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CAN-ADAPTT: Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-Informed Tobacco Treatment

I Introducing CAN-ADAPTT
II Features
III Using CAN-ADAPTT: Getting Started
IV CAN-ADAPTT’s Seed Grant Opportunity
V Why Focus on Clinical Practice Guidelines?
VI Wiki, wiki what? – CAN-ADAPTT’s Wiki-guidelines
VII Benefits
VIII Conclusion

--submitted by Tamar Meyer, MA, Centre for Addiction and Mental Health, Toronto

I Introducing CAN-ADAPTT

The Centre for Addiction and Mental Health (CAMH) is pleased to present CAN-ADAPTT – the Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-Informed Tobacco Treatment. CAN-ADAPTT is a practice-based research network (PBRN) committed to facilitating knowledge exchange among those who are in positions to help smokers make changes to their behaviour (health promoters, providers and practitioners) and researchers in the area of smoking cessation. CAN-ADAPTT is designed to engage practitioners and healthcare providers in a process where research questions arise from front-line practice, positioning research to produce results that are clinically relevant and readily useable to healthcare professionals. Dr. Peter Selby, Clinical Director, Addictions Program and Head of the Nicotine Dependence Clinic at CAMH is the Director of CAN-ADAPTT, providing leadership, coordinating efforts and overseeing network membership and activities. CAN-ADAPTT is national in scope with infrastructure in three provinces – Ontario, Alberta and Quebec – and is funded by the Tobacco Programs Division, Health Canada.

CAN-ADAPTT has the following objectives:

  1. To create a national network of smoking cessation researchers, policy/decision-makers and practitioners/providers to inform smoking cessation research and practice.
  2. To develop a practice-informed research agenda in key areas of smoking cessation that bridges the gaps between clinical practice, research and theoretical frameworks.
  3. To translate research findings into a dynamic set of evidence-based guidelines on smoking cessation (i.e., Wiki-guidelines).
  4. To disseminate findings and engage stakeholders from national and professional organizations to promote the adoption of the Wiki-guidelines.

II Features

CAN-ADAPTT membership is open to all individuals interested in or working in the area of tobacco control, either working directly or indirectly with clients/patients. This user-friendly resource has the following features:

  • A discussion board where health promoters, practitioners and researchers can pose questions and engage in discussion related to smoking cessation.
  • Access to up-to-date clinical practice guidelines on smoking cessation.
  • Updates on meetings/conferences related to tobacco control.
  • Links to a variety of smoking cessation/tobacco control resources including websites, projects, literature reviews, and articles.
  • Seed grant opportunities for Canadian practitioner-researcher teams to fund projects that address gaps in research and existing tobacco control guidelines.

III Using CAN-ADAPTT: Getting Started

Register for CAN-ADAPTT by visiting http://www.can-adaptt.net. Members can post to the discussion board and communicate with other healthcare providers/practitioners across Canada.

To find a guideline on a specific topic related to tobacco control or smoking cessation, go to the resources page and click on “Wiki Clinical Practice Guidelines.” This link leads to the most recent version of the Dynamic Guidelines for Tobacco Control. The full text of this document can be searched by selecting “Find” from the “Edit” menu and typing in a keyword. For example, current guidelines related to smoking cessation interventions for youth can be found by typing in “youth” using the “Find” tool.''

These guidelines are termed “dynamic” in order to reflect a continuously evolving evidence base, practice environment, client needs and treatment opportunities. As such, users are invited to help identify gaps in these current better practice guidelines by posting comments, experiences and insight on the discussion board or by developing their own research questions. For example a general search for smoking cessation resources for “youth” might not yield smoking cessation guidelines and recommendations related specifically to GLBTTQ youth, revealing that no specific guidelines exist and little or no evidence-based research has been conducted. Health promoters and practitioners are invited to contribute to the network and address this gap by engaging in any of the following activities based on interest and capacity: make a comment or contribute to a conversation on the discussion board; post a practice question; work with your provincial coordinator to develop a research question addressing the gap; or develop a seed grant proposal with a team of your colleagues.

IV CAN-ADAPTT’s Seed Grant Opportunity

Seed grants awards of up to $5,000 are available to Canadian collaborative practitioner-researcher teams for the preparation of a scientific product in tobacco control research, e.g., literature review, pilot study, or funding proposal. The proposal should address a need and/or gap in the current practice guidelines identified by practitioners on any of the following suggested topics:

  • Counseling and psychosocial treatment, e.g., screening and assessment, treatment structure and intensity, treatment elements.
  • Medications, e.g., first-line medications including bupropion, nicotine replacement therapy, varenicline; second-line medications including clonidine, nortriptyline; and combination medications.
  • Specific populations, e.g., children and adolescents, light smokers, pregnant smokers.
  • System-level approaches to cessation, e.g., clinician/practitioner training, providing cessation treatment as a covered health benefit.

V Why Focus on Clinical Practice Guidelines?

In 2006, only half of Canadian smokers who saw their doctor in the previous year reported receiving advice to quit smoking and even fewer received advice from their dentist/dental hygienist (33.8%) or pharmacist (14.2%). [1] Providing practitioners and healthcare providers with appropriate tools and training can facilitate their smoking cessation practices. Clinical practice guidelines (CPG) are “systematically developed statements to assist practitioners and patients in arriving at decisions on appropriate health care for specific clinical circumstances.” [2] Clinical practice guidelines for tobacco control help healthcare professionals and practitioners provide the most up-to-date, evidence-based care and interventions to help their clients and patients quit smoking.

VI Wiki, Wiki What? – CAN-ADAPTT’s Wiki-guidelines

CAN-ADAPTT’s guideline development process is unique in that it utilizes a modified wiki to update guidelines as new evidence becomes available. According to Wikipedia, the world’s most well-known wiki, a “wiki” is a web page or collection of web pages designed to enable anyone with access to contribute or modify content, using a simplified markup language. [3] CAN-ADAPTT’s wiki feature allows guideline developers to directly edit and update the guidelines, allowing the timely incorporation of new scientific evidence and expert opinion, as well as allowing users to remove outdated recommendations. In comparison, traditional guideline development typically involves a scheduled review date (usually every 7–8 years), which may result in wasted resources if a scheduled review occurs in a slowly evolving field, or CPG’s that are out of date in a rapidly evolving field. CAN-ADAPTT’s guideline development process thus becomes a “continuous prospective exercise” [4] that results in a dynamic set of evidence-based wiki-guidelines that can be easily accessed by anyone with an internet connection (by visiting www.can-adaptt.net) and are relevant to the unique needs of practitioners and smokers in Canada.

VII Benefits

Benefits of becoming a CAN-ADAPTT member include:

  • Connecting/collaborating with other healthcare professionals and practitioners interested in tobacco control/smoking cessation across Canada.
  • Exchanging knowledge and expertise of better smoking cessation practices and tobacco control policies.
  • Access to the discussion board to post questions, receive feedback, disseminate information and resources.
  • Increasing the capacity and commitment among Canadian practitioners, tobacco control researchers, and policy developers in the area of tobacco control.
  • Access to up-to-date, evidence-based clinical practice guidelines for tobacco control in Canada.
  • Contributing to the first Canadian clinical practice guidelines for tobacco control.

VIII Conclusion

As more healthcare professionals and practitioners become involved with CAN-ADAPTT, the network will continue to grow and expand generating new research and knowledge and addressing gaps in the current set of clinical practice guidelines. This new evidence will then be incorporated, ultimately keeping the guidelines up-to-date and clinically relevant to those who are in the position to help smokers make changes to their behaviour.

If you would like to be part of CAN-ADAPTT’s practice-based research network or would like to comment on the existing version of clinical practice guidelines, visit the CAN-ADAPTT website and register to join the discussion.

For more information contact Tamar Meyer, Provincial Coordinator, CAN-ADAPTT at the Centre for Addiction and Mental Health at (416) 535-8501 x 7446 or tamar_meyer@camh.net.

IX References

[1] Leatherdale S, Shields, M. (2009). Smoking cessation among Canadian smokers: Intentions, attempts and techniques. Health Reports, 20:1-9.

[2] Field M, Lohr K. (1990). Clinical practice guidelines: Directions for a new program. Institute of Medicine. Washington, DC: National Academy Press.

[3] http://en.wikipedia.org/wiki/Wiki Accessed July 17, 2009

[4] Shekelle P, Eccles MP, Grimshaw JM, Woolf SH. (2001). When should clinical guidelines be updated? British Medical Journal. 323:155-157.