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Zimansky M, Hofmann B, Schneider N, Stiel S. [Implications for health services research in GP practices using the example of an intervention study on palliative care]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 164:44-50. [PMID: 34215530 DOI: 10.1016/j.zefq.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION So far there has been little evidence of the extent to which project steps can affect the timing and successful implementation of research projects in general practitioner (GP) practices. Using the example of an intervention study on palliative care, the aim of this article is to report a) how the overall course of the project turned out compared to the original planning, and b) what recommendations can be derived to promote efficient implementation of intervention studies in GP practices. METHODS In two workshops each, GP practice teams selected specific measures to improve their palliative care and tested them during a four-month implementation phase. In order to track the progress of the project, the times at which the practice teams reported their participation in the study, the individual project steps and the contacts were documented and descriptively analysed using Microsoft Excel. RESULTS Due to a high willingness of practice teams to participate in the intervention study, recruitment was completed on time. The overall duration of the project was extended due to an increased workload for the preparation of an unexpectedly high number of selected measures to improve palliative care. DISCUSSION Conducting intervention studies in GP practices is promising if practice teams take an active and co-determining role during the entire research process. Research projects can best be implemented if they involve minimal time commitment for the practice teams, and if continuous personal support from the study team is ensured. CONCLUSION When planning future intervention studies with a high participatory share of GP practice teams, it is advisable to take into account potential additional work for the preparation and further development of intervention measures.
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Affiliation(s)
- Manuel Zimansky
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Birte Hofmann
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stephanie Stiel
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
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Houghton C, Dowling M, Meskell P, Hunter A, Gardner H, Conway A, Treweek S, Sutcliffe K, Noyes J, Devane D, Nicholas JR, Biesty LM. Factors that impact on recruitment to randomised trials in health care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 10:MR000045. [PMID: 33026107 PMCID: PMC8078544 DOI: 10.1002/14651858.mr000045.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Randomised trials (also referred to as 'randomised controlled trials' or 'trials') are the optimal way to minimise bias in evaluating the effects of competing treatments, therapies and innovations in health care. It is important to achieve the required sample size for a trial, otherwise trialists may not be able to draw conclusive results leading to research waste and raising ethical questions about trial participation. The reasons why potential participants may accept or decline participation are multifaceted. Yet, the evidence of effectiveness of interventions to improve recruitment to trials is not substantial and fails to recognise these individual decision-making processes. It is important to synthesise the experiences and perceptions of those invited to participate in randomised trials to better inform recruitment strategies. OBJECTIVES To explore potential trial participants' views and experiences of the recruitment process for participation. The specific objectives are to describe potential participants' perceptions and experiences of accepting or declining to participate in trials, to explore barriers and facilitators to trial participation, and to explore to what extent barriers and facilitators identified are addressed by strategies to improve recruitment evaluated in previous reviews of the effects of interventions including a Cochrane Methodology Review. SEARCH METHODS We searched the Cochrane Library, Medline, Embase, CINAHL, Epistemonikos, LILACS, PsycINFO, ORRCA, and grey literature sources. We ran the most recent set of searches for which the results were incorporated into the review in July 2017. SELECTION CRITERIA We included qualitative and mixed-methods studies (with an identifiable qualitative component) that explored potential trial participants' experiences and perceptions of being invited to participate in a trial. We excluded studies that focused only on recruiters' perspectives, and trials solely involving children under 18 years, or adults who were assessed as having impaired mental capacity. DATA COLLECTION AND ANALYSIS Five review authors independently assessed the titles, abstracts and full texts identified by the search. We used the CART (completeness, accuracy, relevance, timeliness) criteria to exclude studies that had limited focus on the phenomenon of interest. We used QSR NVivo to extract and manage the data. We assessed methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We used thematic synthesis to analyse and synthesise the evidence. This provided analytical themes and a conceptual model. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. Our findings were integrated with two previous intervention effectiveness reviews by juxtaposing the quantitative and qualitative findings in a matrix. MAIN RESULTS We included 29 studies (published in 30 papers) in our synthesis. Twenty-two key findings were produced under three broad themes (with six subthemes) to capture the experience of being invited to participate in a trial and making the decision whether to participate. Most of these findings had moderate to high confidence. We identified factors from the trial itself that influenced participation. These included how trial information was communicated, and elements of the trial such as the time commitment that might be considered burdensome. The second theme related to personal factors such as how other people can influence the individual's decision; and how a personal understanding of potential harms and benefits could impact on the decision. Finally, the potential benefits of participation were found to be key to the decision to participate, namely personal benefits such as access to new treatments, but also the chance to make a difference and help others. The conceptual model we developed presents the decision-making process as a gauge and the factors that influence whether the person will, or will not, take part. AUTHORS' CONCLUSIONS This qualitative evidence synthesis has provided comprehensive insight into the complexity of factors that influence a person's decision whether to participate in a trial. We developed key questions that trialists can ask when developing their recruitment strategy. In addition, our conceptual model emphasises the need for participant-centred approaches to recruitment. We demonstrated moderate to high level confidence in our findings, which in some way can be attributed to the large volume of highly relevant studies in this field. We recommend that these insights be used to direct or influence or underpin future recruitment strategies that are developed in a participant-driven way that ultimately improves trial conduct and reduces research waste.
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Affiliation(s)
- Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Aislinn Conway
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katy Sutcliffe
- Department of Social Science, Social Science Research Unit, UCL Institute of Education, London, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Jane R Nicholas
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Thoomes-de Graaf M, Wiersma RE, Karel Y, Duijn E, Spek B, Rizopoulos D, Scholten-Peeters GGM, Verhagen AP. The Effect of a Personalized Newsletter to Physical Therapists on Patient Recruitment: A Cluster Randomized Trial in Primary Physiotherapy Care. J Manipulative Physiol Ther 2020; 43:476-482. [PMID: 32828570 DOI: 10.1016/j.jmpt.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 10/30/2019] [Accepted: 12/05/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the effect of a personalized newsletter compared with a standard newsletter on patient recruitment in physiotherapy research. METHODS We performed a cluster-randomized trial including 120 physiotherapists who recruited patients for a prospective cohort and were randomly assigned to either receiving personalized feedback in a newsletter (intervention group) or a standard newsletter (control group). We calculated the difference in the number of patients included in the study corrected for inclusion time between both groups. RESULTS The physiotherapists in the control group (n = 59) included 110 patients (35.4% of the total number of patients included) compared with an inclusion of 200 patients (64.6% of the total number of patients included) by the physiotherapists in the intervention group (n = 61), a difference of 90 patients in favor of the intervention group. However, when corrected for inclusion time and a cluster effect, we found no statistically significant difference between both groups. In addition, therapists who did not include a single patient (inactive therapists) were evenly divided between the 2 groups (n = 29 [49%] in the control group; n = 30 [49%] in the intervention group). CONCLUSIONS A personalized newsletter does not significantly increase the number of recruited patients by physiotherapists. However, therapists receiving personalized feedback recruited nearly double the number of patients compared with the ones receiving standard feedback.
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Affiliation(s)
- Marloes Thoomes-de Graaf
- Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands; Research Group Diagnostics, Avans University of Applied Science, Breda, Netherlands.
| | - Rienke E Wiersma
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Yasmaine Karel
- Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands; Research Group Diagnostics, Avans University of Applied Science, Breda, Netherlands
| | - Edwin Duijn
- Research Group Diagnostics, Avans University of Applied Science, Breda, Netherlands
| | - Bea Spek
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | - Gwendolijne G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Arianne P Verhagen
- Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Physiotherapy, Graduate School of Health University of Technology Sydney, Sydney, Australia
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Sunderji N, Ion A, Zhu A, Perivolaris A, Rodie D, Mulsant BH. Challenges in conducting research on collaborative mental health care: a qualitative study. CMAJ Open 2019; 7:E405-E414. [PMID: 31201177 PMCID: PMC6579651 DOI: 10.9778/cmajo.20180172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We sought to understand poor uptake of the Primary Care Assessment and Research of a Telephone Intervention for Neuropsychiatric Conditions with Education and Resources study (PARTNERs), a pragmatic randomized controlled trial of a collaborative care intervention for people experiencing depression, anxiety or at-risk drinking. We explored primary care providers' experience with PARTNERs, and preferences regarding collaborative care models and trials. METHODS In this qualitative study, we interviewed primary care providers across Ontario who had participated in PARTNERs, using stratified sampling to reach high-, low- and nonreferring providers in urban and rural settings. We audio-recorded, transcribed and thematically analyzed the interviews between May and December 2017, collecting and analyzing data concurrently until achieving saturation. RESULTS We interviewed 23 primary care providers. They valued the unique availability of telephone-based coaching for patients but desired greater integration of the coach into their practice. They appreciated expert psychiatric recommendations but rarely changed their practices. Sites varied in organizational adoption and implementation of the study, including whether they designated a local champion, proactively identified eligible patients, integrated the study into existing workflows and reflected on (and revised) practices. These behaviours affected continuing awareness of the study and referral rates. INTERPRETATION Study uptake was influenced by the limited relationship between PARTNERs coaches and primary care providers, and variable attention to leadership, training and quality improvement as vital elements of collaborative care. Study designs focusing on implementation could promote reach and penetration of novel interventions in the practice setting and more successfully advance collaborative care implementation.
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Affiliation(s)
- Nadiya Sunderji
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont.
| | - Allyson Ion
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - Annie Zhu
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - Athina Perivolaris
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - David Rodie
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - Benoit H Mulsant
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
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