title: Building an international network for a primary care research program: reflections on challenges and solutions in the set-up and delivery of a prospective observational study of acute cough in 13 European countries.
abstract: BACKGROUND
  Implementing a primary care clinical research study in several countries can make it possible to recruit sufficient patients in a short period of time that allows important clinical questions to be answered. Large multi-country studies in primary care are unusual and are typically associated with challenges requiring innovative solutions. We conducted a multi-country study and through this paper, we share reflections on the challenges we faced and some of the solutions we developed with a special focus on the study set up, structure and development of Primary Care Networks (PCNs).
  
  
  METHODS
  GRACE-01 was a multi-European country, investigator-driven prospective observational study implemented by 14 Primary Care Networks (PCNs) within 13 European Countries. General Practitioners (GPs) recruited consecutive patients with an acute cough. GPs completed a case report form (CRF) and the patient completed a daily symptom diary. After study completion, the coordinating team discussed the phases of the study and identified challenges and solutions that they considered might be interesting and helpful to researchers setting up a comparable study.
  
  
  RESULTS
  The main challenges fell within three domains as follows:i) selecting, setting up and maintaining PCNs;ii) designing local context-appropriate data collection tools and efficient data management systems; andiii) gaining commitment and trust from all involved and maintaining enthusiasm.The main solutions for each domain were:i) appointing key individuals (National Network Facilitator and Coordinator) with clearly defined tasks, involving PCNs early in the development of study materials and procedures.ii) rigorous back translations of all study materials and the use of information systems to closely monitor each PCNs progress;iii) providing strong central leadership with high level commitment to the value of the study, frequent multi-method communication, establishing a coherent ethos, celebrating achievements, incorporating social events and prizes within meetings, and providing a framework for exploitation of local data.
  
  
  CONCLUSIONS
  Many challenges associated with multi-country primary care research can be overcome by engendering strong, effective communication, commitment and involvement of all local researchers. The practical solutions identified and the lessons learned in implementing the GRACE-01 study may assist in establishing other international primary care clinical research platforms.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT00353951.
authors.affiliation: South East Wales Trials Unit (SEWTU), Department of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, UK. Nuttallj@cf.ac.uk
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Nuttall
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.forename: Theo Jm
authors.initials: TJ
authors.lastname: Verheij
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Curt
authors.initials: C
authors.lastname: Brugman
authors.forename: Robert Er
authors.initials: RE
authors.lastname: Veen
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
mesh_terms: D000208:Acute Disease; D035843:Biomedical Research / Q000458:organization & administration*; D003371:Cough / Q000175:diagnosis / Q000628:therapy; D005060:Europe; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies