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

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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.

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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.-

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

A Health Department list of all physicians licensed in the state was obtained to identify potentially eligible physicians, and the list was supplemented with a private directory of physicians who practice in the state.¹⁶ Medical staff lists from local hospitals, health maintenance organizations, and community health centers were used. Office addresses were further verified by phone.

Recruitment strategy

The multi-stepped recruitment process included 3 phases. Phase 1 of recruitment included widespread promotion through various forms of written communication in which the important role of physician involvement in smoking cessation efforts was emphasized.^1,7,17,18 based on the work of Rogers¹⁹ and Lomas and coworkers,²⁰ an advisory board made up of local, influential physicians was formed to assist with recruitment efforts during the Phase 1. Board members were selected from various physician and health-related organizations throughout the state. The advisory board was designed to serve as a linkage system²¹ between research intervention offerings and community physicians.

A mailed invitation to participate was sent on advisory board letterhead, under the signature of the medical director of the state Health Department and the president of the state medical society. The mailing included information about the study, an enrollment form that assessed eligibility, and a consent form for participation along with a postage-paid return envelope. Mailed postcards and telephone calls from research staff were used as follow-up for those who did not respond to the initial mailing. In addition, public relations departments at the State Health Department, state medical society, 3 community hospitals, and a regional metropolitan newspaper were asked to include a brief article about the study in their newsletter or newspaper, which they all did.

Phase 2 of the recruitment process involved making appearances at local hospitals and visits to practices and clinics. Physicians had an opportunity to enroll at department staff meetings following presentations that were made by the principal investigator and staff. In addition, individual meetings were scheduled with a small number of physicians who requested this. Also, members of the physician advisory board were asked to make brief phone calls to a small number of their physician colleagues to solicit their participation in the study. Physicians who enrolled during these 2 phases were also encouraged to talk to their colleagues informally about participating in the project. Phase 3 of the recruitment process focused on enrolling remaining eligible physicians. Paid physician recruiters were hired to assist the principal investigator in making telephone contact. Physicians who could not be reached by the paid recruiters also received a phone call from the principal investigator. Early outreach required participant initiative for enrollment, therefore all refusals occurred during telephone contacts in Phase 3.

Participation requirements

Participation requirements were kept minimal to facilitate and encourage enrollment of all eligible physicians, regardless of their readiness to adopt smoking interventions.^12,19,22,23 To enroll, physicians had to agree to complete 3 annual, 20-minute surveys and allow 20-minute assessments of the office environment to determine smoking cessation tools and resources available to patients and providers. This latter assessment was conducted with one of the office staff in order to minimize time demands of the physician. The intervention was designed to test an approach to gain enhanced access to physicians in their offices. Acceptance of intervention visits from research staff was optional in order to encourage participation of physicians with a broad range of interest and readiness to adopt smoking cessation interventions.

Upon return of their completed baseline survey, physicians in the intervention were offered information based on their readiness to enhance their cessation efforts, samples of patient education materials, a poster listing local smoking cessation programs, and the NCI physician manual, “How to Help Your Patients Stop Smoking.”²⁴ Physicians in the intervention area were offered various resources and training opportunities to enhance smoking cessation interventions in their office. Research staff, trained as consultants to deliver tailored interventions based on an academic detailing approach, scheduled intervention meetings to be most convenient for the physician and office staff. While physician attendance at intervention meetings was encouraged, physicians were offered the option of designating office staff to meet with the research consultants. The goal was to meet with physicians or designated staff roughly 4 to 5 times during the intervention year. No adoption of cessation efforts were required. Physicians in the control area were offered the same manual after completing their baseline survey and the opportunity to receive the other resources and participate in counseling skills training at the end of the intervention period.

Results

Of 2316 licensed physicians in Rhode Island in 1989, 822 were identified as meeting the primary care specialty criteria, based on information provided in the listings used: 557 from the control area and 265 from the 2 intervention areas. Of the physicians from the control area, 202 were matched to the physicians from the intervention areas and became part of the sampling frame. Initial contacts to physicians in the sampling frame determined that an additional 148 were not eligible. The majority of these did not meet the requirements for primary care due to not practicing in a primary specialty or not providing regular, ongoing care to at least 25% of their patients.²⁵ Others had moved from the state, retired, or died. After elimination of physicians who did not meet eligibility criteria, 187 intervention area physicians and 132 control area physicians remained in the final pool of physicians eligible for recruitment. Less than 10% of recruitments responded to the initial mailing, and another 10% were recruited directly from the in-person presentations at department meetings.