A prospective cluster-randomized trial to implement the Ottawa Model for Smoking Cessation in diabetes education programs (GRAND Study)
Clinical practice guidelines for treating tobacco use and dependence have been developed and stress that clinicians and health care delivery systems should consistently identify smokers and treat every tobacco user in a health care setting using counseling treatments and medications. Evidence alone is insufficient to change routine clinical practice if knowledge transfer or practice change processes are not undertaken to alter current practices. The Ottawa Model for Smoking Cessation (OMSC) is a knowledge transfer and practice change process to introduce evidence-based interventions for smoking cessation into clinical practices. The GRAND study uses a randomized control trial design to determine the effectiveness of the OMSC within Diabetes Education Programs (DEPs) in addressing smoking cessation among smokers with diabetes, and in doing so, improving quit rates in this high risk population.
Study Design and Purpose
This is a 52-week, matched-pair cluster design trial in 18 DEPs in Ontario. These sites will be matched based on baseline rates of assistance with smoking cessation at each clinic. Within each pair, sites will be allocated randomly to either OMSC intervention or control groups. From each participating DEP, a “before” and “after” sample of 70 smokers will be recruited to assess smoking cessation outcomes. In a three-month period between the “before” and “after” samples, strategies to implement the OMSC will be carried out at the intervention sites.
Significance of the Research
Type 2 diabetes mellitus (T2DM) is a chronic disease that requires a lifelong commitment to complex lifestyle modifications. While primary care physicians are at the forefront of providing support for people living with T2DM, community-based DEPs have been developed to support patient self-care behaviours (e.g. adherence to medications, insulin therapy, nutrition management, regular blood glucose monitoring, and physical activity). We reviewed the processes related to advice and assistance regarding smoking cessation from DEPs in Ontario and found that specific assistance for smoking cessation was rarely provided in DEPs. This is a potential missed opportunity to assist a high-risk group of smokers.