An increase in primary care prescriptions of stop-smoking medication as a result of health insurance coverage in the Netherlands: population based study

Abstract

Aims: To examine the impact of two national tobacco control interventions in the past decade on (dispensed) prescriptions of stop-smoking medication.

Design: Ecological study with interrupted time-series analyses of quarterly data points of three nation-wide representative databases.

Setting: The Netherlands 2001-2012, with the introduction of the guideline for smoking cessation care for general practitioners (GP) in 2007 and full insurance coverage for smoking cessation treatment in 2011.

Participants: GPs, pharmacists and people in the general population aged 15 years and older.

Measurements: Time-series plots were inspected visually and segmented regression analyses were performed to estimate the change in level and slope of (dispensed) prescriptions of stop-smoking medication and smoking prevalence in the years preceding and after the tobacco control interventions.

Findings: No measurable effects of the GP guideline on (dispensed) prescriptions were observed. Shortly after the start of health insurance coverage, an estimated increase in primary care prescriptions of 6.3 per 1000 smokers [95% confidence interval (CI) = 2.9-9.8; P = 0.001] and 17.3 dispensed items per 1000 smokers (95% CI = 12.5-22.0; P < 0.000) was accompanied by a sudden drop in smoking prevalence of 2.9% (95% CI = 4.6-1.1; P = 0.002) in the first quarter of 2011. Immediately after the coverage abolition, smoking prevalence increased by 1.2% (95% CI = 0.5-2.8; P = 0.156) and dispensed prescription rates decreased with 21.6 per 1000 smokers (95% CI = 26.0-17.2; P < 0.000).

Conclusions: Full health insurance coverage for smoking cessation treatment in the Netherlands was accompanied by a significant increase in the number of (dispensed) prescriptions of stop-smoking medication and a decrease in smoking prevalence.

Keywords: Drug prescriptions; health policy; primary health care; smoking cessation; tobacco use cessation products.