Exploring successful recruitment to CONTACT in CRN Wessex: randomised pragmatic clinical trial of low-dose Colchicine Or Naproxen Treatment for ACute gouT
Primary care remains a challenging arena for patient recruitment to research, particularly for opportunistic recruitment in acute conditions. The constantly changing nature of general practice in terms of workforce, staff roles and varying roles between practices can translate into challenges for developing effective recruitment strategies. There is a need to learn from complex studies that recruit successfully to provide insight into recruitment methodology.The CONTACT study involved opportunistic recruitment by GPs within consultations for acute gout to a Clinical Trial of an Investigational Medicinal Product (CTIMP). This paper examines the reasons why one geographical area recruited over twice as many patients than the others.
Quantitative data was obtained from the National Institute for Health Research: recruitment rates and number of practices recruiting to CONTACT were examined using descriptive statistics.We carried out semi-structured qualitative interviews with the local study coordinator, local academic lead and four members of practice staff involved in the delivery of the study regarding the roles of the different organisations in recruitment. A total of six people were interviewed for this purpose, either face-to-face or by telephone. The study co-ordinator and local academic lead were interviewed using an open ended semi-structured questionnaire with four questions about their perceptions on recruitment. We used qualitative descriptive analysis of themes and subthemes.
CRN Wessex was the top recruiter to CONTACT with 38% (n=153) of all patients recruited across six other geographical regions (n= 399). This was more than double the recruitment achieved in other areas. Quantitative findings about recruitment in CRN Wessex:• The prevalence of gout in the area was moderate to low.• The best recruiting practices were not found to be the ones with a largest list size.• The highest number of practices recruiting to the study were not in CRN Wessex when compared to other areas. • The best recruiting practices in CRN Wessex were not the ones with the most experience of research. None of the above were enough to explain the higher recruitment of patients by practices in the area.The qualitative data revealed the following themes of perceived facilitators:• Appropriate selection of the practices for the study• Good practice communications• Whole practice buy-in• Succinct data collection and Standard Operating Procedures designed to address the research question only. This influenced all paperwork making it very clear and thereby reducing the time required for recruitment.As data collection, standard operating procedures and practice presentations were the same in all recruiting areas, this suggests that the process of selection of practices in Wessex was crucial as it included professional judgements on good practice communications and whole practice buy-in.
The careful selection of practices appropriate to specific studies by Clinical Research Network staff is an important factor in recruitment success.