Abstract
Purpose of study: General practitioners (GPs) are often asked to recruit patients for research studies. However, a mismatch exists between the numbers of potential patients (estimated from pilot work and reported literature) and actual patients recruited. The purpose of this study was to establish GPs’ perceptions of the reasons for this mismatch.
Background: An OCPS survey reported that 16% of adults consulted their GP with back pain per year. Thus a GP, serving an average population of ~1900 patients, might expect to see around 300 patients with back pain every year, although this estimate includes all causes of back pain. Nevertheless, this represents a significant proportion of a GP’s workload.
In the ‘Back Home’ study, which was a randomised controlled trial of a patient information leaflet for people with acute low back pain (previously presented to this Society), recruitment of patients was problematic. A total of 28/97 GPs in the New Forest area agreed to recruit patients for the study, but in 22 weeks, only 8 patients emerged. Despite extending the catchment area of the study, and having 51 participating GPs, in 2_ years, only 64 patients were entered from 19 of these GPs. Therefore, we decided to investigate GPs’ perceptions of the reasons for such poor recruitment.
Methods: The challenge for this research was identifying how best to gain information from GPs about poor recruitment, recognising that requests for information about poor response rates may yield a limited response! The least intrusive means of accessing information was considered to be a brief questionnaire containing an open question that asked GPs to list any reasons that they thought may have contributed to the slow recruitment of patients into the study. GPs were then asked to rate 12 factors, identified by GPs who had withdrawn from the study. The factors were rated using a Likert scale from 1–4 (1=‘not at all’, 2=‘mildy’, 3=‘moderately’ and 4=‘very significantly’).
Results: Of the initial 51 participating GPs, 11 did not complete the study: 1 left the practice; 2 retired; 7 withdrew (3 of these due to pressure of work); and 1 was asked to leave the study by the research team due to issues of non-conformity with the study protocol.
Forty GPs were sent a questionnaire and 24 responded (60%). They gave 47 unprompted reasons for poor recruitment of patients – the most popular being: pressure of work (n=12); difficulty remembering (n=10); feeling ‘over-researched’ (n=4); and few patients fitted the inclusion criteria (n=4). When GPs rated the 12 listed factors, the maximum score for each item = 96 (24x4). According to the GPs, the top 4 factors were: pressure of work (score=60); forgetting to include suitable patients (52); time-consuming process of entering patients (39); GPs are ‘over-researched’ (31).
Conclusion: Research studies that necessitate GPs accessing patients from their routine surgeries are likely to experience difficulties with recruitment. It is vital that researchers and funding agencies address this issue if research within primary care is to survive.
The abstracts were prepared by Dr P Dolan. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
