Simply no time? Barriers to GPs' participation in primary health care research

Hummers-Pradier, Eva; Scheidt‐Nave, Christa; Martin, Heike; Heinemann, Stephanie; Kochen, Michael M.; Himmel, Wolfgang

doi:10.1093/fampra/cmn015

Cited by 138 publications

(133 citation statements)

References 26 publications

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“…All had graduated from TCM colleges in Canton or Hong Kong, had practiced in San Francisco for more than 10 years, and served a range of 50 to 100 clients per week. With 6 of 10 TCM providers being willing to participate, the possible participation rate of 60% in this study is similar to rates of participation by Western health professionals in a postal survey (59%) (18) and electronic health record research (42%) (19), and is much higher than the 1% to 2% rates in typical intervention studies (20). …”

Section: Methodssupporting

confidence: 58%

Engaging Traditional Medicine Providers in Colorectal Cancer Screening Education in a Chinese American Community: A Pilot Study

Wang¹,

Burke²,

Tsoh³

et al. 2014

Prev. Chronic Dis.

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IntroductionAlthough colorectal cancer (CRC) screening is effective in preventing colon cancer, it remains underused by Asian Americans. Because Chinese Americans often use traditional Chinese medicine (TCM), we conducted a pilot study to explore the feasibility and acceptability of having TCM providers deliver education about CRC screening.MethodsFour TCM providers (2 herbalists and 2 acupuncturists) were trained to deliver small-group educational sessions to promote CRC screening. Each provider recruited 15 participants aged 50 to 75. Participants completed a baseline survey on CRC-related knowledge, attitudes, and behaviors and then attended one 2-hour educational session delivered by the providers in Cantonese or Mandarin. Three months later, participants completed a postintervention survey.ResultsSixty participants were recruited from the San Francisco Chinatown neighborhood. The average age was 62.4 years. Most participants had limited English proficiency (96.7%), annual household income less than $20,000 per year (60%), and low educational attainment (65.1% < high school education). At postintervention (n = 57), significant increases were found in having heard of CRC (from 52.6% to 79.0%, P < .001) and colon polyps (from 64.9% to 84.2%, P < .001). Knowledge regarding screening frequency recommendations also increased significantly. The rate of ever having received any CRC screening test increased from 71.9% to 82.5% (P <.001). The rate of up-to-date screening increased from 70.2% to 79.0% (P = .04).ConclusionThe findings suggest that TCM providers can be trained to deliver culturally and linguistically appropriate outreach on CRC screening within their community. Participants reached by TCM providers increased CRC knowledge and self-reported CRC screening.

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Section: Methodssupporting

confidence: 58%

Engaging Traditional Medicine Providers in Colorectal Cancer Screening Education in a Chinese American Community: A Pilot Study

Wang¹,

Burke²,

Tsoh³

et al. 2014

Prev. Chronic Dis.

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“…20 of the 63 non-responders (30%) participated (see Figure 1, second study arm). The response rate was in line with another German study assessing reasons for non-response or non-participation in a follow-up [40]. …”

Section: Resultssupporting

confidence: 76%

“…In summary, reasons to participate beyond work-related and personal factors include personal or professional interest in a topic and the perceived relevance in research in primary care [19,27,40,42]. …”

Section: Resultsmentioning

confidence: 99%

Gaining information about home visits in primary care: methodological issues from a feasibility study

et al. 2014

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BackgroundHome visits are part of general practice work in Germany. Within the context of an expanding elderly population and a decreasing number of general practitioner (GPs), open questions regarding the organisation and adequacy of GPs’ care in immobile patients remain. To answer these questions, we will conduct a representative primary data collection concerning contents and organisation of GPs’ home visits in 2014. Because this study will require considerable efforts for documentation and thus substantial involvement by participating GPs, we conducted a pilot study to see whether such a study design was feasible.MethodsWe used a mixed methods design with two study arms in a sample of teaching GPs of the University Halle. The quantitative arm evaluates participating GPs and documentation of home visits. The qualitative arm focuses on reasons for non-participation for GPs who declined to take part in the pilot study.ResultsOur study confirms previously observed reasons for non-response of GPs in the particular setting of home visits including lack of time and/or interest. In contrast to previous findings, monetary incentives were not crucial for GPs participation. Several factors influenced the documentation rate of home visits and resulted in a discrepancy between the numbers of home visits documented versus those actually conducted. The most frequently reported problem was related to obtaining patient consent, especially when patients were unable to provide informed consent due to cognitive deficits.ConclusionsThe results of our feasibility study provide evidence for improvement of the study design and study instruments to effectively conduct a documentation-intensive study of GPs doing home visits. Improvement of instructions and questionnaire regarding time variables and assessment of the need for home visits will be carried out to increase the reliability of future data. One particularly important methodological issue yet to be resolved is how to increase the representativeness of home visit care by including the homebound patient population that is unable to provide informed consent.

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“…One of the most frequently cited barriers to participation, even among centres showing initial interest in participating in the study, was a lack of capacity to dedicate time or resources to external research projects due to their already considerable work commitments. This was particularly evident among primary care centres; many of whom did not have designated support staff that were able to assist with research activities, an assertion consistent with previous research which has identified time and work commitments as a major barrier to participation in primary care research [38]. Primary care workloads are also very much influenced by seasonal variations in illness.…”

Section: Resultssupporting

confidence: 62%

Challenges in quantifying the patient-reported burden of herpes zoster and post-herpetic neuralgia in the UK: learnings from the Zoster Quality of Life (ZQOL) study

et al. 2013

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BackgroundAcute presentation of herpes zoster (HZ) and the subsequent development of post-herpetic neuralgia (PHN) can have a significant impact on patients’ lives. To date, evidence regarding the human and economic burden of HZ and PHN in the UK is limited. To address this knowledge gap a national, multicentre, large-scale real-world study was conducted to inform the scientific community and healthcare decision-makers. This paper outlines difficulties encountered and challenges to conducting real-world studies in the UK, methods used to overcome these hurdles and strategies that can be employed to promote and facilitate the conduct of future studies.FindingsThe Zoster Quality of Life (ZQOL) study is the first UK-wide and largest observational study investigating patient burden associated with HZ and PHN. A total of 383 patients (229 HZ; 154 PHN) over the age of 50 years were recruited from 42 primary and secondary/tertiary care centres. Patient-reported outcome (PRO) assessments of pain, quality of life and treatment satisfaction were completed by all participants and supplemented by clinical information from participating physicians.Key challenges encountered during the conduct of this study can be broadly categorised as follows: 1) identification of centres willing/able to participate in the study: lack of resources and limited research experience were major barriers to recruitment of centres for participation in the study; 2) obtaining local research & development (R&D) approval: lack of clearly defined processes and requirements specific to real-world studies and limited degree of standardisation between R&D departments in approval procedures led to significant variability in submission requirements and lead times for obtaining approval; 3) recruitment of study participants: rates of recruitment were slower than anticipated, meaning it was necessary to extend the study recruitment period and increase the number of participating centres.DiscussionInitiatives designed to promote and facilitate the conduct of research in the UK are important for real-world studies. The ZQOL study shows that opportunities exist for real-word research. However, streamlining the R&D approval process where possible and further incentivising the participation of primary care centres in such studies would help to further facilitate the generation of real-world evidence to inform healthcare decisions.

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Simply no time? Barriers to GPs' participation in primary health care research

Abstract: Doctors' negative attitudes, concerns and ambivalent feelings should be addressed in recruitment strategies, especially when the analysis of EPRs or direct patient contact is required. Some doctors do not participate in research out of principle and will be very difficult to convince.

Cited by 138 publications

References 26 publications

Engaging Traditional Medicine Providers in Colorectal Cancer Screening Education in a Chinese American Community: A Pilot Study

Engaging Traditional Medicine Providers in Colorectal Cancer Screening Education in a Chinese American Community: A Pilot Study

Gaining information about home visits in primary care: methodological issues from a feasibility study

Challenges in quantifying the patient-reported burden of herpes zoster and post-herpetic neuralgia in the UK: learnings from the Zoster Quality of Life (ZQOL) study

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