From: Hypertension Improvement Project (HIP): study protocol and implementation challenges
Challenge | Solution |
---|---|
Setting | Â |
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 | Â |
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 | Â |
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 | Â |
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). |