Study Says Cost a Big Barrier to Smoking Cessation Referrals

Participation in a referral program for smoking and obesity prevention program dropped off 97 percent when patients were asked to pay for their own care, according to a recent study (PDF).

Researchers from Virginia Commonwealth University set up a collaborative effort with primary-care physicians and community counselors to use an electronic system (called eLinkS) to refer patients with unhealthy behaviors to counseling services. During a five-week period when the program was offered for free, 21.8 percent of qualifying patients were referred to intensive counseling.

However, during a subsequent three-week period where funding was not available, only 0.7 percent of patients were referred to counseling. Healthcare professionals were significantly less likely to refer patients to the program when it cost money as opposed to when it was offered for free, and patients said cost was a major barrier to their participation.

“Our quantitative and qualitative data underscore that clinicians, not just patients, are influenced by costs,” said researcher Alex H. Krist, M.D. “Despite prompts, nurses were less likely to record patients' [body-mass index] and smoking status during the no-coverage period, triggering fewer eLinkS prompts. Clinicians were also less likely to discuss health behaviors with patients. However, even when clinicians did offer a referral, 81 percent fewer patients accepted.

Krist said the findings indicate that “policymakers and payers should support clinical-community partnerships and eliminate cost as a barrier to intensive smoking cessation and weight-loss counseling. Modifying health behaviors is daunting enough for patients and clinicians — cost can be the tipping point in their decision to forego the effort.”

The study appears in the March 2010 issue of the American Journal of Preventive Medicine.