title: Challenges faced in recruiting patients from primary care practices into a physical activity intervention trial. Activity Counseling Trial Research Group.
abstract: BACKGROUND
  Special challenges are encountered when clinical trial recruitment targets a physician practice-based population, as opposed to recruiting from the community. Since most published information about recruitment has focused on the latter group, summation of successful primary-care-based recruitment strategies could prove useful for future trials recruiting from this population.
  
  
  METHODS
  The Activity Counseling Trial (ACT) is a multicenter, randomized clinical trial that evaluated approaches to primary care-based interventions to increase physical activity in sedentary adults 35-75 years of age. Fifty-four clinicians from eight practices recruited 874 participants from three U.S. sites. Recruitment challenges that related, in great part, to the primary care setting included: (1) focusing on patients from ACT physician practices who had regularly scheduled or intend-to-schedule appointments within the next year; (2) placing trial staff in the clinical offices for recruitment purposes; and (3) placing trial interventionists in the physicians' offices. Other challenges were related to recruitment of minorities and men.
  
  
  RESULTS
  Patient mailing yielded 43.4% of all randomized participants, followed by office-based questionnaires (32.5%) and direct telephone contact (21.6%). Based on a retrospective cost-effective analysis (indirect costs excluded), the self-administered office-based questionnaire was the least costly strategy for one site ($14/randomized participant), followed by patient mailing at another site ($58). The direct telephone contact method utilized at one site serving primarily a minority population yielded a per randomized participant cost of $80.
  
  
  CONCLUSIONS
  Recruitment of clinical trial participants from practice-based populations requires modification of the strategies used to recruit from the community. Multiple strategies should be employed, followed closely for their respective yields, and adapted as needed.
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. smargiti@wfubmc.edu
authors.forename: S
authors.initials: S
authors.lastname: Margitić
authors.forename: M A
authors.initials: MA
authors.lastname: Sevick
authors.forename: M
authors.initials: M
authors.lastname: Miller
authors.forename: C
authors.initials: C
authors.lastname: Albright
authors.forename: J
authors.initials: J
authors.lastname: Banton
authors.forename: K
authors.initials: K
authors.lastname: Callahan
authors.forename: M
authors.initials: M
authors.lastname: Garcia
authors.forename: L
authors.initials: L
authors.lastname: Gibbons
authors.forename: B J
authors.initials: BJ
authors.lastname: Levine
authors.forename: R
authors.initials: R
authors.lastname: Anderson
authors.forename: W
authors.initials: W
authors.lastname: Ettinger
mesh_terms: D000328:Adult; D000368:Aged; D015709:Correspondence as Topic; D003362:Cost-Benefit Analysis; D003376:Counseling; D015444:Exercise; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009819:Office Visits; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D011795:Surveys and Questionnaires / Q000191:economics; D013689:Telephone / Q000191:economics