Physicians' Recommendations to Medicaid Patients About Tobacco Cessation

Smoking is highly prevalent among low-income Medicaid beneficiaries and tobacco-cessation benefits are generally available. Nonetheless, use of cessation medications or counseling remains low, and many clinicians are hesitant to urge smokers to quit. This study examines the extent to which physicians provide advice to Medicaid patients about quitting.

Data from the 2014-2015 Nationwide Adult Medicaid Consumer Assessment of Health Plans survey were merged with state Medicaid policy variables and analyzed in 2017-2018. Multivariate regression models examined factors associated with smoking status, physician advice to quit smoking, and discussion of cessation medications or other strategies, as well as patients' ratings of their personal physicians.

Almost one third (29%) of adult Medicaid beneficiaries smoke. Almost four fifths of smokers with a personal doctor (77%) say their doctor at least sometimes advised quitting and almost half of smokers discussed cessation medications (48%), or another strategy, such as counseling (42%). Smokers' ratings of satisfaction with their physicians and their health plans rose as the frequency of smoking recommendations increased. Those in Medicaid managed care plans smoked more, but received less advice about cessation medications than those in fee-for-service care.

Clinicians and Medicaid managed care plans can improve their efforts to motivate Medicaid patients to try to quit smoking. These findings indicate that patients value prevention-oriented advice and give better ratings to physicians and health plans that offer more support and advice about cessation.