Effectiveness of Agency for Health Care Policy and Research clinical practice guideline and patient education methods for pregnant smokers in Medicaid maternity care,☆☆,

Presented at the Sixteenth World Conference on Health Promotion and Health Education, San Juan, Puerto Rico, June 1998; at the Annual Meeting of the American Public Health Association, Washington, D.C., November 1998; and at the Tobacco Control in Managed Care Symposium, San Diego, California, February 1999.
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Abstract

Objective: The purposes of this study were (1) to determine the extent to which tobacco exposure assessment and new patient education methods, derived from a meta-analysis and the Agency for Health Care Policy and Research guideline recommendations, could be provided routinely by trained Medicaid maternity care staff members and (2) to document the behavioral impact of these interventions among pregnant smokers. Study Design: After 265 pregnant smokers were assigned at their first visit to an experimental group (n = 139) or a control group (n = 126), they received standardized risk information and were advised to quit smoking. The experimental group also received evidence-based patient education methods, including the videocassette Commit to Quit During and After Pregnancy, the publication A Pregnant Woman’s Guide to Quit Smoking, and a brief counseling session. Self-report and saliva cotinine assessments of tobacco exposure were performed at baseline and at the end of pregnancy. Results: A significantly higher percentage of patients quit smoking in the experimental group (17.3%) than in the control group (8.8%). Conclusions: The application of principles of organizational development and quality improvement at the management and clinical practice levels and the delivery of evidence-based health education methods by trained prenatal care providers significantly increased smoking cessation rates among pregnant Medicaid recipients. (Am J Obstet Gynecol 2000;182:68-75.)

Section snippets

Smoking Cessation or Reduction in Pregnancy Trial (SCRIPT)

This is the first evaluation report of the 5-year (1997-2001) SCRIPT supported by the National Institutes of Health. SCRIPT was designed to confirm the effectiveness11 of patient education methods (derived from a meta-analysis and from the Agency for Health Care Policy and Research guideline recommendations) delivered by trained regular staff members to a representative sample of pregnant smokers whose care was supported by Medicaid. It was critical to conduct a rigorous formative evaluation11

Statewide organizational and policy development methods

A critical step at the onset of planning was to involve program managers of Medicaid maternity care services in the preparation of the organizational development plan to introduce and to evaluate evidence-based educational methods at multiple service sites.12, 13 A formal contract and management-science partnership between tobacco control research specialists at the University of Alabama at Birmingham and directors of services in the Bureau of Family Health Services of the Alabama Department of

Phase 1

The objectives of phase 1 were to randomly select and to recruit a representative sample of Alabama Medicaid maternity care sites and to document their patients’ smoking prevalence rate, passive smoke exposure rate, and smoking behavioral change rate. A site plan for integrating the new patient assessment methods into routine care was jointly developed by the University of Alabama at Birmingham and site staff members during training meetings (2 hours at each site) in May and June 1997. Tobacco

Process evaluation

Of the 1540 patients screened in phase 1 and phase 2, a total of 25.3% (n = 389) reported being smokers. Among the 265 self-reported pregnant smokers who participated, 84% were white. Cotinine analysis of phase 1 data confirmed a 24% deception rate among patients who reported not being smokers at their first visit. Most of the deception (50%) in this study occurred among patients who said at their first visit that they had quit smoking after conception. If the same deception rate is assumed for

Comment

These process and impact data confirmed successful achievement of the 5 SCRIPT formative evaluation objectives. We finalized all procedures with this evidence-based insight and initiated SCRIPT phase 3 in May 1998. We are currently documenting among a cohort of >1200 pregnant smokers (>600 in the experimental group and >600 in the control group) whether the new health education methods (1) can be routinely delivered during a 24-month period by regular staff members (feasibility ), (2) can

Acknowledgements

The success of the SCRIPT phase 1, 2, and 3 activities has been achieved because of the consistent and enthusiastic support of the following colleagues: Don Williamson, MD, State Health Officer, Alabama Department of Public Health; Sherry George, Phyllis Gilchrist, Laurie Stout, Sharon Gerogiannis, Connie McMichael, Wendy Blackmon, and Martha Kreauter, SCRIPT Management Committee, Alabama Department of Public Health, Bureau of Family Health Services; Robert Azadian, Toya Russell, Stephanie

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  • Cited by (0)

    Funded by grant HL RO1 56010 02, National Heart, Lung, and Blood Institute (1997-2001).

    ☆☆

    Reprint requests: Richard A. Windsor, PhD, Research Professor and SCRIPT Principal Investigator, The University of Alabama at Birmingham, Education BLDG, Room 232R, 901 13th St S, Birmingham, AL 35294-1250.

    0002-9378/2000 $12.00 + 06/1/100135

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