title: Costs and difficulties of recruiting patients to provide e-health support: pilot study in one primary care trust.
abstract: BACKGROUND
  Better use of e-health services by patients could improve outcomes and reduce costs but there are concerns about inequalities of access. Previous research in outpatients suggested that anonymous personal email support may help patients with long term conditions to use e-health, but recruiting earlier in their 'journey' may benefit patients more. This pilot study explored the feasibility and cost of recruiting patients for an e-health intervention in one primary care trust.
  
  
  METHODS
  The sample comprised 46 practices with total patient population of 250,000. We approached all practices using various methods, seeking collaboration to recruit patients via methods agreed with each practice. A detailed research diary was kept of time spent recruiting practices and patients. Researcher time was used to estimate costs. Patients who consented to participate were offered email support for their use of the Internet for health.
  
  
  RESULTS
  Eighteen practices agreed to take part; we recruited 27 patients, most (23/27) from five practices. Practices agreed to recruit patients for an e-health intervention via waiting room leaflets (16), posters (16), practice nurses (15), doctors giving patients leaflets (5), a study website link (7), inclusion in planned mailshots (2), and a special mailshot to patients selected from practice computers (1). After low recruitment response we also recruited directly in five practices through research assistants giving leaflets to patients in waiting rooms. Ten practices recruited no patients. Those practices that were more difficult to recruit were less likely to recruit patients. Leaving leaflets for practice staff to distribute and placing posters in the practice were not effective in recruiting patients. Leaflets handed out by practice nurses and website links were more successful. The practice with lowest costs per patient recruited (£70) used a special mailshot to selected patients.
  
  
  CONCLUSIONS
  Recruitment via general practice was not successful and was therefore expensive. Direct to consumer methods and recruitment of patients in outpatients to offer email support may be more cost effective. If recruitment in general practice is required, contacting practices by letter and email, not following up non-responding practices, and recruiting patients with selected conditions by special mailshot may be the most cost-effective approach.
authors.affiliation: Faculty of Health, Education and Society, Plymouth University, Plymouth PL4 8AA, UK. ray.jones@plymouth.ac.uk
authors.forename: Ray B
authors.initials: RB
authors.lastname: Jones
authors.forename: Anita
authors.initials: A
authors.lastname: O'Connor
authors.forename: Jade
authors.initials: J
authors.lastname: Brelsford
authors.forename: Neil
authors.initials: N
authors.lastname: Parsons
authors.forename: Heather
authors.initials: H
authors.lastname: Skirton
mesh_terms: D000329:Advertising / Q000191:economics* / Q000379:methods; D002908:Chronic Disease / Q000453:epidemiology; D003365:Costs and Cost Analysis; D034742:Electronic Mail / Q000706:statistics & numerical data; D004739:England; D005194:Family Practice / Q000191:economics* / Q000706:statistics & numerical data; D005240:Feasibility Studies; D006801:Humans; D007255:Information Services / Q000600:supply & distribution; D020407:Internet / Q000706:statistics & numerical data; D008875:Middle Aged; D010174:Pamphlets; D010358:Patient Participation / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D018579:Patient Selection; D010865:Pilot Projects; D057175:Posters as Topic; D012108:Research Personnel; D060756:Social Networking; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics* / Q000379:methods; D013997:Time Factors