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Current Cessation Projects

Current cessation work includes evaluations of various quit smoking initiatives in a variety of settings including the workplace and health care settings, a study of effectiveness and cost effectiveness of cessation services, an examination of the use of the existing cessation system in Ontario, an assessment of current government incentives and regulatory policies related to health insurance coverage for cessation treatment, work to better capture tobacco related information in electronic health records, and creation of a smokers’ panel that will provide a platform for studies on cessation pathways, factors related to relapse, and intervention outcomes.

Current State and Perspectives on Health Insurance Coverage of Smoking Cessation Treatment in Ontario

Start Date: May 2010
Expected Date of Completion: March 2013
Principal Investigator: Robert Schwartz
Co- Investigators: Alexey Babyan, Roberta Ferrence, Chris Longo
Project Team: Farzana Haji
Source of Funding:Canadian Institutes of Health Research

Project Description

This project assesses current government incentives and regulatory policies that affect insurer decisions about coverage of cessation interventions in health benefit packages.

Scope

The project examines the current state of health insurance coverage of cessation benefits in Ontario, explores how insurers make decisions on the extent of coverage, identifies major barriers faced by health insurers and employers in expanding coverage for cessation services, examines the effects of incentives and regulatory policies in other jurisdictions on coverage, uptake, reach and cessation rates, and provides strategic policy recommendations.

Main Research Questions
  • What is the current state of health insurance coverage for smoking cessation treatments in Ontario?
  • What can be learned from Canadian and international experience about creating environments conducive to inclusion of cessation services in health benefits?
  • What are the most effective policy tools and measures by government to encourage insurance coverage for smoking cessation treatment?
Methodology
  • Review of best practices in other jurisdictions with in-depth examination of selected cases
  • Semi-structured interviews with key informants

Data Standards

Start Date: May 2012
Expected Date of Completion: March 2013
Project Lead: Sue Keller-Olaman
Principal Investigators: Sue Bondy, Steve Brown, Robert Schwartz
Project Team: Lori Diemert
Funding Source:Ministry of Health and Long-Term Care

Project Description

Data standards ensure that data in one part of the health system is available and meaningful across a range of settings such as primary care and other health settings, clinical practice settings, research studies and NGO initiatives. Standards increase efficiency and responsiveness. The exchange of health information in an electronic format, and the pooling of data from multiple sources (e.g., multiple service providers, laboratory results, etc.), favour the adoption of a standardized language and format. OTRU is developing standards for data collection and reporting, including a standardized minimal dataset of tobacco-related elements (with definitions) that can be incorporated into an electronic health record.

Scope

This project has two aims

  • Creation of a dataset for those providing cessation services under the Smoke-free Ontario umbrella, seeking data collection and reporting standards. The common data would be comprehensive but not exhaustive, and would include the minimal dataset.
  • Creation of a minimal dataset (MDS) that may be included in an e-health record for all patient records in the health care system (e.g., 5 or so standard tobacco-related questions).
Main Research Questions
  • What standards are most important for a tobacco-related minimal dataset?
  • What standards are most important to support a systematic approach for cessation projects funded by Smoke-Free Ontario?
Methodology
  • A scan of existing questions, standards and definitions in Ontario and other jurisdictions.
  • Development of a framework for the fields of information gathered, highlighting common elements (at the outset favouring Ontario-based information).
  • Completion of a document with the distillation of information and working with stakeholders, establish a process to reach agreement on the final dataset questions and definitions.

Developmental Evaluation of Workplace Cessation Initiative

Start Date: August/ Sept 2012
Expected Date of Completion: March 2014
Project Lead: Sue Keller-Olaman
Principal Investigators: Sue Bondy, John Garcia, Robert Schwartz
Project Team: Emily DiSante, Sylvia Hoang
Funding Source:Ministry of Health and Long-Term Care

Project Description

Using a realist approach, this research investigates how workplace smoking cessation initiatives’ setting, and social and organizational contexts influence outcomes and draws attention to understanding how and why workplace-based cessation initiatives work.

Scope

This project evaluates workplace-based smoking cessation initiatives in 11 selected demonstration sites in Ontario. The initiatives aim to reduce present levels of smoking and the research focuses on four employment sectors: construction, mining, manufacturing and hospitality.

Main Research Question
  • What workplace-based smoking cessation initiatives are effective for which sub-group of workers, in what circumstances?
Methodology
  • Baseline and post-initiative surveys
  • Semi-structured interviews with public health practitioners, managers, workplace leaders and selected program participants

Effectiveness and Cost Effectiveness of Cessation Services

Start Date: Fall 2012
Expected Date of Completion: March 2013
Project Lead: Sue Keller-Olaman
Principal Investigators: Sue Bondy, Steve Brown, Robert Schwartz
Project Team: Lori Diemert and Rita Luk
Funding Source:Ministry of Health and Long-Term Care

Project Description

Currently smoking cessation interventions are delivered at different settings such as hospitals, primary care and pharmacy, and by different healthcare providers such as physicians, nurses, pharmacists, respiratory therapists, peer-coaches, etc. s Using results from existing studies and new data, we are working with partners to conduct appropriate cost-effectiveness analysis. Information on effectiveness and cost effectiveness will help stakeholders better plan their interventions.

Main Research Question
  • What can be learned from an analysis of effectiveness and cost effectiveness to improve current cessation interventions?
Methodology
  • Secondary data analysis

Evaluation of Demonstration Projects Designed to Support Smoking Cessation During and After Pregnancy

Start Date: December 2010
Expected Date of Completion: December 2012
Principal Investigator: Robert Schwartz
Project Lead: Sue Keller-Olaman
Co-Investigators: Alexey Babayan, Maritt Kirst
Project Team: Tracey Borland
Source of Funding:ECHO: Improving Women’s Health in Ontario

Project Description

This project is an evaluation of the implementation (formative evaluation) and effectiveness (outcome evaluation) of three demonstration projects to support smoking cessation during and after pregnancy.

Main Research Questions
  • What are the key factors related to the implementation and effectiveness of these demonstration projects?
  • What insights can be learned about improvement in the different approaches taken by each demonstration project?
Methodology

Mixed Methods

  • Survey of participants
  • Qualitative inquiry (i.e. interviews, focus groups, observations)
  • Review of program documents and administrative records

Exploring Opportunities and Challenges for Developing a New Coordinated Smoking Cessation System in Ontario

Start Date: April 2012
Expected Date of Completion: March 2013
Project Lead: Maritt Kirst
Principal Investigators: Sue Bondy, Steve Brown, John Garcia, Robert Schwartz
Project Team: Alexey Babayan, Michael Chaiton, Jaklyn Andrews, Emily Di Sante
Source of Funding:Ministry of Health and Long-Term Care

Project Description

Cessation is a complex process that may span from many months to years, and evidence shows that the paths to cessation are varied. A coordinated system would be able to attract tobacco users and support them throughout their entire cessation process. Currently, there is not a coordinated tobacco user support system in Ontario. However, existing services/programs provide a basis for such a coordinated system. This project explores the experience of tobacco users with existing cessation services/programs and identifies opportunities for strengthening linkages across these services/programs.

Research Questions
  • What are tobacco users’ experiences with existing cessation services/programs in Ontario?
  • To what extent are their cessation needs being met as they move through the cessation system?
  • What recommendations do tobacco users have for improvements in linkages and continuity of care among cessation services?
Methodology
  • Quantitative survey to map out common cessation service pathways,
  • In-depth qualitative, narrative interviews to explore service use trajectories and experiences

Formative Evaluation of the STOP with Family Health Teams and STOP with Community Health Centres Programs

Start Date: August 2011
Expected Date of Completion: March 2013
Project Lead: Alexey Babayan
Principal Investigators: Sue Bondy, Steve Brown, John Garcia, Robert Schwartz
Project Team: Erika Yates in collaboration with CAMH team
Funding Source: Ministry of Health and Long-Term Care

Project Description

STOP with Family Health Teams (FHTs) and STOP with Community Health Centres (CHCs) are programs funded by the Ministry of Health and Long-Term Care to enhance support to smokers by providing access to free nicotine replacement therapy and smoking cessation counselling. This formative evaluation of the programs aims to: validate that program activities are being implemented as planned; explore variation in program implementation across participating FHTs and CHCs; and inform improvements and adjustments to the programs. Evaluation findings are fed back to participating FHTs and CHCs to facilitate learning and sharing of best practices across participating health care settings.

Scope

The evaluation assesses program outcomes and effects at the patient (smokers), implementer (health professional), and organizational (FHT/CHC) levels; and explores the relationships among contexts, mechanisms, and outcomes.

Main Research Questions
  • To what extent is the program influencing the quitting behaviours of individual participants as well as sub-populations?
  • To what extent and how is the program affecting the provision of smoking cessation service by health professionals?
  • To what extent and how is the program influencing the development of cessation policies and practices within FHTs and CHCs?
  • How can the STOP with FHTs and STOP with CHCs programs further improve the delivery of the intervention?
  • How are the STOP with FHTs and STOP with CHCs programs influencing the smoking cessation system in Ontario?
Methodology
  • Longitudinal case studies of select FHTs and CHCs (including a series of semi-structured interviews with managers, health professionals, and patients)
  • Baseline and follow-up surveys of FHTs, CHCs
  • Baseline and follow-up assessments of patients
  • Program performance data (e.g. distribution of NRT, patient enrolment, etc)

Physical Exercise for Smoking Cessation: Evaluation of the Quit and Get Fit Program

Start Date: February 2011
Expected Date of Completion: May 2013
Principal Investigator: Robert Schwartz
Project Lead: Alexey Babayan
Source of Funding:Ontario Lung Association

Project Description

Since 2010, the Ontario Lung Association has been implementing the Quit & Get Fit program to assist smokers in quitting by offering an exercise program and behavioural smoking cessation support. This project is evaluating the process of program implementation and its effectiveness in helping smokers quit and improve their levels of physical activity.

Main Research Question
  • Can Quit and Get Fit, an intervention that combines physical exercise and smoking cessation assistance provided by personal trainers – lead to smoking cessation outcomes and better physical fitness that a personal trainer facilitated physical exercise intervention alone?
Methodology
  • Web-based baseline and follow-up surveys of participants,
  • Web-based survey of personal trainers
  • Case studies of fitness facilities
  • Analysis of administrative data

RNAO Provincial Nursing Best Practice Smoking Cessation Initiative Assessment

Start Date: September 2012
Expected Date of Completion: December 2012
Principal Investigator: Robert Schwartz
Project Lead: Alexey Babayan
Source of Funding:Registered Nurses’ Association of Ontario

Project Description

This project examines how the RNAO smoking cessation initiative builds capacity for smoking cessation and affects treatment of tobacco dependence under a variety of contexts.

Scope

The project assesses the effects of the smoking cessation initiative on smoking cessation practice at individual and organizational levels and assesses the initiative’s impact on Public Health Unit programming in smoking cessation and other chronic disease prevention work.

Main Research Question
  • What is the impact of the RNAO smoking cessation initiative on current practice and Public Health programming?
Methodology

Mixed Methods

  • Key informant interviews
  • Focus group
  • Case studies
  • Web-based surveys

Smokers’ Panel

Start Date: May 2012
Expected Date of Completion: Ongoing
Project Lead: Robert Schwartz
Principal Investigators: Sue Bondy, Steve Brown
Project Team: Sue Keller-Olaman, Lori Diemert, Alexey Babayan, Michael Chaiton, Shawn O’Connor
Funding Source: Ministry of Health and Long-Term Care

Project Description

An Ontario-based smokers’ panel that consists of current tobacco users and those who are trying to quit is under development. Members of the panel are being recruited through cessation services and via a question included in the minimal dataset (Data Standards project). A series of innovative studies will use the powerful interlinked data platform of a Smokers’ Panel, incorporating both quantitative studies with in-depth qualitative exploration to better understand areas such as long-term relapse, smoking cessation pathways and outcomes with planned interventions.

Potential Research Questions
  • What is the impact and effectiveness of existing smoking cessation interventions implemented by Smoke Free Ontario partners at reducing smoking prevalence in Ontario?
  • What is the relative cost-effectiveness of different cessation approaches and interventions, including those that engage smokers in the long-term to prevent relapse?
  • How can barriers to implementing effective cessation interventions be overcome among specific sub-populations?
Methodology

Mixed Methods

  • Survey
  • Qualitative enquiry