Barriers and Facilitators in the Recruitment and Retention of More Than 250 Small Independent Primary Care Practices for EvidenceNOW

Cuthel, Allison; Rogers, Erin; Daniel, Flora; Carroll, Emily; Pham-Singer, Hang; Shelley, Donna

doi:10.1177/1062860619893422

Cited by 8 publications

(16 citation statements)

References 31 publications

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“…To address these challenges, EvidenceNOW grantees made recommendations for recruitment and retention strategies including increasing the recruitment budget, engaging stakeholders early to align research goals with practices' priorities, and maintaining consistent communication. [24][25][26][27] Our findings also suggest that implementers consider using data already routinely collected by the practice, which might mitigate the Hawthorne effect while making participation less onerous to the practice. During site selection, implementers should consider whether a practice has the capacity at the start to generate data needed for the trial; if not, allocate resources from the research budget so any burden associated with modifying data infrastructure and collection does not fall on the practice.…”

Section: Discussionmentioning

confidence: 62%

Considerations Before Selecting a Stepped-Wedge Cluster Randomized Trial Design for a Practice Improvement Study

et al. 2022

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PURPOSE Despite the growing popularity of stepped-wedge cluster randomized trials (SW-CRTs) for practice-based research, the design's advantages and challenges are not well documented. The objective of this study was to identify the advantages and challenges of the SW-CRT design for large-scale intervention implementations in primary care settings. METHODSThe EvidenceNOW: Advancing Heart Health initiative, funded by the Agency for Healthcare Research and Quality, included a large collection of SW-CRTs. We conducted qualitative interviews with 17 key informants from EvidenceNOW grantees to identify the advantages and challenges of using SW-CRT design. RESULTSAll interviewees reported that SW-CRT can be an effective study design for largescale intervention implementations. Advantages included (1) incentivized recruitment, (2) staggered resource allocation, and (3) statistical power. Challenges included (1) time-sensitive recruitment, (2) retention, (3) randomization requirements and practice preferences, (4) achieving treatment schedule fidelity, (5) intensive data collection, (6) the Hawthorne effect, and (7) temporal trends. CONCLUSIONSThe challenges experienced by EvidenceNOW grantees suggest that certain favorable real-world conditions constitute a context that increases the odds of a successful SW-CRT. An existing infrastructure can support the recruitment of many practices. Strong retention plans are needed to continue to engage sites waiting to start the intervention. Finally, study outcomes should be ones already captured in routine practice; otherwise, funders and investigators should assess the feasibility and cost of data collection.

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Section: Discussionmentioning

confidence: 62%

Considerations Before Selecting a Stepped-Wedge Cluster Randomized Trial Design for a Practice Improvement Study

et al. 2022

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“…Among the 12 studies which included in-person visits or meetings at practices as a recruitment strategy, meetings were typically conducted by member(s) of the research team 36 , 39 or the team and Principal Investigator (PI) 32 , 40 . Some specified that a clinical member (e.g., research nurse or GP researcher) of the team conducted the visits 16 , 38 , 41 while others did not provide this detail 11 , 13 , 33 , 34 , 37 . Four studies involved conducting in-person meetings with practices with which some of which the team already had links 32 , 36 , 39 , 41 .…”

Section: Resultsmentioning

confidence: 99%

“…Two studies explicitly mentioned making “cold calls” to practice managers 16 , 33 identifying practices within a certain radius of the study region, from telephone books, medical society' membership list and provider directories 34 . Randomly ordered lists of practices were used to confirm practice eligibility and ascertain their initial interest 16 Leathem et al provided more detail on the content of the calls, that they included a brief explanation and mention of the financial resource, and that they avoided making these calls at especially busy times such as Monday mornings and Friday afternoons and asked reception staff for appropriate times to speak to a GP or practice manager, not wanting to use time slots reserved for patients.…”

Section: Resultsmentioning

confidence: 99%

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What works to recruit general practices to trials? A rapid review

2023

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Background: Recruitment challenges are a barrier to the conduct of trials in general practice, yet little is known about which recruitment strategies work best to recruit practices for randomised controlled trials (RCTs). We aimed to describe the types of strategies used to recruit general practices for trials and synthesize any available evidence of effectiveness. Methods: We conducted a rapid evidence review in line with guidance from Tricco et al. Eligible studies reported or evaluated any strategy to improve practice recruitment to participate in clinical or implementation RCTs. PubMed, Embase, and Cochrane Central Library were searched from inception to June 22nd, 2021. Reference lists of included studies were screened. Data were synthesized narratively. Results: Over 9,162 articles were identified, and 19 studies included. Most (n=13, 66.7%) used a single recruitment strategy. The most common strategies were: in-person practice meetings/visits by the research team (n=12, 63.2%); phone calls (n=10, 52.6%); financial incentives (n=9, 47.4%); personalised emails (n=7, 36.8%) or letters (n=6, 52.6%) (as opposed to email ‘blasts’ or generic letters); targeting practices that participated in previous studies or with which the team had existing links (n=6, 31.6%) or targeting of practices within an existing practice or research network (n=6, 31.6%). Three studies reporting recruitment rates >80%, used strategies such as invitation letters with a follow-up phone call to non-responders, presentations by the principal investigator and study coordinator, or in-person meetings with practices with an existing affiliation with the University or research team. Conclusions: Few studies directly compared recruitment approaches making it difficult to draw conclusions about their comparative effectiveness. However, the role of more personalised letter/email, in-person, or phone contact, and capitalising on existing relationships appears important. Further work is needed to standardise how recruitment methods are reported and to directly compare different recruitment strategies within one study. PROSPERO registration: CRD42021268140 (15/08/2021)

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“…Additionally, we anticipate that facilitators may experience challenges in meeting with staff due to high patient volume or staffing turnover. However, the BEHS has long-standing relationships with their network practices and providers have noted the advantage of the PF process which facilitates engagement [ 18 , 68 ]. If we encounter lower than expected responses, practice facilitators will conduct in-person and phone outreach to increase rates of engagement.…”

Section: Discussionmentioning

confidence: 99%

Facilitation of team-based care to improve HTN management and outcomes: a protocol for a randomized stepped wedge trial

Shelley

Brown

Cleland

et al. 2023

BMC Health Serv Res

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Background There are well-established guidelines for treating hypertension (HTN), yet only half of patients with HTN meet the defined target of < 140/90. Team-based care (TBC) is an evidence-based strategy for improving blood pressure (BP) management and control. TBC is defined as the provision of health services by at least two health professionals “who work collaboratively with patients and their caregivers to accomplish shared goals to achieve coordinated, high-quality care”. However, primary care practices experience challenges to implementing TBC principles and care processes; these are more pronounced in small independent practice settings (SIPs). Practice facilitation (PF) is an implementation strategy that may overcome barriers to adopting evidence-based TBC to improve HTN management in SIPs. Methods Using a stepped wedge randomized controlled trial design, we will test the effect of PF on the adoption of TBC to improve HTN management in small practices (< 5 FTE clinicians) in New York City, and the impact on BP control compared with usual care. We will enroll 90 SIPs and randomize them into one of three 12-month intervention waves. Practice facilitators will support SIPs to adopt TBC principles to improve implementation of five HTN management strategies (i.e., panel management, population health, measuring BP, supporting medication adherence, self-management). The primary outcome is the adoption of TBC for HTN management measured at baseline and 12 months. Secondary outcomes include the rate of BP control and sustainability of TBC and BP outcomes at 18 months. Aggregated data on BP measures are collected every 6 months in all clusters so that each cluster provides data points in both the control and intervention conditions. Using a mixed methods approach, we will also explore factors that influence the effectiveness of PF at the organization and team level. Discussion This study will provide much-needed guidance on how to optimize adoption and sustainability of TBC in independent primary care settings to reduce the burden of disease related to suboptimal BP control and advance understanding of how facilitation works to improve implementation of evidence-based interventions. Trial registration ClinicalTrials.gov; NCT05413252.

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Barriers and Facilitators in the Recruitment and Retention of More Than 250 Small Independent Primary Care Practices for EvidenceNOW

Cited by 8 publications

References 31 publications

Considerations Before Selecting a Stepped-Wedge Cluster Randomized Trial Design for a Practice Improvement Study

Considerations Before Selecting a Stepped-Wedge Cluster Randomized Trial Design for a Practice Improvement Study

What works to recruit general practices to trials? A rapid review

Facilitation of team-based care to improve HTN management and outcomes: a protocol for a randomized stepped wedge trial

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