1. Arthritis Research UK Primary Care Centre Winner of the Queen’s Anniversary Prize For Higher and Further Education 2009 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. Arthritis Research Campaign National Primary Care Centre Keele University l Recruitment is an ever present problem l For patients  The perceived importance of the research question  Ease and speed of access to treatment  Financial incentives Introduction

3. Arthritis Research Campaign National Primary Care Centre Keele University 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 Introduction

4. Arthritis Research Campaign National Primary Care Centre Keele University 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 Background

5. Arthritis Research Campaign National Primary Care Centre Keele University 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 Aim of the PROG-RES study

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

7. Arthritis Research Campaign National Primary Care Centre Keele University l Read codes  Hierarchy of morbidity codes  Used in UK general practice to label consultations l Exclusions  life threatening pathology, inflammatory synovitis and vulnerable groups l The prompt -identified the correct patients -asked 7 brief pain related questions designed to fit in the normal consultation Methods

8. Arthritis Research Campaign National Primary Care Centre Keele University Pop-up electronic template activated by the appropriate musculoskeletal Read code in the PROG-RES study

9. Arthritis Research Campaign National Primary Care Centre Keele University l A self-complete questionnaire  to all patients with prompt data l Non-responders  reminder after 2 weeks l Patients completing the questionnaire  consent to access their medical records Methods

10. Arthritis Research Campaign National Primary Care Centre Keele University l Electronic prompt activated 650 times l Recruitment over 19 weeks  40% of the recruitment in first 4 weeks  95% was within 16 weeks l Four practices completed templates at a similar rate l One practice at a reduced frequency Results

11. Arthritis Research Campaign National Primary Care Centre Keele University Rates of recruitment by practices over time in the PROG-RES study

12. Arthritis Research Campaign National Primary Care Centre Keele University 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. Arthritis Research Campaign National Primary Care Centre Keele University Methods used in PROG-RES to maximise GP and patient participation 1 l Pop-up programme on general practice computer system l Pop-ups must be designed to minimise the burden of the research on GPs l GP involvement with template design l Practice visit by lead investigator l Clinically relevant topic l Provide a study information pack to the practice

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

15. Arthritis Research Campaign National Primary Care Centre Keele University l Support from the Health Informatics Team l Provide educational materials and an appraisal certificate of participation l TEAM WORK Methods in PROG-RES to maximise GP and patient participation 3

16. Arthritis Research Campaign National Primary Care Centre Keele University Acknowledgements Professor Christian Mallen, Dr Mark Porcheret, Dr Elaine Thomas, Prof George Peat Mr Simon Wathall, Centre Administrative staff, partipating practices and patients