Richard A Hayward NIHR GP Clinical Lecturer

1. Recruiting patients and collecting data for an observational study using computerised record pop-up prompts: the PROG-RES study. Richard A Hayward NIHR GP Clinical Lecturer

2. Introduction • Recruitment is an ever present problem • For patients • The perceived importance of the research question • Ease and speed of access to treatment • Financial incentives

3. Introduction For Health Professionals • Motivation of the recruiter • The relevance of the research topic • Easier access to treatment or investigations • Techniques to aid and simplify the recruitment

4. Background Computer prompts during the consultation can perform 2 functions 1) Act as a prompt to recruitment of patients 2) Facilitate collection of research data during the consultation with the patient present

5. Aim of the PROG-RES study Assessment of the prognosis of patients age>50yr consulting for a non-inflammatory musculoskeletal pain Sept 2006 to March 2007 in a prospective cohort study

6. Methods • 44 GPs in 5 General Practices using EMIS (Egton Medical Information System) • GPs part of the Primary Care Research Network • The Health Informatics Team • Developed and installed the prompt at GP practices • Linking the prompt to over 200 MSK Read codes • When an eligible Read code was entered the prompt was activated

7. Methods • Read codes • Hierarchy of morbidity codes • Used in UK general practice to label consultations • Exclusions • life threatening pathology, inflammatory synovitis and vulnerable groups • The prompt -identified the correct patients -asked 7 brief pain related questions designed to fit in the normal consultation

8. Pop-up electronic template activated by the appropriate musculoskeletal Read code in the PROG-RES study

9. Methods • A self-complete questionnaire • to all patients with prompt data • Non-responders • reminder after 2 weeks • Patients completing the questionnaire • consent to access their medical records

10. Results • Electronic prompt activated 650 times • Recruitment over 19 weeks • 40% of the recruitment in first 4 weeks • 95% was within 16 weeks • Four practices completed templates at a similar rate • One practice at a reduced frequency

11. Rates of recruitment by practices over time in the PROG-RES study

12. During the recruitment period Electronic template activated 650x 40% of recruitment in 4 weeks 95% of recruitment within 16 weeks 502 (77.2%) completed the questionnaire (of these) 428 (85%) permission to access medical records

13. Methods used in PROG-RES to maximise GP and patient participation 1 • Pop-up programme on general practice computer system • Pop-ups must be designed to minimise the burden of the research on GPs • GP involvement with template design • Practice visit by lead investigator • Clinically relevant topic • Provide a study information pack to the practice

14. Methods used in PROG-RES to maximise GP and patient participation 2 • Regular clinician-clinician contact by email, practice visits, telephone, letters etc • Monthly ‘progress reports’ • Short period for recruitment in this case 4 months maximum • Involvement of network of research general practitioners is desirable but not a necessity • Simple inclusion / exclusion criteria

15. Methods in PROG-RES to maximise GP and patient participation 3 • Support from the Health Informatics Team • Provide educational materials and an appraisal certificate of participation • TEAM WORK

16. Acknowledgements Professor Christian Mallen, Dr Mark Porcheret, Dr Elaine Thomas, Prof George Peat Mr Simon Wathall, Centre Administrative staff, partipating practices and patients