Australian Primary Care Research Network Issue 1 December 2013 Special points of interest: Types of services and supports typically provided by PBRNs in Australia Tips for PBRNs around what to include in a budget for recruitment of practices A PBRN Case Study: Recruiting practices for the National Prescribing Service (NPS) MedicineInsight Program Inside this issue: Types of services and supports typically provided by PBRNs in Australia: Costing practice recruitment for primary care research budgets Tips for PBRNs around what to include in a budget for recruitment of practices A PBRN Case Study: Recruiting practices for the National Prescribing Service (NPS) MedicineInsight Program Contact Us 5 2 2 3 4 Introducing APCReN - A message from the President of AAAPC As the president of the Australian Association of Academic Primary Care Inc. (AAAPC) I would like to introduce to you our first edition of the Australian Primary Care Research Network (APCREN ) newsletter. APCReN is auspiced and overseen by the AAAPC which is a nationally representative body for people undertaking teaching and research in general practice and academic primary care. The AAAPC was funded earlier this year by the Australian Primary Health Care Research Institute (APHCRI) to establish a national support service for primary care practicebased research networks (PBRNs) across Australia. APCReN aims to: build and strengthen linkages between the existing Practice Based Research networks (PBRNs) and affiliated Universities from across Australia, as well as with new structures including Medicare Locals and Local Health/Hospital Networks. support research that is related to the national reform agenda and is intended to improve primary care services for consumers based on research at the practice level. provide advocacy and build capacity for practice-based research and foster collaboration and communication amongst the networks. To-date there has been little opportunity for formal collaboration between networks. With the establishment of APCReN, it is hoped that such collaboration will become possible. Professor Nick Zwar School of Public Health and Community Medicine, UNSW What can APCReN offer your PBRN or network of practices? A recent survey conducted by APCReN identified that PBRNs across Australia have very different levels of operational activity and governance arrangements. Each PBRN has the potential to participate in research opportunities, however some currently have greater capacity than others depending on their infrastructure. The establishment of APCReN will potentially provide PBRNs with some support and a point of contact to get involved in mutually benefi- cial research opportunities. Researchers will be able to engage with PBRNs to access a very large collection of general practices interested in participating in primary care research from across every part of Australia.
Page 2 Types of services and supports typically provided by PBRNs in Australia Researchers must establish and maintain rapport with practice staff and work to ensure that the clinical care of patients is not compromised or interrupted by the research The following list of services and supports were identified as being offered by a small selection of the PBRNs surveyed by AP- CReN earlier this year. Services and supports included: Regular e-bulletins / newsletters advertising research projects and opportunities for participation Emails to specific subsets of the membership to request input or participation (eg. those interested in cancer research) Active recruitment of general practitioners and/or practice nurses by PBRN staff (eg. for a survey of GPs, an audit of patients/gps across multiple practices, for clinical trials.) Organisation and hosting event(s) e.g. focus groups / workshops / training events to discuss research issues. This could involve researchers wanting to utilise the expertise of the PBRN Committee and/or broader membership including GPs, practice nurses, practice managers. Identification of an appropriate GP Costing practice recruitment for primary care research budgets Conducting research in a primary care setting can be difficult because of the necessity that it must take a secondary role to that of the clinical care of patients. Every practice has its own internal mechanisms and ways of managing work load. Researchers must establish and maintain rapport with practice staff and work to ensure that the clinical care of patients is not compromised or interrupted by the research. Active recruitment may involve a range of tasks and elements, some of which are costly and need to be adequately resourced. Experience has shown that promoting research through website and newsletters may seem an easy and attractive option for practice recruitment because it costs little. However these methods typically yield a very small response from GPs and practice staff. Other strategies often need to be utilised to provide better recruitment outcomes. PBRNs will also benefit from establishing some kind of formalised membership and electronic data base to record information about each practice and the interests of those on the membership list. Which types of research opportunities should not be presented to PBRN members? PBRN members should not be asked to participate in any research which: Is not relevant to Adviser for a research project or other role. These services may be offered free of charge by some PBRNs which have staff employed to maintain the network. However most PBRNS will need to consider offering services in the future, at least on a cost recovery basis to ensure sustainability. PBRNs will thus need to develop budgets to cost their role in participating in studies in order to take advantage of new opportunities which are expected to arise thorough APCReN. primary care Does not have a clear method or provide adequate support ie. either financial, training or practical Does not have relevant ethics approval Will impact on their practice excessively or unreasonably and is without sufficient remuneration eg workload for staff or patients Does not reflect the existing interest and research activities of the practice Membership to PBRNs is usually voluntary and free of charge and therefore PBRNs must always be mindful of not spamming members with information which is not relevant or inappropriate for their membership.
Page 3 Tips for PBRNs around what to include in a budget for recruitment of practices Project management and administration costs - Coordination time must be included in the budget. The coordinator must become familiar with the project, liaise with project team throughout the study, recruit and oversee casual staff, administer the project including, if required, budgeting, literature review, data analysis and report writing. Advertising - Sending out advertisements in an e-bulletin or emailing membership for a specific research project or purpose. Each PBRN may have a different arrangement for advertising i.e. free to academic colleagues, small fee for external agencies. Employment of casual recruitment staff PBRNs may need to recruit appropriately trained call staff and liaison officers who have worked in the general practice environment and are familiar with data collection (For eg. Casual HEW 4 or HEW 6 ). The budget should also include any training expenses. Develop a tracking database A database may be required for recruitment management and monitoring especially when multiple staff are required and a large number of practices are being sought. Travel costs - Hire cars for visits to practices or reimbursement for travel costs for Liaison Officers should be included in a recruitment budget. Travel costs to rural areas may need to be budgeted differently to metropolitan areas. Computer Assisted Telephone Interviewing (CATI services) PBRNs will need to consider the cost of providing suitable space for CATI staff to make calls, and estimating costing for the volume of calls, especially if calling mobile numbers. It will be necessary to predict how many practices will need to be called to achieve the desired target, and how many calls on average may be needed to successfully recruit each practice eg. 6 calls to achieve a visit and maybe 2 more after the visit, to finalise recruitment. Printing and postage costs May include printing and postage of survey forms, information sheets, consent forms, flyers etc Payment/remuneration for GPs - It is often beneficial to provide appropriate remuneration to GPs and practices for their time to participate in the research RACGP CME points or PIP points - Administration time (2-3 weeks FT) should be budgeted to prepare, if appropriate, RACGP CME points. Payments for reference group members Hosting an event or dinner (potentially 2-3 weeks work) PBRNs may host a dinner to seek interest in participation in a study or hold a focus group event on a specific research subject. This may involve the following: Organising a venue eg. booking function room, catering Designing flyers/advertisements for the event Emailing or mailing invitations Contacting the membership to encourage participation Coordination of the event including RSVPs and confirmation lists, materials for the event Other costs such as purchasing PC, software, other equipment, advertising Overheads for the lead organisation/university should also be included in these costs (Approximately 35%). PBRNs will also benefit from establishing some kind of formalised membership and electronic data base to record information about each practice and the interests of those on the membership list
Page 4 A PBRN Case Study: Recruiting practices for the National Prescribing Service (NPS) MedicineInsight Program The establishment of APCReN will potentially provide PBRNs with future opportunities to learn about and participate in collaborative primary care research The University of Melbourne (via VicReN the Victorian Primary Care Practice-Based Research Network at the General Practice & Primary Health Care (GP&PHC) Academic Centre) was contracted by the National Prescribing Service (NPS) in May 2013, to recruit general practices to the MedicineInsight program. MedicineInsight program MedicineInsight is an innovative program conducted by the National Prescribing Service utilising information technology in the primary care setting. The program aims to collect de-identified information from 2 million patients and then to provide feedback to practices to support improvements in prescribing and clinical activity. The information will also be used to build a national medicines database to influence health policy. Practice recruitment target VicReN was first contracted by the NPS on the 3rd May, 2013 to recruit general practices to the MedicineInsight program. Based on the success of the first phase of the project, a second contract was entered into on 29th July 2013. VicReN staff continued recruitment work between the two stages to benefit fully from the momentum generated through contacts made with practices during Stage 1. This resulted in a 23 week long recruitment window. The recruitment targets set for each stage were as follows: Stage 1 - to recruit a minimum of 30 practices to participate in the program in 6 weeks Stage 2 - to recruit an additional 40 practices in 9 weeks (30 new practices and a further 10 practices followed up from the stage 1 target population). Overall target - The overall target number therefore was a minimum of 70 practices recruited to MedicineInsight by the end of stage 2. VicReN successfully recruited 75 practices from a pool of 373 eligible practices in a 6 month period. This translates to an overall 20.1% sign-up rate by the end of the recruitment phase based on those practices that were eligible and had the MedicineInsight Program explained in full to either the Practice Manager or a Principal GP (practices excluded include solo or specialist practices or those with non compatible practice software). Resources required prior to recruitment University of Melbourne staff including the Department Head, VicReN coordinator, Research Training Director and recruitment staff initially provided input and feedback to the NPS team on a variety of customised marketing and program materials prior to the commencement of practice recruitment. This process involved attending several planning meetings, a workshop, and contribution to document reviews to ensure that all materials used in the program were designed suitably for the general practice environment and were user friendly for practice managers and GPs. The University of Melbourne and VicReN staff provided the following services: Direction and input for the production of marketing materials, letters of approach and an expression of interest form (EOI) Modification of specific forms to be used and completed by practices Provision of advice on the design and development of kits for use in recruitment of practices Development of tools for recruitment staff to use to manage the steps involved in the recruitment process Identification of a suitable target population for NPS As part of the marketing of MedicineInsight to general practitioners, VicReN advertised the MedicineInsight program to the broader VicReN membership base via a monthly e-bulletin. Interested members were invited to attend a specially organised dinner to hear about the programs benefits for individual GPs and their practices. A total of 14 people attended the dinner including 7 GPs from
Page 5 VicReN. The evening was very successful with 5 of the GPs expressing interest to participate in MedicineInsight. These GPs went on to receive a visit to their practice by a Liaison Officer and are now participants in the program. Tracking Database The Academic Centres research and teaching database of general practices (which includes VicReN members) was utilised as the source of practices for recruitment to the MedicineInsight program. The database manager adapted an inhouse tracking database to enable the needs of MedicineInsight to be accommodated. The multiuser tracking system assists in the management of a team of call and Liaison staff who are required to simultaneously access and modify a large dataset of practices. The system allows staff to be calling simultaneously with multiple shifts rostered per day. The system tracks how many calls are made, when they are made, and when further calls should be made. The system also allows comments to be recorded at the time of the call to enable the next caller to continue the progress with each practice seamlessly. Practices were extracted from the main database in 12 waves and based on geographical bands to enable more costeffective follow-up via practice visits. Wave 1 represented VicReN members located within 50 km of the Melbourne CBD (66 practices). All General Practices on the target list were sent an initial marketing postcard followed by a letter and information pack. Recruitment of practice Liaison staff and training VicReN engaged a total of 6 casual staff to work on the MedicineInsight practice recruitment work, the majority of whom had prior experience in practice recruitment at the University of Melbourne. A recruitment training manual and one-day training workshop was designed and delivered to all casual staff. A second follow-up training day was also held in order to refine some of the procedures and allow staff time to practice the scripts and familiarise themselves with the recruitment materials and processes. Recruitment activities Recruitment staff were employed casually for a period of 23 weeks. Computer assisted telephone interviewing (CATI) staff hours of operation varied over the duration of the recruitment. Due to the very tight timeline of stage 1, VicReN had 2 to 3 staff calling practices simultaneously over the first two weeks between 5 and 7 hours per day. The later weeks involved rosters with one shift per day or sometimes two with an overlap in the middle of the day. The roster was usually staggered so practice opening hours could be covered adequately. Overlapping shifts also assisted to support a staff handover and to cover GP availabilities. See table for further details. Lessons learnt from Stage 1 Lessons from stage 1 informed us more accurately about the ideal number of staff required per day, preferred timelines to follow-up practices and how many practices we could actively followup simultaneously with the resources available. Approximately half the number of practices was targeted for Stage 2 compared to the first stage. The longer timeline of 9 weeks also meant that only one staff member was required per day for an average of 4 hours per day. This arrangement enabled better efficiency and economy for the recruitment model. A total of 629 practices were contacted at least once with a total number of 2489 calls made to practices. The average number of calls per practice was 4.0. A total of 100 practices agreed to and received a visit from a VicReN liaison Officer with a final number of 75 practices signed up to the MedicineInsight program (75% signed up after visit) Conclusions The establishment of APCReN will potentially provide PBRNs with future opportunities to learn about and participate in collaborative primary care Recruitment staff Computer Assisted Telephone Interviewing (CATI) or call staff HEW 4 Level Liaison Officers for visiting practices HEW 6 Level Total Hours across 23 weeks research such as the MedicineInsight program. It is also anticipated that once APCReN has a greater public profile and specific organisations become aware of the existence of this network, that some will see the potential benefits of having access to a large cohort of practices located in regions from all over Australia. It will therefore be important for PBRNs to be prepared and able to respond to these opportunities through the preparation of quotations for recruitment of practices and getting involved directly in large scale and multi-site studies. The future sustainability of both APCReN and each of the existing PBRNs will be influenced by the ability of the individual networks to engage and respond to these opportunities. References: Bridget Gaglio, Candace C. Nelson, Diane King. The Role of Rapport: Lessons Learned From Conducting Research in a Primary Care Setting, Qual Health Res May 2006 vol. 16 no. 5 723-734. Average hrs per week Output 577.5 25 110 calls per week 4.4 calls per hour 530.25 23 Avg 4.8 visits per week Range 1-12 per week
Contact Us: APCReN Academic Director Associate Professor Meredith Temple-Smith APCReN Coordinator Ms Natalie Appleby General Practice and Primary Health Care Academic Centre 200 Berkeley St, Carlton, Vic 3053 Phone: 03 98344 3392 or 03 8344 3371 Fax: 03 8344 6136 E-mail: nappleby@unimelb.edu.au E-mail: m.temple-smith@unimelb.edu.au APCReN Website coming soon!!