Transcript CAN-ADAPTT: Canadian Smoking Cessation Guideline

CAN-ADAPTT
Peter Selby MBBS, CCFP, MHSc, FASAM
Associate Professor,
Family and Community Medicine, Psychiatry, Public Health Sciences,
University of Toronto
Clinical Director, Addictions Program
PI, Ontario Tobacco Research Unit
Executive Director, TEACH
PI, CAN-ADAPTT, STOP STUDY
CAN-ADAPTT Team: Rosa Dragonetti, Jess Rogers, Katie Hunter, Denise
Koubanioudakis, Tamar Meyer, Janet Ngo, Stephanie Elliott
Agenda
 CAN-ADAPTT
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Rationale
Methodology
Results
Challenges & Lessons Learned
 Seed Grant Presentations
 Discussion and Next Steps
CAN-ADAPTT Team
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Rosa Dragonetti, Manager
Jess Rogers, Project Manager
Katie Hunter, Atlantic Canada Coordinator
Denise Koubanioudakis, Quebec Coordinator
Tamar Meyer, Ontario Coordinator
Janet Ngo, Western Canada Coordinator
Stephanie Elliott, Administrative Secretary
Guideline Development Group
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Gerry Brosky, MD, MSc, CCFP
Paul McDonald, PhD, FRSPH
Jennifer O'Loughlin, PhD
Sheila Cote-Meek, BScN, MBA, PhD
Alice Ordene, MD, CCFP, MHSc
Robert Reid, PhD, MBA
Charl Els M.B. ChB., F.C. Psych, M.Med
Psych, A.S.A.M., M.R.O.
 Peter Selby, MBBS, CCFP, MHSc, FASAM
Executive Committee
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Peter Selby
Cameron Norman
Roberta Ferrence
Charl Els
Michèle Tremblay
John Garcia
Paul McDonald
Tupper Bean
Laurie Zawertalio
Virginia Chow
Louise Walker
Professional Advisory Group
Todd Evans
Health Canada
Meridene Haynes
Asthma Society of Canada
John Tucker
Canadian Chiropractic Association
Judy Lux
Canadian Dental Hygienists Association
Dr. Euan Swan
Canadian Dental Association
Jayne Thirsk
Dieticians of Canada
Tony D'Urzo
Director, Primary Care Lung clinic
Tracy Vanderwoude
Canadian Nurses' Association
Dr. Kirsten North
Canadian Association of Optometrists
Kristine Petrasko
Canadian Pharmacists Association
Dr. Maura Ricketts
Canadian Physiotherapy Association
Professional Advisory Group
Carol Miller
Canadian Physiotherapy Association
Dr. Sonu Gaind
Psychiatrists
Dr. Karen Cohen
Canadian Psychological Association
Chritiane Menard
Canadian Society of Respiratory Therapists
Donna Czukar
Canadian Cancer Society
Doug Brothwell
Canadian Association of Public Health Dentists
Canadian Association of Occupational Therapists (CAOT)
Brenda McGibbon Lammi Royal Ottawa Care Group & Ontario Assoc. of Social
Karen Poole
Worker
Bob Reid
University of Ottawa Heart Institute
Millicent Toombs
Canadian Medical Association
Health Canada
 3 year Project Funding
 Drugs and Tobacco Initiatives Program,
Health Canada
“There are therefore 2 major disconnects between
research and practice: research may not translate
expeditiously to everyday practice, and clinical problems
encountered in everyday practice are often underinvestigated.”
(Tierney et al., 2007)
Barriers and the Care Gap
Structure of Care
System Level
Process of Care
Organization/Setting
Level
‘IDEAL’ CARE
CARE
GAP
Research
?
Experience
CURRENT CARE
Content of Care
Provider/Patient Level
Collaboration
Objectives
1. National Network: To create a national network of smoking cessation
researchers, policy/decision- makers and practitioners/providers to inform
smoking cessation research and practice.
2. Clinical Practice Guideline: build from existing guidelines identify and
3.
adapt evidence to the Canadian context through a practice-informed
approach
Research Agenda: To develop a practice-informed research agenda in
key areas of smoking cessation that bridges the gaps between clinical
practice, research and theoretical frameworks.
4. Knowledge Translation: To translate research findings into a dynamic
set of evidence-based guidelines on smoking cessation.
5. Dissemination and Engagement: To disseminate findings and
engage stakeholders from national and professional organizations to promote
the adoption of the Wiki-guidelines.
5. Collaboration: To collaborate with other projects in smoking cessation.
6. Evaluation: To evaluate the system and population impacts of the
proposed practice-based research network.
Clinical Practice
Guideline
RESEARCH
Research Agenda
National Network
Seed Grants
Dissemination
& Engagement
PRACTICE
Guideline Development
Guideline Development Process
Applied principles of ADAPTE*…..
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Review existing smoking cessation CPGs (internationally
and across disciplines)
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CPGs rated using the AGREE instrument
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Highest-scoring CPGs were used
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Sections subject to ongoing input by CAN-ADAPTT network
* ADAPTE. www.adapte.org (2007)
Pregnant and
Breastfeeding
Women/ Femmes
enceintes et qui
allaitent
Youth (Children
and Adolescents)/
Jeunes (enfants et
adolescents)
Mental Health and/or
Other Addictions/
Santé mentale et/ou
autres dépendances
Hospital-based
populations/
Populations des
hôpitaux
Aboriginal
Peoples/
Autochtones
Practice-informed Approach
Best available evidence filtered through end-users
Practitioner input is collected via:
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Annual General Meetings (n=2 with 50-60 participants)
Stakeholder meetings (n=118)
Presentations/Workshops (n=39)
Teleconferences/Webcasts (n=15)
Online discussion board (posts, n=221)
Member surveys (n=3)
Network
Network
• 800 members
Eastern
Canada
– National
– Interprofessional
Ontario
– Multidisciplinary
Western
Canada
Network
• 800 members
– National
Policy/
decision
Researcher maker
– Interprofessional
– Multidisciplinary
Health care
provider
Network
• 800 members
Chiropractor
Psychologist
– National
PT/OT
Social Worker
– Interprofessional
Physician
Pharmacist
– Multidisciplinary
Counsellor/Therapist
RT/Asthma Educator
Dental Professional
Nurse professional
0
50
100
150
200
250
Engagement and
Dissemination
Engagement and Dissemination
 Connected with 100+ organizations
 Promoted CAN-ADAPTT at 50+ conferences and events
• Workshops, poster presentations, key note address
 Website visitors from 66 countries
Engagement
 Regional coordinators
• Provide outreach
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Overall: Jess Rogers and Stephanie Elliott
Western Canada: Janet Ngo
Ontario: Tamar Meyer
Quebec: Denise Koubanioudakis
Atlantic Canada: Katie Hunter
CAN-ADAPTT’s Monthly
Transdisciplinary Tobacco Rounds:
6 Online/In-person Transdisciplinary Tobacco Rounds (TTR) held in
the past year
CAN-ADAPTT held monthly tobacco rounds, inviting speakers to
share their knowledge in smoking cessation treatment and
approaches, helping to promote best practices and share
experiences with network members.
Audience: practitioners, researchers, students and decision makers.
Attendees from across Canada
CAN-ADAPTT’s Monthly
Transdisciplinary Tobacco Rounds:
Special Transdisciplinary Tobacco Rounds Symposiums:
January 2011: "Exploring Law as a Tool in Canadian Tobacco Control and Public
Health Policy."
Presenters: Eric LeGresley M.Sc., LL.M., Barbara Russell, PhD, and David Sweanor,
B.A., J.D.
April 2010: “Neuroscience and Tobacco” (presented in conjunction with the CAMH
Neuroscience department);
Presenters: Dorothy Hatsukami, PhD, Fang Liu, PhD,
Maryka Quik, PhD
CAN-ADAPTT’s Monthly
Transdisciplinary Tobacco Rounds for 2010/2011:
February 2010: Martin Stampfli, PhD: “How cigarette smoke skews immune
responses to promote infection.”
June 2010: Dr. Milan Khara MBChB, CCFP, cert. ASAM: “Smoking Cessation in
Patients with Substance Use Disorders: The Vancouver Coastal Health Tobacco
Dependence Clinic”.
September 2010: Dr. Shawn O’Connor, Ph.D. "PUTTING DATA IN THE HANDS OF
STAKEHOLDERS: THE EXPERIENCE OF THE TOBACCO INFORMATICS
MONITORING SYSTEM (TIMS)“
November 2010: Heather Manson, MD MHSc FRCPC. "Evidence to Guide Action:
Comprehensive Tobacco Control in Ontario."
CAN-ADAPTT’s Webinar
“Lunch and Learn series”
CAN-ADAPTT has held 5 Lunch and Learn webinar series to date;
1.
2.
3.
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5.
Aboriginal Peoples: Sheila Cote-Meek, BScN, MBA, PhD
Pregnant and Breastfeeding Women: Alice Ordean, MD, CCFP, MHSc
Youth (Children and Adolesecents): Jennifer O’Loughlin, PhD
Hospital Based Populations: Robert Reid, PhD, MBA
Pharmacotherapy: Peter Selby,
These webinars are being held to discuss and explore each of the guideline sections.
Webinars are hosted by the lead developer of their respective section from the
Guideline Development Group.
Québec- Highlights
• Project in Québec began mid-December
2010
• Established an Advisory Committee
composed of policy makers, researchers,
professors, public health practitioners and
clinicians
• Held a first Advisory Committee meeting in February 2011
• Revising the translation of the documentation and the Website
Western Canada - Highlights
Key Successes:
 Collaborations with dental hygiene
organizations in Alberta (CRDHA &
Univ. of Alberta Dental Hygiene
program)
 Resource-sharing with Partnership to
Assist with Cessation of Tobacco
(PACT) in Saskatchewan
Atlantic Canada – Highlights
 Regional Smokers Helpline &
Advocacy Groups
• Smoke Free Nova Scotia
• SHL Newfoundland & Labrador
 New Brunswick Respiratory
Therapists
• Conference presentation
• Collaborative manuscript
Ontario - Highlights
 Canadian and Ontario Association of Public Health
Dentistry conference keynote/workshop
 Ontario Dental Assistants Association Affiliate
workshops
 Ontario Dental Hygienists Association
Impact and Evaluation
OTRU Evaluation
Ontario Tobacco Research Unit is conducting a mixed method evaluation.
1. On-line survey of CAN-ADAPTT members:
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Initial/baseline survey (February-March 2010)
Follow-up survey (February-March 2011)
2. Case-studies of health professions (interviews):
(1) dentists/dental hygienist; (2) family physicians; (3) pharmacists; (4) nurses
3. Semi-structured interviews with CAN-ADAPTT team
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Interviews aim to examine progress in establishing CAN-ADAPTT network,
promotion activities to recruit network members, management of the network,
processes of revision, update and dissemination of the guidelines
FINAL REPORT APRIL 2011
Learning and
Next Steps
Challenges:
Guideline Development
 New, experimental process
• learning curve for team and network members
 Pharmacotherapy section
 Applying LOE/GR
• building from existing LOE
• GRADE limitations
 ‘Clinical Practice Guideline’ vs ‘Implementation Guide’
 Balancing evidence, expert opinion, and network
feedback
Challenges:
Engaging a Network
 Challenges with encouraging use
of online platform
• Learning curve for network
members
 Lack of ‘final’ guideline for
providers
 Support and relationship building
 Coordinated dissemination &
engagement
Next Steps
 Funding beyond March 31/11 not secured
 CAMH will maintain CAN-ADAPTT website
 Open to new opportunities to collaborate for
funding
 Next steps for the project could include
– Wiki platform
– Revisit traditional methodology for application to a
practice-informed guideline
– Consistent integration of network members in the
process
– Sharing Best Practices (tools/resources etc.)
Lessons Learned
 Timing is everything
• Aligning launch of guideline with other efforts
• It takes time to build a self-sustaining network
• Huge need to continue small grant funding to
continue momentum and sustain great research
work in Canada
• Knowledge
Attitudes
Practice
This is just the beginning…..
Seed Grants
Seed Grants
Purpose: To make research more responsive to practice by
addressing gap in current practice guidelines, research question of
importance to Health Care Providers (HCPs)
Mechanism to support practice-informed approach of PBRN –
collaborative, Canadian researcher-practitioner teams (must
include >1 HCP)
Awards of up to $5,000 to facilitate preparation of a scientific product
in smoking cessation research (e.g.: lit review, pilot study,
publication, grant proposal)
CAN-ADAPTT Seed Grants
 23 applications received from across Canada; 12 funded
 Applicants: researchers, practitioners, and collaborations of
both.
Disciplines
Topic Themes
Proposed Products
• Optometry
• Women’s
health
• Addictions
• Mental health/
psychiatry
• Health
sciences
• Specific
populations
• Role of HCPs
• Counselling
• Capacity and
theory building
• Scientific publications
• Academic posters
• Grant proposals
• Collaborative
meetings
Current
 Reports were completed from each Seed Grant team
 CAN-ADAPTT Team teleconference with each Seed Grant
Team
• Feedback
• Status update
• Reflections on the Process
 Outstanding Achievements and overwhelming support for
CAN-ADAPTT process
 Full Seed Grant Report available April 2011