AHRQ Research Influences Colorado Tobacco Policy Decisions
As a result of participating in the Medicaid Medical Directors Learning Network—an AHRQ Knowledge Transfer project—Colorado Medicaid officials used two AHRQ research reports to influence policy and program decisions. The resources used were "Treating Tobacco Use and Dependence: 2008 Update," and the AHRQ Effective Health Care (EHC) Program research report, "Developing Evidence-Based Research Priorities for Off-Label Drug Use."
Judy Zerzan, MD, MPH, Colorado Medicaid Medical Director and member of the Learning Network, reports that Colorado Medicaid added information about accessing the Colorado QuitLine to its client identification cards in July 2010 as a way to encourage the use of this resource among smokers interested in quitting. "Quitlines" are telephone-based resources for accessing tobacco cessation coaching and medication. The report, "Treating Tobacco Use and Dependence: 2008 Update," states, "Quitline counseling is an effective intervention with a broad reach." Zerzan learned of the resource through the Learning Network Web site, which highlights new clinical tools and resources of specific interest to Medicaid clinical policymakers. After adding the call number to client materials, the Colorado QuitLine experienced a 30 percent increase in call volume during the second half of 2010.
The report "Treating Tobacco Use and Dependence: 2008 Update" also notes that there is "new evidence that health care policies significantly affect the likelihood that smokers will receive effective tobacco dependence treatment and successfully stop tobacco use. For instance, making tobacco dependence treatment a covered benefit of insurance plans increases the likelihood that a tobacco user will receive treatment and quit successfully."
In July 2010, Colorado Medicaid also changed its tobacco cessation drug benefit policy from a once per lifetime benefit to a twice a year benefit. Zerzan notes that the information was useful in convincing policymakers that, even though this drug benefit would increase expenses in the short term, the longer-term health benefits would outweigh the short-term costs. Zerzan states, "We used some of the figures from the 2008 Update to build the case that this was the right thing to do for our clients."
The EHC report, "Developing Evidence-Based Research Priorities for Off-Label Drug Use" was also influential in helping Medicaid officials in Colorado make important decisions. The report was specifically used to develop measures examining off-label use of anticonvulsant medications, which are normally prescribed for people with seizure conditions. Colorado Medicaid is exploring the use of anticonvulsants among individuals with depression and other off-label diagnoses in which the drug's use may or may not be appropriate to the clinical condition(s) being treated.
One of the first measures implemented to examine off-label use was to quantify the number of prescriptions for anticonvulsant medications among clients without a seizure disorder diagnosis. Colorado Medicaid began collecting this data in late 2010. With the short-term goal of exploring the conditions for which these medications are being used and whether there is evidence supporting that use, and the long-term goal of improving Colorado Medicaid clients' health outcomes, Medicaid officials drew upon AHRQ research to support their focus on off-label medications. Zerzan notes, "We wanted to further examine specific high-frequency drugs that were being used without adequate supporting evidence. We needed an unbiased scientific resource [in AHRQ] that helped us justify our need to focus on anticonvulsant medications as a drug class warranting attention at this time."
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; May 2008.
Developing Evidence-Based Research Priorities for Off-Label Drug Use, May 2009. Effective Health Care Research Report No. 12. Agency for Healthcare Research and Quality, Rockville, MD.