Cost analysis and efficacy of recruitment strategies used in a large pragmatic community-based clinical trial targeting low-income seniors: a comparative descriptive analysis

Abstract

Objective One of the most challenging parts of running clinical trials is recruiting enough participants. Our objective was to determine which recruitment strategies were effective in reaching specific subgroups. Study design and setting We assessed the efficacy and costs of the recruitment strategies used in the Assessing Outcomes of Enhanced Chronic Disease Care Through Patient Education and a Value-based Formulary Study (ACCESS) in Alberta, Canada. Results Twenty percent of the study budget ($354,330 CAD) was spent on recruiting 4013 participants, giving an average cost per enrolled of $88 CAD. Pharmacies recruited the most participants (n = 1217), at a cost of $128/enrolled. ”Paid media” had the highest cost ($806/enrolled), whereas ”word of mouth” and ”unpaid media” had the lowest (~$3/enrolled). Participants enrolled from ”seniors outreach” had the lowest baseline quality of life and income, while participants from ”word of mouth” had the lowest educational attainment. Conclusion The ”health care providers” strategies were especially successful — at a moderate cost per enrolled. The "media" strategies were less effective, short lasting, and more costly. No strategy was singularly effective in recruiting our targeted groups, emphasizing the importance of utilizing a variety of strategies to reach recruitment goals. Trial registration ClinicalTrials.gov, NCT02579655. Registered on 19 October 2015.

Pharmacist and patient perspectives on recruitment strategies for randomized controlled trials: a qualitative analysis

“…The use of pharmacists was an invaluable method of recruitment for the ACCESS trial [ 15 ], as has been documented in other trials [ 24 ]. Utilizing pharmacists allowed us to leverage pre-existing relationships they had with patients.…”

“…study staff, colleagues, and patients). Pharmacists were a natural fit to assist with recruitment for the ACCESS trial, however, other health care professionals were also involved in recruitment to a lesser degree [ 15 ], and many of the principles outlined above would apply to these providers as well.…”

“…Regardless of the means by which a participant heard about the study, they were directed to call a central study telephone line where they were then screened for eligibility, after which they completed written informed consent and baseline questionnaires before being randomized. We recently published a detailed retrospective examination of the various recruitment strategies utilized to enroll more than 4000 participants in the ACCESS trial [ 15 ]. We found that pharmacists recruited 38% of participants.…”

“…However, this strategy was also relatively resource intensive, costing over CAD$150,000. The vast majority of ACCESS participants were enrolled either through pharmacies (where recruitment materials were present) or by encountering recruitment materials such as brochures and posters in other locations such as community centres, medical offices, churches, seniors’ centres, recreational centres, and shopping malls – accounting for another 43% of our participants [ 15 ]. Given the importance of these two recruitment methods for helping us achieve our target sample size, we decided to focus this qualitative study on exploring these two methods in greater detail.…”

“…The two groups were drawn from the two intervention arms in the ACCESS trial; individuals within each group were selected through purposive sampling based on age, gender, and income. As the purpose was to obtain feedback on the recruitment materials, individuals recruited by pharmacists and by friends/family members [ 15 ] were not included, as they may have been told about the study without having seen the printed materials. Only participants situated close to Calgary were invited to minimize travel requirements.…”