Background
Brief History
The CAN-ADAPTT Practice-Based Research Network (PBRN) was established in 2008 with funding from Health Canada’s Federal Tobacco Control Strategy. The overall goal is to facilitate research and knowledge exchange among those in positions to help smokers make changes to their behaviour (e.g., practitioners, healthcare and service providers) and researchers so to inform the development of a dynamic set of cessation guidelines for use in clinical practice and population-based strategies within Canada.
CAN-ADAPTT is designed to engage practitioners and health care/service providers, in a “bottom-up” process whereby research questions are informed by “real-world” clinical practices, positioning the research to produce results that are readily applicable in the practice setting.
Why focus on Clinical Practice Guidelines?
Despite the existence of a seemingly comprehensive set of clinical practice guidelines for smoking cessation, only about half of Canadian smokers reported receiving advice from their healthcare provider to quit or reduce the amount they smoke (CTUMS, 2006). Healthcare providers have indicated a number of reasons as to why they have not completely embraced the guidelines:
- the research-driven approach used to develop ‘evidence-based’ guidelines;
- the lack of generalizability of such research findings to their actual patient population;
- inadequate awareness of the guidelines; and,
- lack of practitioner training
(Cabana et al., 1999; Schultz et al., 2006; Gelskey et al., 2002; Rowan et al, 1998).
Given that clinical interventions have demonstrated a strong capacity in helping smokers quit (Prochaska, 2000), addressing the gap between recommended care and actual care is crucial to achieving and maintaining lower overall smoking prevalence in Canada. CAN-ADAPTT aims to address this gap by:
- facilitating practice-based research informed by a dynamic set of smoking cessation guidelines; and,
- promoting and educating practitioners and healthcare/service providers in the use of these guidelines.
The guidelines are termed “dynamic” in order to reflect a continuously evolving evidence base, practice environment, client needs and treatment opportunities.
Evidence for Practice-Based Research Networks (PBRNs)
Traditionally, clinical research questions are defined by academia-based investigators. In CAN-ADAPTT, practitioners and health care/service providers can define and frame research questions based on what they see in their practices. The research results are then more readily applicable in the practice setting.
CAN-ADAPTT has recruited existing clinical research apparatus (i.e., The STOP Study, University of Ottawa Heart Institute, etc.) and better-practices training organizations with the proven capacity to deliver (i.e., TEACH, WATI, PREGNETS, etc.) to aid in:
- building the initial research capacity of the network; and
- training network members in implementing the outputs of the research.
Sound evidence supports the practice-based research model to meet the needs identified. There is a strong body of literature produced by primary care PBRNs that demonstrate the ability of this “bottom-up” research model to produce results that can exert immediate impact on practice.
Examples:
(1) A recent report by RIOS Net, a practice based research network of primary care physicians in New Mexico, identified Hispanic women to be the largest proportion of smokers in their practice population (Ralston et al., 2007). These results allow for more efficient delivery of smoking cessation or prevention intervention to RIOS Net patients, than population based surveys that identify white males to be most common and Hispanic females to be least common smokers in New Mexico.
(2) OKPRN, a network of practicing family physicians in Oklahoma, evaluated several methods of managing laboratory test results in their practice settings. Subsequently, many of the practices in the network readily adopted all or portions of the method found to be most efficient (Mold et al., 2000).