PHARMACISTS ROLE IN A SMOKING-CESSATION PROGRAM AT A HEALTH MAINTENANCE ORGANIZATION

A comprehensive smoking-cessation program sponsored by a health maintenance organization (HMO) and the role of pharmacists in the program are described. Group Health Cooperative of Puget Sound is an HMO serving more than 385,000 enrollees in western Washington State. Group Health established a smoking-cessation program in 1985. The smoking-cessation benefit consists of interventions by providers to determine smoking status, a formal behavioral modification program, and nicotine-replacement therapy (beginning in 1993) for patients undergoing behavioral modification. The behavioral modification program is offered in group or individualized format. A team of trained nursing, medical, and pharmacy staff members provides consultative support to the program's smoking-cessation specialists. A tobacco-use road-map team has been created as part of the quality-improvement effort at Group Health; a pharmacist serves on this team. The ultimate goal of the team is to reduce the percentage of adult enrollees who smoke from the current 20% to 12.5% by 2000. A procedure for promoting smoking cessation was presented to all the pharmacists, along with continuing-education sessions. The pharmacists are encouraged to be brief but consistent in their antismoking message and to apply the ''four A's'' (ask about the patient's smoking status, advise the patient to quit smoking, assist in the patient's efforts to quit, and arrange follow-up). The inclusion of nicotine-replacement products in the smoking-cessation program in 1993 provided pharmacists with a key role in determining dosages and monitoring patients. Although the program is leading many smokers to quit, efforts will have to be intensified if program goals are to be realized by 2000. Pharmacists at an HMO that offers a comprehensive smoking-cessation program help identify smokers and encourage them to quit, assist with enrollees' nicotine-replacement therapy, and participate on the organization's quality-improvement team for tobacco use.