Physician Recruitment for a Community-Based Smoking Cessation Intervention

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Original Research

Physician Recruitment for a Community-Based Smoking Cessation Intervention

J Fam Pract. 2002 January;51(1):1

By

Elyse R. Park, PhD

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References

1. Kottke T.E., R. N. Battista, et al. Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials. JAMA 1988;259(19):2883-9.

2. Ockene J. K., J. Kristeller, et al. Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial [see comments]. J Gen Intern Med 1991;6(1):1-8.

3. Schwartz J. L. Methods of smoking cessation. Med Clin North Am 1992;76 (2):451-76.

4. Fiore M., W. Bailey, et al. (1996). Smoking Cessation: Clinical Practice Guideline No. 18, Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health And Human Services.

5. Wilson D. M., D. W. Taylor, et al. A randomized trial of a family physician intervention for smoking cessation. JAMA 1988;260(11):1570-4.

6. Cummings S. R., R. J. Richard, et al. Training physicians about smoking cessation: a controlled trial in private practice. J Gen Intern Med 1989;4(6):482-9.

7. Kottke T. E., L. I. Solberg, et al. A comparison of two methods to recruit physicians to deliver smoking cessation interventions. Arch Intern Med 1990;150(7):1477-81.

8. Haug K., P. Fugelli, et al. Recruitment and Participation of General Practitioners in a Multipractice Study of Smoking Cessation. Scandanavian Journal of Primary Health Care 1992;10:206-210.

9. Richmond R, C. Mendelsohn, et al. Family physicians’ utilization of a brief smoking cessation program following reinforcement contact after training: a randomized trial. Prev Med 1998;27(1):77-83.

10. Asch S, S. Connor, et al. Problems in Recruiting Community-Based Physicians for Health Services Research. J Gen Internal Med 2000;15:591-599.

11. Goldstein M. G., DePue J.D., Monroe AD, Lessne CW, Rakowski W, Prokhorov A, Niaura R, Dube CE. A Population-Based Survey of Physicians’ Smoking Counseling Behavior. Preventive Medicine 1998;7(5 Pt 1):720-9.

12. Goldstein M. G, N. A. MacDonald, et al. (1993). Dissemination of physician-based smoking cessation interventions. Tobacco and the Clinician; Interventions For Medical and Dental Practice. S. Burns, S. Cohen, E. Gritz and T. Kottke. Bethesda, MD, USDHHS, PHS, NIH, NCI.

13. Kottke T. E., L. I. Solberg, et al. Initiation and maintenance of patient behavioral change: what is the role of the physician? J Gen Intern Med 1990;5 (5 Suppl):S62-7.

14. Dietrich A. J., G. O’Connor, et al. (1990). Will community physicians participate in rigorous studies of cancer control? The methodology and recruitment of a randomized trial of physician practices. Advances in Cancer Control: Screening and Prevention Research, Wiley-Liss, Inc.: 373-381.

15. Goldstein M. G., R. Niaura, et al. Physicians counseling smokers. A population-based survey of patients’ perceptions of health care provider-delivered smoking cessation interventions. Arch Intern Med 1997;157(12):1313-9.

16. Folio Associates (1990). Folio’s Medical Directory of Connecticut and Rhode Island, Folio Associates, Inc. Tobacco and Cancer Program, Division of Cancer Prefvention and Control, National Cancer Institute.

17. Battista R. N., J. I. Williams, et al. Determinants of primary medical practice in adult cancer prevention. Med Care 1986;24(3):216-24.

18. Ockene J. K. Smoking intervention: the expanding role of the physician [editorial]. Am J Public Health 1987;77(7):782-3.

19. Rogers E. M. (1983). Diffusion of Innovations. New York, The Free Press.

20. Lomas J, Enkin M., et al. Opinion Leaders vs audit and feedback to implement practice guidelines. JAMA 1991;266 (9):1217.-

21. Orlandi M. A. Promoting health and preventing disease in health care settings: An analysis of barriers. Preventive Medicine 1987;16:119-130.

22. Prochaska J. O., & DiClemente C. C. Toward a comprehensive model of change. Treating Addictive Disorders: Processes of Change. W. R. Miller and N. Heather. New York, Plenum Press, 1986.

23. Prochaska J., W. Velicer, et al. Measuring processes of change: Applications to the cessation of smoking. J Consult Clin Psychology 1988;56:520-528.

24. Glynn T. J., M. W. Manley (1989). andHow to Help Your Patients Stop Smoking. A National Cancer Institute Manual for Physicians. Bethesda, Maryland, Smoking,

25. Carey T., L. Kinsinger, et al. Research in the Community: Recruiting and Retaining Practices. Journal of Community Health 1996;21:315-327.

26. McBride P., K. Massoth, et al. Recruitment of Private Practices for Primary Care Research: Experience in a Preventive Services Clinical Trial. J Fam Pract 1996;4:389-395.

27. Levinson W., V. Dull, et al. Recruiting Physicians for Office-Based Research. Medical Care 1998;36(6):934-937.

Reprint requests should be addressed to Elyse Park, PhD, MGH, 50 Staniford Street, 904A, Boston, MA 02115. E-mail: epark@partners.org.

ABSTRACT

OBJECTIVE: Our goal was to describe a strategy to recruit a population-based sample of physicians to test an approach to disseminate physician-delivered smoking cessation interventions.

STUDY DESIGN: The 3-phase population-based recruitment trial included: (1) a print-based promotional appeal; (2) in-person presentations by the principal investigator (PI); and (3) follow-up calls by the PI and paid physician recruiters. Participation requirements were kept minimal to facilitate recruitment.

POPULATION: All primary care physicians statewide were targeted; 3 counties were chosen as intervention areas and 2 counties as control areas. A subsample of physicians was targeted in the larger control areas through a matching process.

OUTCOME MEASURED: We measured physician recruitment rate.

RESULTS: Eighty-one percent (n=259) of all eligible physicians were successfully recruited into our study.

CONCLUSIONS: The full multistep process was important in getting participation agreement. By using an intensive recruitment strategy and minimizing research demands, it is possible to recruit community-based primary care physicians for research projects that will help them enhance the preventive services they provide to their patients.

KEY POINTS FOR CLINICIANS

We describe a successful method of recruiting physicians into a community-based trial.
Our multiphase multifaceted recruitment design included an initial mailing, presentations at local hospitals, clinic and office visits, and follow-up phone calls.
Successful recruitment rate was attributed to the enhanced involvement by a physicians, and the minimized research demands in return for participation.

Controlled research trials have demonstrated that physician-delivered smoking interventions are an effective means of increasing quit rates among patients who smoke.^1-4 However, these trials involved samples of physicians-in-training or volunteer physicians that were not representative of the general primary care physician population. Furthermore, the percentage of eligible physicians who participated in community-based trials ranged from 5% to 50%,V^5-9 and obstacles to practicing physician’ participation in research are now greater than ever.¹⁰

Physicians Counseling Smokers (PCS) is a National Cancer Institute-funded phase IV trial that tested the effectiveness of an approach to disseminate physician-delivered smoking cessation interventions.^11,12 Because this was a dissemination trial that would assess smoking outcomes at a population level, it was necessary to recruit a very high percentage of practicing primary care providers within the discreet geographic areas. The objective of this paper is to describe the process of recruiting a population-based sample of physicians.

Methods

Identification of intervention and control areas

The entire state population of primary care physicians was targeted for recruitment. Three counties served as intervention areas; the 2 smaller counties (Newport and Washington) were combined to approximately match the size of the third (Kent). These 2 geographic areas were chosen for intervention because it was feasible to intervene with the total estimated number of physicians (n=100) in each area. Saturation of intervention areas was important because patient level outcomes were being assessed with random digit dial techniques.¹⁵ The largest and smallest counties (Providence and Bristol) were combined to serve as the control area.

Given the comparatively large number of physicians in the control area, a subsample of these physicians were targeted for recruitment. This subsample was created by matching the intervention sample on gender, practice specialty, and years since graduation from medical school. In addition, the control sample was matched at a rate of 1.5 times the mean of the number of eligible physicians in the 2 intervention areas. Eligible physicians in the intervention and control areas practiced in community health centers, colleges or universities, private practices, and a state-wide staff model health maintenance organization. Five large urban public health clinics in Providence, Rhode Island, were not targeted because there was no comparable group of urban public health clinics in the intervention areas. We targeted physicians for enrollment because they were most often the key decision makers, both for consent for the office to participate and for their influence over change in practice patterns. Further, the NCI model being disseminated had been previously tested on physicians. However, once the office was enrolled, all clinicians were invited to participate in sessions with our practice consultants.

We did not include practice-based midlevel providers since the purpose of the study design was to assess the NCI smoking cessation recommendations for physicians, which was a model that had previously been tested specifically on physicians. Also, to conduct a practice-based study, the consent of the physicians is necessary. Our emphasis was to establish physician buy-in so that we could enhance our ability to conduct the intervention and involve all practice-based clinicians.

Identification of the physician sample

To be eligible for participation in PCS, physicians had to (1) have a primary care specialty; (2) provide regular, ongoing care to at least 25% of their patients; (3) practice in a nonhospital-based location; and (4) intend on being available during the 3-year evaluation period.