The challenge of recruiting in primary care for a trial of telemonitoring in asthma: an observational study

Shweta Malhotra, Stanley D. Musgrave, Hilary Pinnock, David Price, Dermot P. Ryan

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Abstract

Aim: Achieving target recruitment in randomized controlled trials (RCTs) is challenging. This paper compares our experience of recruiting for an RCT with the predictions made in our proposal.
Methods: Participating UK primary care practices searched their computer databases to identify patients (12 years and over) with asthma who may be poorly controlled. Postal invitations were sent to all patients identified. Respondees were prescreened by phone, to assess their asthma control and establish their mobile phone suitability. Potentially eligible patients were booked for a trial recruitment visit.
Results: We recruited 288 patients (2.4% of those invited) across 32 practices, with a total list size of 311,926 patients. This compares to our predicted recruitment of 312 patients from a population of 72,000 patients in six to eight practices. In addition to the recognized problem of poor response rates, the major challenges were insufficiently discriminating computer searches and incompatibilities between mobile phone handsets, networks and the asthma application.
Conclusion: Our data have implications for clinicians, managers, and researchers in primary care. Researchers in this area may wish to consider our data when designing their recruitment strategies. Improved coding of asthma morbidity data in clinical practice would ease identification of poorly controlled patients, both for clinical interventions and recruitment to trials. If telehealth is to become mainstream, there needs to be standardization of applications, operating platforms, and network capabilities.
Original languageEnglish
Pages (from-to)51-55
Number of pages5
JournalPragmatic and Observational Research
Volume2012
Issue number3
DOIs
Publication statusPublished - 24 Aug 2012

Bibliographical note

Acknowledgments
This study was funded by Asthma UK. HP is supported by a Primary Care Research Career Award from the Chief Scientist’s Office of the Scottish Government. The Primary Care Research Networks in Norfolk and Yarmouth, East Kent, North of England, and Essex and Hertfordshire identified and recruited practices. We thank the practices, practice nurses, and administrative staff for their active participation and the patients who gave their time to participate in the trial. Professor Amanda Lee was the trial statistician. We thank Dr Andrew Wilson and Neil Kendle for serving on the ITSC and Dr Brian McKinstry and Dr Chris Burton who offered advice as collaborators. ISRCTN number: NCT00512837.
Contributorship: DR initiated the idea for the study and with HP led the development of the protocol, securing of funding, study administration, data analysis, interpretation of results, and writing of the paper. DP is a grant holder who contributed to development of the protocol, securing of funding, study administration, data analysis, interpretation of results, and writing of the paper. SM and SDM recruited practices and undertook the data collection. All authors had full access to all the data and were involved in interpretation of the data. SM wrote the initial draft of the paper, to which all the authors contributed. DR and HP are study guarantors.

Keywords

  • asthma
  • primary care
  • telehealth
  • recruitment
  • randomized controlled trials

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