Skip to main content

Table 6 Study implementation issues

From: Hypertension Improvement Project (HIP): study protocol and implementation challenges

Challenge

Solution

Setting

 

Access to clinic space for study visits

Schedule study visits on days when clinic rooms are available.

Access to space for group intervention

Schedule evening sessions; find local facility.

Minimize disruption to practice flow

Study staff responsible for scheduling, check-in, and posting of signage.

Engage clinic staff/communication

Group meeting prior to (and early part) of implementation; use of e-mail; financial compensation to offset practice costs.

Travel to distant sites

Staff coordinate travel together to minimize travel costs.

Patient population/recruitment

 

Enroll low SES population

Target participants with no insurance, with Medicaid or Medicare without supplemental insurance.

Identify minority population

Target clinics with more minority participants.

Recruit men to participate

Prioritize mailings and phone calls to men.

High proportion of participants at BP goal (clinics are doing well in BP management; volunteer bias)

Chart review to identify patients with uncontrolled BP prior to screening for Cohort 4.

Group intervention

 

Finding patients motivated to undergo group intervention

Recruitment by opt-out changed to opt-in/opt-out method.

Attendance

Useful information; mimics real-world implementation.

No individualized counseling (allows implementation in busy setting)

Use community health advisors.

Physician intervention

 

MD turnover

Refer participants to another participating provider within practice.

Additional work for CPM form completion

Form on non-carbon paper to use as clinic note; brief 1-page form; top part can be filled out by non-MD.

MD time for training module completion

Face-to-face orientation of providers to Web-based (asynchronous) training modules; CME credits offered.

QI developed by researchers (non-practice staff); competing QI initiatives within practice

In future, increase involvement of practice clinicians; use of electronic records to collect BP at routine visits.

Town-gown relationship

Work with existing research partner (PCRC).

  1. BP = blood pressure; CME = continuing medical education; CPM = clinical performance measure; QI = Quality Improvement; JNC = Joint National Committee on Prevention, Evaluation, Detection, and Treatment of High Blood Pressure; MD = physician; PCRC = Primary Care Research Consortium; SES = socioeconomic status.