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Comprehensive Treatment of Tobacco Dependence in Oregon

Lessons Learned

What were the important elements to the intervention's success?

• When considering the development of a tobacco cessation program, it is useful to think of a Quitline as a single component of the overall approach to cessation. Likewise, a cessation program is a single component of a comprehensive tobacco program. One of the most important lessons learned from the Oregon experience is that it is essential that all components work together to be effective. A Quitline needs the comprehensive program to motivate the interest in quitting, to motivate callers and to support maintenance through policies such as clean indoor air policies, the schools, the community and the media. Comprehensive programs need cessation, particularly Quitlines, because they are popular and can be easily understood by politicians. The promotion of a Quitline is more easily observed by the public than policy changes or enhanced health care plan benefits. Therefore, they can facilitate advocacy for other components of the comprehensive program.
• A public/private partnership can work to implement and maintain tobacco programs and, in fact, is important when resources are scarce and politically vulnerable. As the adequacy of state budgets fluctuates, it is essential to cultivate and maintain the support and responsibility of the private sector to ensure at least their contribution to overall program funding. Once governments assume total responsibility for these programs, the private sector will NOT duplicate services nor will they take responsibility back should government involvement decline. Getting the private sector to step up is very difficult and requires bringing pressure from the purchasers of health care, e.g., employers, onto health plans and providers.
• Because of their administrative resources and contractual relationships with health care providers, the state Medicaid program can be a fantastic ally. But, they have enormous challenges. The Oregon program found it very worthwhile to fund a 0.5 FTE tobacco staff person inside the Medicaid agency.
• Motivating health care providers to incorporate tobacco cessation into clinical practice can work IF it is easy for physicians to comply. An essential component of the provider educational process is to support arguments for change with scientific evidence; zealotry will NOT be appreciated.
• Last but not least of the lessons learned in Oregon's experience: measure, measure, measure…and widely report the findings to all appropriate audiences!!

Describe the policy and/or program interventions applicability/replicability to other sites, and include recommendations for other sites.

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Describe the challenges faced, and below each challenge, describe any solutions used to correct or reduce the problem.

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What would you have done differently?

The Oregon partners were quite successful at working through the Medicaid agency's network to reach virtually all health care providers in Oregon. Likewise, the combination of the state's comprehensive program for the uninsured and the Medicaid programs for low income individuals assured that comprehensive services were available for about a third of all tobacco users. However, only about half of the remaining tobacco users have coverage for assistance through their insurer. Failure to enlist the cooperation—from the beginning—of the businesses that can demand a benefit and commercial purchasers was a mistake. Gaining their cooperation in 2003, when costs are escalating, is a considerably greater challenge than it would have been in 1997.

Lessons Learned Notes

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