Grant: Operating Grant: Knowledge to Action

A Cluster Randomized Trial of Tailored vs Generic Knowledge Brokering to Integrate Mood Management into Smoking Cessation Interventions in Primary Care Settings in Ontario, Canada

Cluster Randomized Trial; Community Of Practice; Depression; Evidence-Based Practice; Knowledge Broker; Knowledge Translation; Mood Management; Primary Care; Smoking Cessation; Tailored And Targeted Messages

<html> <body> <p> <strong>Background</strong> Compared to smokers who are not depressed, smokers with depression who try to quit smoking are 10% less likely to succeed when given standard treatment.^{5, 6} A simple program with a detailed handout on relaxation exercises and a journal to record mood and urges to smoke when trying to quit has been shown to increase quit success in depressed smokers by 12 to 20%.^{1, 7-11} However, it remains unclear how to best implement this knowledge into primary care settings.¹² </p> <p> <strong>Setting</strong> CAMH&rsquo;s existing <em>Smoking Treatment for Ontario Patients</em> (STOP) program works in partnership with 80% of eligible Family Health Teams (FHTs) in Ontario and has treated 47,888 smokers with free nicotine replacement and counselling since July 2011.</p> <p> <strong>Research questions</strong> <br> </p> <ol> <li>Does a knowledge broker communicating via generic email reminders engage clinicians to provide patients resources for mood management more or less frequently than via interactive technology (eKB)?</li> <li>Which Knowledge Translation (KT) strategy used to change clinicians&rsquo; behavior (emails vs. eKB) has the greatest effect on smoking quit rates in depressed smokers?</li> <li>What is the incremental cost effectiveness of the two KT strategies?</li> </ol> <p> <strong>Research Approach</strong> Based on data already collected in the STOP Program, the STOP portal (an online data management and collection tool used by all STOP practitioners to complete participant enrollment and record smoking status at each visit), will flag smokers with current or past depressive symptoms. FHTs will be randomly allocated 1:1 to receive messages regarding depression and smoking exclusively via email (Group A) or via an eKB who will develop a one-on-one relationship with clinicians through frequent phone calls, web conferencing, and emails (Group B). We will compare which method is more effective in changing clinician behavior by recording the number of times resources are provided to eligible patients. We will also compare the smoking quit rates of patients from the two groups at 6-month follow-up and ask clinicians and patients what they liked and disliked about the program.<br> </p> <p> <strong>Expected outcomes</strong>:<br> </p> <p> <strong>Advancement of Knowledge and Healthcare:</strong> We will determine which KT strategy used to change clinician behavior has the greatest effect on smoking quit rates in depressed smokers.&nbsp;</p> <p> <strong>Contribution to Health Research:</strong> We will determine whether an e- strategy for knowledge mobilization works and for whom.&nbsp;</p> <p> <strong>Contributions to the Health System:</strong> The web-based portal used by STOP overcomes the issue of compatibility across various electronic medical records in FHTs. Adding a depression intervention to this system could lead to a system-wide implementation of integrated depression care pathways at relatively low cost, potentially reaching 2.25M Ontarians registered at these FHTs. Moreover, a technology-based knowledge broker (KB) model will help reduce travel costs and expand the reach of KBs in the future.<br> </p> <p> <strong>Application to Other Settings</strong> This initiative can be implemented in other healthcare settings that work with STOP such as Community Health Centres, Nurse-Practitioner Led Clinics, community addiction treatment agencies and Public Health Units (reaching 300 organizations and 1,067 clinicians). Similar strategies might also be useful for treatment-seeking smokers with other co-occurring conditions.<br> </p> <p>In summary, our proposal can answer questions about how to best change clinical practice across a wide geographic area to help depressed smokers quit and compare the costs of doing so.</p> </body> </html>