Abstract
Purpose
Prior descriptive epidemiology studies have shown that smokers have lower compliance rates with preventive care services and lower chronic medication adherence rates for preventive care services in separate studies. The goal of this study was to perform a more detailed analysis to validate both of these findings for current smokers versus nonsmokers within the benefit-covered population of a large US employer.
Patients and methods
This study involved the analysis of incurred medical and pharmacy claims for employee and spouse health plan enrollees of a single US-based employer during 2010. Multivariate regression models were used to compare data by active or never-smoker status for preventive care services and medication adherence for chronic conditions. Analysis controlled for demographic variables, chronic condition prevalence, and depression.
Results
Controlling for demographic variables and comorbid conditions, smokers had significantly lower cancer screening rates, with absolute reductions of 6%–13%. Adherence to chronic medication use for hypertension was also significantly lower among smokers, with nearly 7% fewer smokers having a medication possession ratio of ≥80%. Smokers were less adherent to depression medications (relative risk =0.79) than nonsmokers (P=0.10). While not statistically significant, smokers were consistently less adherent to all other medications than nonsmokers.
Conclusion
Current smokers are less compliant with recommended preventive care and medication use than nonsmokers, likely contributing to smoking-related employer costs. Awareness of these care gaps among smokers and direct management should be considered as part of a comprehensive population health-management strategy.
Acknowledgments
Employers Health Coalition, Inc. (EHCI) received payment from Pfizer, Inc., for this research. Wendy D Lynch (Lynch Consulting, Ltd) received payment from EHCI as an independent contractor for supplemental analytics support and manuscript preparation. Bruce W Sherman (Sherman Consulting Services) received payment from EHCI as an independent contractor for study design and manuscript preparation while also serving as the EHCI medical director. Special thanks to Truven Health, Inc. for their role in providing the statistical analysis. Truven Health, Inc., received payment from EHCI as an independent contractor for performing statistical analysis related to the research.
Disclosure
Dr Sherman is currently a member of the speaker bureaus for Abbott, Merck, and Pfizer. He has recently participated in advisory board meetings on behalf of Novo Nordisk, Merck, Eisai, Genentech, Bayer, and Allergan. He serves on the scientific advisory board for Humana, and has received research funding from Sanofi and Pfizer. His recent speaking engagements with Pfizer have included unbranded presentations regarding the employer cost of smoking and value-based benefit design. Dr Lynch has received speaking honoraria from multiple pharmaceutical firms, employer coalitions, and health insurance companies in the past. She is currently receiving consulting fees from Teladoc and Eliza Corporations who may, among other services, encourage patients to quit smoking. Dr Lynch (Lynch Consulting, Ltd) received payment from EHCI as an independent contractor for supplemental analytics support and manuscript preparation. Dr Sherman (Sherman Consulting Services) received payment from EHCI as an independent contractor for study design and manuscript preparation while also serving as the EHCI medical director. This study was funded by a research grant from Pfizer for the statistical analysis (provided by Thomson Reuters/Truven) and manuscript preparation. The authors report no other conflicts of interest in this work.