General practice research: attitudes and involvement of Queensland general practitioners

Recruiting and retaining GPs and patients in intervention studies: the DEPS-GP project as a case study

BACKGROUND

Recruiting and retaining GPs for research can prove difficult, and may result in sub-optimal patient participation where GPs are required to recruit patients. Low participation rates may affect the validity of research. This paper describes a multi-faceted approach to maximise participation of GPs and their patients in intervention studies, using an Australian randomised controlled trial of a depression/suicidality management intervention as a case study. The paper aims to outline experiences that may be of interest to others considering engaging GPs and/or their patients in primary care studies.

METHODS

A case study approach is used to describe strategies for: (a) recruiting GPs; (b) encouraging GPs to recruit patients to complete a postal questionnaire; and (c) encouraging GPs to recruit patients as part of a practice audit. Participant retention strategies are discussed in light of reasons for withdrawal.

RESULTS

The strategies described, led to the recruitment of a higher than expected number of GPs (n = 772). Three hundred and eighty three GPs (49.6%) followed through with the intent to participate by sending out a total of 77,820 postal questionnaires, 22,251 (28.6%) of which were returned. Three hundred and three GPs (37.0%) participated in the practice audit, which aimed to recruit 20 patients per participating GP (i.e., a total of 6,060 older adults). In total, 5,143 patients (84.9%) were represented in the audit.

CONCLUSION

Inexpensive methods were chosen to identify and recruit GPs; these relied on an existing database, minor promotion and a letter of invitation. Anecdotally, participating GPs agreed to be involved because they had an interest in the topic, believed the study would not impinge too greatly on their time, and appreciated the professional recognition afforded by the Continuing Professional Development (CPD) points associated with study participation. The study team established a strong rapport with GPs and their reception staff, offered clear instructions, and were as flexible and helpful as possible to retain GP participants. Nonetheless, we experienced attrition due to GPs' competing demands, eligibility, personnel issues and the perceived impact of the study on patients. A summary of effective and ineffective methods for recruitment and retention is provided.

Questionnaire order significantly increased response to a postal survey sent to primary care physicians

OBJECTIVE

Primary care physicians are increasingly being asked to participate in postal surveys. Difficulties in achieving adequate response rates among physicians have been reported. We investigated the effect of two low-cost interventions on response to a primary care physician postal questionnaire.

STUDY DESIGN AND SETTING

A 2x2 factorial trial was developed within the context of a national survey assessing views and practices of physicians regarding prostate-specific antigen testing. We evaluated questionnaire order (version 1: demographics first, version 2: topic-specific questions first) and written precontact. A national database of primary care physicians was compiled. One thousand five hundred ninety-nine physicians were randomly selected, stratified by health board, and randomized.

RESULTS

47.9% of eligible physicians completed a questionnaire. There was a statistically significant 5.1% higher response rate among physicians receiving version 1 of the questionnaire than those receiving version 2 (50.6% vs. 45.4%, P=0.05); the adjusted odds of response were significantly raised (odds ratio=1.24; 95% confidence interval=1.01-1.54). Precontact resulted in a nonsignificant 3.6% increase in response (49.8% vs. 46.2%; P=0.16). The interventions did not interact.

CONCLUSION

Ordering questionnaires with general questions first can significantly increase response rates, whereas precontact can achieve a modest increase. These strategies may enhance response while adding little to the cost of a physician survey.

Family medicine practice and research: Survey of physicians' attitudes towards scientific research in a post-communist transition country

BACKGROUND

Although the paradigm of modern medicine is evidence-based practice, there is a lack of research output and interest in research in family medicine. We investigated attitudes towards scientific research among family medicine practitioners in a country in post-communist socioeconomic transition, and related it to their attitudes towards alternative medicine and clinical knowledge relevant for their practice.

METHODS

We surveyed 427 family medicine practitioners in Croatia about their attitudes towards scientific research (5-point rating scale, total score range 20-100) and alternative medicine (5-point rating scale, total score range 14-70). We also tested their knowledge on diagnosis and treatment of hypertension (10 questions) and diabetes (12 questions).

RESULTS

The attitude towards scientific research was positive (score 79.0 +/- 7.2 out of maximum 100) and significantly more positive than that towards alternative medicine (score 45.0 +/- 9.9 out of maximum 70; t(425) = 19.06, P < 0.001). The respondents correctly answered about half the questions on hypertension and diabetes; knowledge on new diagnostic and treatment guidelines was better than their textbook knowledge. The attitude scores were not related to knowledge or research activity or the medical practice of the respondents.

CONCLUSIONS

Family medicine practitioners in a transition country have a more positive attitude towards science than towards alternative medicine, despite the adverse situation in which they practice. To involve family medicine practitioners in research, interventions must be directed towards changes in behavior and practice and not only towards increasing positive attitudes.

Barriers to General Practitioner Participation in a Clinical Trial Initiated by Pharmacists

Objective:

The purpose of this study was to determine general practitioners' (GPs) reasons for not entering patients into a randomized trial that compared outpatient anticoagulation management by community pharmacists with that of physicians.

Methods:

An anonymous survey was mailed to all GPs who were invited to participate in the anticoagulation study ( n = 118).

Results:

Completed surveys were received from 78/110 (71%) of GPs who had declined to participate in the anticoagulation study. Of those who had consented to participate, 8/8 completed surveys were received. The top-ranked reasons for not entering patients were “pharmacist should accept legal liability” (40%), “concern about other health care professionals taking over physician responsibilities” (33%), and “concern about responsibility for my patients” (29%). Other frequently cited barriers included concern about pharmacists' ability to manage warfarin patients, general issues related to control over patient care decisions, and lack of time. The top-ranked reason for agreeing to participate was the belief that “research advances the profession” (87%). Shortly after this survey, a statement published by the College of Physicians and Surgeons of BC reinforced physicians' concern about legal liability and recommended that physicians avoid referring patients to community pharmacy—based anticoagulation programs.

Conclusion:

Pharmacists who plan to conduct research in the community setting should thoroughly investigate potential barriers to GP involvement in patient recruitment, because of the difficulty in anticipating the most crucial issues. Local physicians may not support pharmacy-based anticoagulation programs, whether or not they are implemented as part of a clinical trial.

Primary care research--what in the world is going on?

Primary care research has been described as a "lost cause", and, although this claim has been strongly refuted, general practitioners publish less research than their colleagues in surgery, medicine and public health. Despite a fivefold increase in Australian general practice research papers from the 1980s to the 1990s, fewer than half of these focused on clinical topics. Trying to establish a global figure for expenditure on general practice and primary care research is difficult, but data show that public expenditure for primary care research is minimal in Australia, New Zealand, the Netherlands and the United Kingdom--fewer than 1.50 dollars per capita in 2002-2003. Compared with hospital- and laboratory-based research, primary care receives significantly fewer resources, ranging from 3.2% of total public expenditure on health and medical research in the Netherlands to 6.8% in New Zealand. Government-led investment in interventions such as strengthening primary care departments and colleges and supporting primary care academics, establishing practice-based networks, fostering international initiatives for cross-national efforts, and engaging individual primary care practitioners in research projects, are all required to build research capacity in primary care.

Mental health research in general practice

OBJECTIVE

To explore problems in carrying out a mental health research project in the general practice setting.

METHOD

Open-ended interviews were conducted with general practice stakeholders, focusing on impediments to the conduct of mental health research in general practice and possible means for improving the participation of general practitioners in such research. Participants in the consultations were members of five divisions of general practice, senior staff within an academic department of general practice, four general practitioners and a research group engaged with general practice research. The discussions were recorded in detailed interview notes, and key issues and themes emerging from consultations were derived by the researchers.

RESULTS

Three main themes summarized most of the issues reported through the consultations, including structural issues (e.g. disruption of practice, time limitations and lack of remuneration), process issues (e.g. researcher-general practice communication, researcher-imposed issues and need for partnerships) and content issues (e.g. study design, study procedures and methods).

CONCLUSIONS

The consultations revealed similar findings to previously published reports concerning general practice research, with an emphasis on the need for partnerships between researchers and general practice organizations in the conduct of such research.

[Primary Care research: attitudes and hindrances perceived by our doctors]

OBJECTIVES

To discover how much research doctors in our area do; to describe their attitudes to research; and to evaluate the hindrances to developing research that they found.

DESIGN

Cross-sectional, descriptive study.

SETTING

Area 7 of Primary Care, Madrid.

PARTICIPANTS

Area 7 doctors.

MAIN MEASUREMENTS

An anonymous self-administered questionnaire was designed in order to gather the following information: age, gender, professional details, training in research methodology, research activity, questions from a previously validated questionnaire for finding attitudes towards research (scores from 0 to 80), and a question for assigning a value to 6 hindrances to research.

RESULTS

174 were returned (49.4% response). 65.9% of the doctors were women, with an average age of 43.23+/-7.33 years; and 55.5% were specialists in Family and Community Medicine. Over the last 5 years, 49.4% had published a scientific paper and 38% had given reports at congresses. The mean score on attitudes to research was 53.49+/-10.59. Hindrances to research were given in the following order, from greatest to least: case-load, lack of time, structural deficiencies, absence of multi-centred research lines, lack of incentives, lack of training, no motivation.

CONCLUSIONS

The research activity of our doctors is similar to that found in other studies. Attitude to research is no better than "acceptable." The main hindrances stated were: case-load and lack of time.

Chronic disease management in Australia: evidence and policy mismatch, with asthma as an example

All Western countries are developing and implementing new models for managing asthma. In Australia, the Asthma 3+ Visit Plan was implemented in 2001-2002, with the aim of establishing a structured approach in general practice for people with moderate and severe asthma, within a fee-for-service system. Evidence is emerging that the uptake across general practice has been poor, with approximately 5% of eligible people being enrolled. The reasons for the poor uptake include such factors as an inability to identify people with asthma, general practitioners being too busy with other clinical priorities, and the lack of interest and understanding of the need for a structured approach for this disease. This mismatch between evidence and policy development needs to be rectified, if sustainable models of chronic disease care are to be firmly established in general practice.

General practitioners' attitudes towards research in primary care: qualitative results of a cross sectional study

Background

Research in General Practice requires the participation of General practitioners (GPs). In Germany there is little tradition of research in this field, and GPs are not used to be participants in research. Little is known about German GPs attitudes towards research. Therefore the aim of our study was to assess the willingness of German General Practitioners to participate in primary care research and their attitude towards research in general practice. The results should enable a more successful approach to GPs in further studies.

Methods

Cross sectional study using semi-structured interviews with a random sample of 76 General Practitioners who participate in the teaching of medical students at the University of Heidelberg.

Results

Despite little experience, over 85 % of GPs appreciated research in their field. Important reasons for scepticism about research were the gap between theoretical research and practical work of GPs and the domination of research by specialists. Main barriers for participation are clinical workload, administrative overload and the newly introduced Disease Management Programs. The highest motivation for GPs to participate in research emanates from the will to substantiate their quality of care with solid research data.

Conclusions

Financial incentives and personal support e.g. with study nurses are certainly necessary to establish a research culture and to overcome main barriers against participation. The most successful approach to motivate GPs to participate is to convince them that research documents their quality of care. This data may reflect the facts on which the financial resources are provided in the future health care system.

Building family/general practice research capacity

To promote the range of interventions for building family/general practice (family medicine) research capacity, we describe successful international examples. Such examples of interventions that build research capacity focus on diseases and illness research, as well as process research; monitor the output of research in family/general practice (family medicine); increase the number of family medicine research journals; encourage and enable research skills acquisition (including making it part of professional training); strengthen the academic base; and promote research networks and collaborations. The responsibility for these interventions lies with the government, colleges and academies, and universities. There are exciting and varied methods of building research capacity in family medicine.

How physicians perceive and utilize information from a teratogen information service: the Motherisk Program

BACKGROUND

Teratogen information services have been developed around the world to disseminate information regarding the safety of maternal exposures during pregnancy. The Motherisk Program in Toronto, Canada, fields thousands of these inquiries per year. Our primary objective was to evaluate the perception and utilization of information received from us by physicians. Our secondary objective was to examine their information seeking behavior, in particular regarding teratogen information.

METHODS

A one page survey was sent to physicians who had called Motherisk for information concerning pregnancy exposures in the previous 30 days for three months. Among the questions that were asked were demographics, which included gender, years in practice, specialty, information resources, and how they utilized the information received from Motherisk.

RESULTS

We received 118/200 completed questionnaires (59% response rate). The mean age of the respondents was: 42 +/- 9 years, mean years of practice was: 14 +/- 8 years, males: 46(38%) and females 72(62%) and 95(80%) were family physicians. 56(48%) researched their question prior to calling Motherisk, 106(91%) and passed on the information received to their patient verbatim. The top four resources for information were: 1) The CPS (PDR), 2) textbooks, 3) journals and 4) colleagues. Only 8% used the Medline for gathering information.

CONCLUSIONS

Physicians feel that a teratogen information service is an important component in the management of women exposed to drugs, chemicals, radiation and infections diseases etc. during pregnancy. Despite the advent of the electronic age, a minority of the physicians in our survey elected to use electronic means to seek information.