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 Rationale Methodology Results Challenges & Lessons Learned  Seed Grant Presentations  Discussion and Next Steps

CAN-ADAPTT Team  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  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  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 Meridene Haynes John Tucker Judy Lux Dr. Euan Swan Jayne Thirsk Tony D'Urzo Tracy Vanderwoude Dr. Kirsten North Kristine Petrasko Dr. Maura Ricketts Health Canada Asthma Society of Canada Canadian Chiropractic Association Canadian Dental Hygienists Association Canadian Dental Association Dieticians of Canada Director, Primary Care Lung clinic Canadian Nurses' Association Canadian Association of Optometrists Canadian Pharmacists Association Canadian Physiotherapy Association

Professional Advisory Group Carol Miller Dr. Sonu Gaind Dr. Karen Cohen Chritiane Menard Donna Czukar Doug Brothwell Brenda McGibbon Lammi Karen Poole Bob Reid Millicent Toombs Canadian Physiotherapy Association Psychiatrists Canadian Psychological Association Canadian Society of Respiratory Therapists Canadian Cancer Society Canadian Association of Public Health Dentists Canadian Association of Occupational Therapists (CAOT) Royal Ottawa Care Group & Ontario Assoc. of Social Worker University of Ottawa Heart Institute 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 under- investigated.” (Tierney et al., 2007)

Structure of Care System Level Process of Care Organization/Setting Level Content of Care Provider/Patient Level ‘IDEAL’ CARE CURRENT CARE CARE GAP Barriers and the Care Gap Research Experience 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 adapt evidence to the Canadian context through a practice-informed approach 3.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.

Dissemination & Engagement Clinical Practice Guideline Research Agenda Seed Grants PRACTICE RESEARCH National Network

Guideline Development

Guideline Development Process Applied principles of ADAPTE*…..  Review existing smoking cessation CPGs (internationally and across disciplines)  CPGs rated using the AGREE instrument  Highest-scoring CPGs were used  Sections subject to ongoing input by CAN-ADAPTT network * ADAPTE. (2007)

Aboriginal Peoples/ Autochtones Hospital-based populations/ Populations des hôpitaux Mental Health and/or Other Addictions / Santé mentale et/ou autres dépendances Pregnant and Breastfeeding Women/ Femmes enceintes et qui allaitent Youth (Children and Adolescents)/ Jeunes (enfants et adolescents)

Practice-informed Approach Best available evidence filtered through end-users Practitioner input is collected via: Annual General Meetings (n=2 with participants) Stakeholder meetings (n=118) Presentations/Workshops (n=39) Teleconferences/Webcasts (n=15) Online discussion board (posts, n=221) Member surveys (n=3)

Network

800 members –National –Interprofessional –Multidisciplinary

Network 800 members –National –Interprofessional –Multidisciplinary

Network 800 members –National –Interprofessional –Multidisciplinary

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 and Dissemination

Engagement  Regional coordinators Provide outreach – 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.Aboriginal Peoples: Sheila Cote-Meek, BScN, MBA, PhD 2.Pregnant and Breastfeeding Women: Alice Ordean, MD, CCFP, MHSc 3.Youth (Children and Adolesecents): Jennifer O’Loughlin, PhD 4.Hospital Based Populations: Robert Reid, PhD, MBA 5.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

Ontario Tobacco Research Unit is conducting a mixed method evaluation. 1. On-line survey of CAN-ADAPTT members: 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 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 OTRU Evaluation

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

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) Seed Grants

CAN-ADAPTT Seed Grants  23 applications received from across Canada; 12 funded  Applicants: researchers, practitioners, and collaborations of both. Topic Themes Proposed Products Scientific publications Academic posters Grant proposals Collaborative meetings Optometry Women’s health Addictions Mental health/ psychiatry Health sciences Specific populations Role of HCPs Counselling Capacity and theory building Disciplines

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