Objectives: This research program was designed to investigate the potential cost-benefit of academic detailing to promote increased tobacco-cessation-related behaviors by dentists enrolled in a dental-managed-care organization (DMHO). Methods: A randomized clinical trial utilized 72 eligible dentists, i.e., those with >300 enrolled DMHO adult patients. Half of these dentists were assigned to an academic-detailing intervention and the other half to the control condition, i.e., practice as usual. All dentist-subjects were mailed a questionnaire concerning their knowledge, attitudes, beliefs, and practices about tobacco use and cessation at baseline and again 12 months later. Dentist-subjects assigned to the intervention were visited for an hour-long detailing visit by a dentist focusing on a discussion of how procedures associated with tobacco cessation could be integrated into individual office settings. This visit was followed by three reinforcement visits, each approximately 9 minutes long, by a dental hygienist. Participation by dentists assigned to the control condition was restricted to completing the questionnaires. Results: Dentists exposed to the intervention were more likely than those in the control condition to discuss setting a specific quit date, discusssing specific strategies for quitting, advising about nicotine gum, and referring patients to cessation programs. Costs associated with the intervention included recruitment, travel, detailers' time, office personnel time, and the cost of educational materials. Total DMHO costs were about $32,000, with a mean cost/office of about $900, approximately twice DMHO administrative expenditures for managing the control condition. Conclusions: Health benefits of the intervention are evident and costs seemingly moderate. However, the substantial costs to be borne by a DMHO, if this program were to be adopted on a system-wide basis, would undoubtedly lead to extensive analyses and discussion by corporate leadership of additional costs and potential health-care-related savings downstream, as well as potential marketing opportunities and return on investment.
"This project was supported by Robert Wood Foundation Grant Number 7-78806 and Aetna Dental."