Scaling Smoking Cessation in the Community: TEN Years of Implementation and Dissemination in Ontario, Canada. Dr. Peter Selby 1,2 , MBBS, CCFP, FCFP, MHSc, DipABAM, DFASAM Panel Presentations : TEACH Project: Ms. Rosa Dragonetti 1 STOP Program: Dr. Laurie Zawertailo 1,2 Indigenous Adaptation: Ms. Megan Barker 1,2 1 Centre for Addiction and Mental Health 2 University of Toronto Toronto, Ontario, Canada
Disclosures (5 years) Grants/Research Support: • CAMH, Health Canada, OMOH, CIHR, CCSA, PHAC, Pfizer Inc./Canada, OLA, • Medical Psychiatry Alliance, ECHO, CCSRI, CCO, OICR, Ontario Brain Institute, • McLaughlin Centre, AHSC/AFP, WSIB, NIH, AFMC, Shoppers Drug Mart, • Bhasin Consulting Fund Inc., Patient-Centered Outcomes Research Institute Speaking Engagements (Content not subject to sponsors approval)/Honoraria: • Pfizer Canada Inc., ABBVie, Bristol-Myers Squibb Consulting Fees : • Pfizer Inc./Canada, Evidera Inc., Johnson & Johnson Group of Companies, • Medcan Clinic, Inflexxion Inc., V-CC Systems Inc., MedPlan Communications, • Kataka Medical Communications, Miller Medical Communications, • NVision Insight Group, Sun Life Financial Other: (Received drugs free/discounted for study through open tender process) • Johnson & Johnson, Novartis, Pfizer Inc. NO TOBACCO or ALCOHOL or FOOD INDUSTRY FUNDING
Tobacco Use • 37-45k annual deaths in Canada • 2 M of 5M smokers live in Ontario • Mostly male, less than high school, blue collar, working poor • Comorbid mental illness and addiction
Challenge • Untrained/uninterested workforce • No coverage for smoking cessation • Limited budget for cessation • Tobacco control no balance, population versus clinical responses • Stigma- do it on your own! • My clinic= 1000 patients annually
Funder question to me Can you help us treatment smokers in Ontario?
Early models • Proceed- precede model- Green for Pregnets (www.pregnets.org) • Greenhalgh • KTA- Strauss • Addiction and behaviour model
Society Behaviour and Biology: Making the Case for EBB interventions T.A. Glass, M.J. McAtee / Social Science & Medicine 62 (2006) 1650 – 1671
Integrated model • Values based – Compassion Clinic – Acceptance – Partnership Research Training – Evocation (Bench to and Public technical – Equity Health assistance $$$Multisource funding model
Wandersman, et al. (2008). Bridging the gap between prevention research and practice: The interactive systems framework for dissemination and implementation. American journal of community psychology, 41(3-4), 171-181.
Evaluation model • R x E- Abhrams • REAIM Glasgow • Our addition to guide planning REAIM/T+M
2005/06 Ontario Ministry of Health announced funding for smoking cessation. Our program would support a provincial cessation strategy. TRAINING AND IMPLEMENTATION REDUCING CAPACITY OF EVIDENCE-BASED INEQUITY: BUILDING INTERVENTIONS ADAPTATIONS
TEACH A Knowledge Translation/Training Program in Intensive Tobacco Cessation Rosa Dragonetti 1 MSc, RP, Myra Fahim 1 , Megan Barker 1,2 , MA, MSc, BEd, Mathangee Lingam 1 , Sheleza Ahad 1 , Arezoo Ebnahmady 1 , PhD, Peter Selby 1,2 , MBBS, CCFP, FCFP, MHSc, DipABAM, DFASAM 1 Centre for Addiction and Mental Health 2 University of Toronto Toronto, Ontario, Canada
Disclosures (5 years) No disclosures
Wandersman, et al. (2008). Bridging the gap between prevention research and practice: The interactive systems framework for dissemination and implementation. American journal of community psychology, 41(3-4), 171-181.
Prevention Support System Train Health Care Providers NDS creates program to build inter- professional capacity in evidence-based tobacco dependence among Ontario practitioners across disciplines and diverse healthy/social service settings. Wandersman, et al. (2008). Bridging the gap between prevention research and practice: The interactive systems framework for dissemination and implementation. American journal of community psychology, 41(3-4), 171-181.
Straus SE, Tetroe J, Graham I. Defining knowledge translation. CMAJ. 2009; 181(3-4):165-168.
Select, tailor, implement interventions From in-person to online Practice Leaders for local support Assess barriers to knowledge Monitor knowledge use use Evaluate outcomes 3 month follow ups/evaluation 6 month follow ups Listserv plus experts provide Level 5 and 6 evaluation solutions/options Adapt knowledge to local context Sustain Knowledge Use Ongoing feedback from Listserv, Education Rounds, practitioners on issues specific Consultations, Toolkits, to their settings (primary care, Videos, Advanced Issues cancer, etc) conference, etc. Identify, Review, Select Knowledge Ongoing changes to knowledge (e.g., electronic devices, cannabis, etc) Adapted from Straus SE, Tetroe J, Graham I. Defining knowledge translation. CMAJ. 2009; 181(3-4):165-168.
Knowledge Synthesis Knowledge Products & Tools Selby P, et al BMJ Open. 2017 Nov 3;7(11)
Identify, Review, Select Knowledge Prescribe cessation Screen for medication tobacco use Provide Cognitive Behaviourial Therapy Use a harm reduction approach Advocate for my clients
Adapt Knowledge to Local Context Primary Care Public Addictions Family Health Teams Health and Mental Community Health Centres Community Nurse-Practitioner Led Health Workshops Clinics
Need more Funding Staff/peer concrete resistance clinical tools Need more practice Organizational Time Support Assess Barriers to Knowledge Use
Monitor Knowledge Use and Evaluate Outcomes 3- and 6- Patient Pre- and Formative Summative month Outcomes Post-Course Evaluations Evaluation Follow-up and Assessments Surveys Interviews
Sustain Knowledge Use TEACH Community of Practice TEACH YouTube channel: E-mail http://www.youtube.com/ Listserv user/teachproject Coaching by TEACH Monthly Webinars Trainer’s Toolkits
Sustain Knowledge Use
Training Outcomes 83% 5774 Set practice goals Practitioners trained From 37+ disciplines in 1300 organizations Significant increase in feasibility, importance, and confidence in changing practice (p<0.05) 76% Offering cessation interventions (~38% response rate) 6 80.9% Engaging in knowledge transfer activities Community of Practice Outcomes 111 826 800+ Webinars TEACH Listserv Toolkits offered subscribers disseminated
Thank You! Rosa.Dragonetti@camh.ca www.teachproject.ca www.nicotinedepenceclinic.com
The Smoking Treatment for Ontario Patients (STOP) Program: 10 Years of Implementation and Dissemination in a Variety of Clinical Settings Laurie Zawertailo, PhD Senior Scientist, Nicotine Dependence Service, Centre for Addiction and Mental Health Associate Professor, Dept. of Pharmacology and Toxicology, University of Toronto Toronto, Ontario CANADA
Disclosures • NO FINANCIAL DISCLOSURE • GRANTS – Pfizer Inc. Canada, Pfizer Global – Global Research Awards for Nicotine Dependence (GRAND Grant), Health Services Research Fund – Ontario Ministry of Health and Long-term Care, Canadian Institutes of Health Research, Canadian Cancer Society Research Institute • NO TOBACCO FUNDING
What is the STOP Program? Smoking Treatment for Ontario Patients • An evidence-based program examining the effectiveness of different methods of providing cost- free smoking cessation treatment to Ontario smokers • Goal: To decrease smoking prevalence in Ontario
STOP Program Goals Revolutionize how smoking cessation treatment is delivered Increase access to free treatment for Ontario smokers Decrease prevalence of smoking in Ontario Build practitioner and system capacity for delivering treatment
In The Beginning… • In 2005, we were awarded one-time funding from the government of Ontario to distribute Nicotine Replacement Therapy (NRT) • A pilot study was done in partnership with tertiary care centres (CAMH, Ottawa Heart Institute & Thunder Bay Regional Cancer Centre) • In January 2006 we conducted a 1-800 mass distribution of NRT to over 13,000 Ontarians – the first program of its kind in Canada. • Due to the success and popularity of these pilot projects, the “STOP Program” was born, and our funding has continued under the Smoke -Free Ontario strategy
History of STOP 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Tertiary-Care Centres Public Health Units Mass Distribution Community Pharmacies Community Health Centres 1st engagement STOP on the Road workshops with PHUs Internet-based Enrolment Family Health Teams 1st engagement Family Physicians Family Health Teams 2nd engagement Community Health Centres 2nd engagement Addiction Agencies Workplace Project Aboriginal Health Access Centres Nurse Practitioner-Led Clinics Hospital Project
Mass Distributions and Mail-Outs (Phone & Web-based Enrollment) Using technology to enrol participants 46,994 allowed virtually ANY participants eligible smoker in across all regions Ontario to access free of Ontario NRT
STOP on the Road: Mobile Smoking Cessation Clinics • Workshops held with Public Health Units across Ontario • > 26,000 participants • Able to reach underserved and sparsely-populated regions
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