Spotlight on Health

Stopping Ontario’s health care from going up in smoke

Imagining Dr. Peter Selby as the hero firefighter bravely battling the flames that burn through Ontario’s spending on healthcare isn’t that far from the truth. He’s been on the frontlines for nearly two decades, helping ordinary Ontarians, as well as policy makers, find ways to conquer addictions and the added costs related to tobacco and other substance abuse.

Now chief of the Addictions Division at the Centre for Addiction and Mental Health (CAMH), Dr. Selby, a trained family doctor, recalls there were times at the start when he felt very much isolated at the forefront of this kind of work especially for those with mental illnesses and other addictions. He describes “a barren landscape” in the early 2000s in terms of the ability to help people with quitting.

“Tobacco addiction wasn’t being taught anywhere — not in medical or nursing school — so most people were left to their own devices to quit,” he explains.

Dr. Selby

Fortunately, Dr. Selby wasn’t entirely alone. It was a challenge the Ontario Medical Association took on early, providing a strong voice in shaping policy initiatives, lobbying for legislation to limit tobacco exposure, marketing and youth access and helping patients to quit. It was a turning point in the fight against the health costs of tobacco exposure and use, and Ontario led the way both in Canada and around the world. The next step was to turn that policy into better patient care.

“Evidence was mounting but we had a research-practice gap,” describes Dr. Selby.

That’s when Dr. Selby developed the Training Enhancement in Applied Cessation Counselling and Health (TEACH) Course, a continuing education certificate program for health care professionals. Hugely successful, the TEACH program reduced the knowledge gap. But training alone was not enough.

Program implementation through the Smoking Treatment for Ontario Patients (STOP) has been adopted in
over 80 per cent of family health teams and community health centres across Ontario, enabling them to
assess patients and provide them with nicotine replacement and counselling.

Over the past eight years, TEACH has trained 6,500 practitioners from across 15 disciplines, many of whom are practice leaders in their communities. More than 120,000 smokers have been treated through STOP with 40,000 of these through 300 primary care sites in the last two years, reports Dr. Selby.

“We provide free nicotine replacement, a community of practice for coaching practitioners, quality improvement and evaluation at the practice and patient level.”

Programs like this helped Ontario make a lot of progress, but quitting rates have now plateaued. With approximately two million Ontarians still smoking, Dr. Selby and Ontario’s doctors are redoubling their efforts. With advocacy for legislation to ban flavoured tobacco that are designed to lure young users, and new programs to tackle tobacco addiction in populations with mental health co-morbidities, other addictions and pregnant women, it’s a challenge that Dr. Selby and his colleagues are determined to help patients and our health system overcome.

Posted on January 19, 2017 in newsletter

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