ontario
  (CTI clinical tobacco intervention)
• CTI uses state-of-change model for smoking
  cessation
• Engaged chains banners
• Over 250 pharmacists committed initially

17
Plan Administrators Perspective

• Electronic Adjudication
• Using the existing claims form CPhA v.3
• Tie the consultative claim to payment
• AND
• Allow for ineligible benefits to be eligible on
  individual basis i.e. pay for patches, gum, etc.

18
Plan Administrators Perspective

• Electronic Adjudication
• Need for pharmacists to understand
• Presentation was prepared and delivered in
  specific areas of concern (e.g. Oshawa, Windsor)
• Green Shield website used to inform pharmacists
  of process two Green Shield pharmacists
  dedicated for FAQ troubleshooting

19
Plan Administrators Perspective

• Communication
• Plan members - basically through GMCL and CAW
  with help from Durham Health
• Pharmacists via mailings, presentations, faxes,
  chains, banners

20
Plan Administrators Perspective

• Data Mining
• How many succeeded?
• Also important to note the persistence

21
  Number of Patients Number Relapsed/ Withdrawn Number Quit Quit
By Gender a By Gender a By Gender a By Gender a By Gender a
Male 47 25 22 46.8
Female 33 25 8 24.2

By Employee/Dependent b By Employee/Dependent b By Employee/Dependent b By Employee/Dependent b By Employee/Dependent b
Employees 53 28 25 47.2
Dependents 27 22 5 18.5
Total 80 50 30 37.5
a p 0.034, Fisher exact test a p 0.034, Fisher exact test a p 0.034, Fisher exact test a p 0.034, Fisher exact test a p 0.034, Fisher exact test
b p 0.011, Fisher exact test b p 0.011, Fisher exact test b p 0.011, Fisher exact test b p 0.011, Fisher exact test b p 0.011, Fisher exact test
22
Plan Administrators Perspective

• Persistence
• Pierce and Gilpin (2002)1
• Median duration of OTC NRT use 14.0 days
• Mean duration of OTC NRT use 28.2 days
• Uncontrolled Rx2 39-45 days (mean)
• GMCL intervention group2 61.2 days (mean)