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OtherAbout Practice-Based Research Networks

Barriers, Enablers, and Incentives for Research Participation: A Report from the Ambulatory Care Research Network (ACRN)

Suzanne Bakken, Rafael A. Lantigua, Linda V. Busacca and J. Thomas Bigger
The Journal of the American Board of Family Medicine July 2009, 22 (4) 436-445; DOI: https://doi.org/10.3122/jabfm.2009.04.090017
Suzanne Bakken
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Rafael A. Lantigua
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Linda V. Busacca
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J. Thomas Bigger
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  • Article
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Article Figures & Data

Tables

    • View popup
    Table 1.

    Practice Activity of the Ambulatory Care Network Physicians (n = 24)

    Mean ± SDRange
    Years in practice (n)11 ± 81–28
    Commute time (minutes)36 ± 167–60
    Practice hours per work week (n)43 ± 149–70
    Time with patients (%)48 ± 2413–80
    Patients seen per day (n)13 ± 55–20
        African-American patients (%)13 ± 100–40
        Hispanic patients (%)77 ± 2015–95
    • View popup
    Table 2.

    Research Training and Experience of the Ambulatory Care Network Physicians (n = 24)

    Formal research trainingPercent
        None76
        Research fellowship16
        Research-oriented master's degree16
        Research-oriented doctoral degree0
    Research experience
        None24
        Retrospective studies (chart reviews)28
        Prospective observational studies24
        Behavioral intervention16
        Health services/outcomes research40
        Clinical trials24
    Research sponsors (funding)
        Industry4
        Foundations8
        City or state12
        Agency for Healthcare Research and Quality4
        Centers for Disease Control and Prevention4
        National Institutes of Health12
        Other (mostly various medical school funds for students)44
    Research training certificates
        None76
        Good clinical practices20
        National Institutes of Health0
        Association of Clinical Research Professionals0
        Other (medical school elective)4
    Satisfaction with previous research experiences
        Positive81
        Neutral13
        Negative6
    Currently involved in any research projects (NIH, Health Services)36
    Currently employs a clinical research coordinator12
    • NIH, National Institutes of Health.

    • View popup
    Table 3a.

    Barriers to Ambulatory Care Network Physician Participation in Research Identified in Both Survey and Focus Groups

    SurveyParticipant's Statements from Focus Group
    ItemPhysicians Who Agree (%)*
    Lack of time/competing demands for time92.0
    • Am I interested in research? I am really interested in research. Am I interested in being reimbursed for research? I am, but right now I have only 5 clinical sessions a week and one of those I precept the residents. So I only see patients 4 sessions a week. I don't think I can go down to 3 and still call myself a primary care doctor so easily, or I don't know if I am ready to go down to 3. And so, again, we wear so many hats and, yes, I would love to wear another hat. (IM)

    • The largest barrier is basically time. There is no time to do any of this, or it's going to be in your sleep. …it's been going on for 3 years, and it's difficult. (FM)

    • Coming from residency, if you haven't gone into a program that fosters research you don't have the skills in order to write grants or be the principal investigator of a research project, …unless you've had a mentor who's actually taught you how to do that, so adequate skills or training…. (IM)

    My lack of appropriate training80.0
    • We don't really understand what it entails. In terms of what do we have to put in to it really … and how much do we want to put in? Do we want to be the PIs, or do we want to be involved in projects with other people that are staying up until 3:00 in the morning so we don't have to? (FM)

    • And not getting reimbursed for it makes a huge difference (IM)

    Inadequate compensation for my time79.2
    • It's [the grant] been going on for 3 years, and it's difficult. My time is not bought out; it's in kind. So this is on top of all of the things that I'm doing. (FM)

    • * Percent of participants selecting strongly agree or agree in response to statement; only statements that >50% participants rated as strongly agree or agree are included.

    • PI, primary investigator; IM, internal medicine; FM, family medicine.

    • View popup
    Table 3b.

    Barriers Identified in Survey Only

    ItemPhysicians Who Agree (%)*
    Support staff time66.7
    Inadequate compensation for support staff time62.5
    Support staff training58.4
    • * Percent of participants selecting strongly agree or agree in response to statement; only statements that >50% participants rated as strongly agree or agree are included.

    • View popup
    Table 3c.

    Barriers Identified in Focus Group Only

    ThemesParticipant's Statements
    Difficulty filling clinical sessions to enable release for compensated research time
    • You have to consider that when a peg is gone, there's a hole there, and how do you fill that hole? And then will it get to a critical point where there is no more leftover pegs to fill in. When you pull someone to cover that, you're pulling them from something else. There is a domino effect. You can't hire, appoint one person to cover that hole, either, even if you have the release money. And then what happens when she loses her funding? Do you throw away that person we hired? Then it becomes a budget issue. (FM)

    Lack of collaborators to sustain research
    • And then we did the survey and having to get it translated, right, then we realized the survey was too complicated for our patients so we needed then to simplify and then we had to resubmit it. I mean, it was just exhausting. So we did it and we did quite a few of them, but we never did anything with it because again you need a group of people who can consistently meet. (IM)

    • It's just very hard to sustain things. That sustainability is one of my biggest challenges. (IM)

    Difficulties overcoming IRB hurdles
    • I can't believe how hard it was to get IRB approval for something that involved no drugs. You know, this couldn't have been more soft research. And it's just because it doesn't matter what it is, you have to go through all the steps no matter what. And it was so hard and so many back and forths in getting the consents approved and being confused about whether…oh, I was originally supposed to include kids so I needed assent and consent and kids never came, thank goodness. . . . and the grant was written for like 100 people and I got 20 at the beginning and then 10 and then 6. (IM)

    • I have projects and I tried to get IRB approval. And I finally found someone I thought could help me on the process. They did help me, but when I submitted it, it still got denied, and then we couldn't figure out how to overcome that barrier. So we get to a certain point. We marshal all of our time and energy and resources, and we get to a certain point and reach another hurdle, and we just drop it. (FM)

    Community distrust of research
    • . . . Spanish was my primary language and I feel like I have a special connection with them because I speak exactly as they do, . . . they feel that you are using them sometimes. They don't trust you enough. (IM)

    • . . . I can speak from the African American population that there's a lot of mistrust of the medical community. . . . They don't want to be experimented on, especially after that whole Tuskegee experiment. (IM)

    • IRB, institutional review board; FM, family medicine; IM, internal medicine.

    • View popup
    Table 4a.

    Facilitators for Ambulatory Care Network Physician Participation in Research Identified in Both Survey and Focus Group

    SurveyParticipant's Statements from Focus Group
    ItemPhysicians Who Agree (%)*
    Potential to improve care in my practice and Contribution to knowledge development on topic100
    • And so any study that helps contribute to our knowledge of what can help our patients and what is the best practice is something that this group is going to be interested in. (IM)

    • I have found people very open to working with things if they're brought in a way that their collaborating, inclusive, right, you don't have to do this but we think this might work, in a place that people can feel like it's incorporating things into their practice and not adding more work into their practice. Key. (IM)

    Opportunity for my professional development100
    • I think we are all academics and that's why we're here. We're not in private practice for a reason. (IM)

    Research collaborators/mentors92
    • One of the issues with collaborators if we're all primarily clinicians then it gets very difficult because as clinicians we tend to put the clinical first. The only reason why I actually ended up finishing was because the person I worked with was primarily a researcher and he pushed and pushed because he wanted to get this done so he gave me deadlines. . . (IM)

    • That's the importance of mentorship, to keep you from wasting your time on things that you should not have to be focusing on. (FM)

    • * Percent of participants selecting strongly agree or agree in response to statement; only statements that >50% participants rated as strongly agree or agree are included.

    • IM, internal medicine; FM, family medicine.

    • View popup
    Table 4b.

    Facilitators Identified in Survey Only

    ItemPhysicians Who Agree (%)*
    Recognition as a member of a practice-based research network66.6
    Recognition as a research collaborator64.0
    Continuing medical education credit60.0
    • * Percent of participants selecting strongly agree or agree in response to statement; only statements that >50% participants rated as strongly agree or agree are included.

    • View popup
    Table 4c.

    Facilitators Identified in Focus Group Only

    Thematic CategoriesParticipant's Statements
    Research support staff
    • You need support of other staff that's going to help you to be able to implement this research project. (IM)

    • A definite support staff under research, not necessarily the top people, but the bottom people, . . . who can get data for you so you don't have to spend time doing that. (FM)

    Patient/community engagement strategies
    • It's a matter of education in our community to try to convey the information to our people that research is needed to be able to understand how our community responds to treatments, the management of disease, preventive medicine, and so forth; and not just to rely on what other communities have done. . . (IM)

    • And having a relationship with your physician is a key part. I mean, my patients, some of them I have been with for 10 years, I see their family and I know this and that. . . . there's a rapport absolutely that would allow some of it to happen. (IM)

    • And if it's just a survey and you can have them do it in your waiting room, then you catch them and it's a little bit easier, especially if you're handing them, whatever, a $10 metro card or $20 gift card. (IM)

    • IM, internal medicine; FM, family medicine.

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The Journal of the American Board of Family Medicine: 22 (4)
The Journal of the American Board of Family Medicine
Vol. 22, Issue 4
July-August 2009
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Barriers, Enablers, and Incentives for Research Participation: A Report from the Ambulatory Care Research Network (ACRN)
Suzanne Bakken, Rafael A. Lantigua, Linda V. Busacca, J. Thomas Bigger
The Journal of the American Board of Family Medicine Jul 2009, 22 (4) 436-445; DOI: 10.3122/jabfm.2009.04.090017

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Barriers, Enablers, and Incentives for Research Participation: A Report from the Ambulatory Care Research Network (ACRN)
Suzanne Bakken, Rafael A. Lantigua, Linda V. Busacca, J. Thomas Bigger
The Journal of the American Board of Family Medicine Jul 2009, 22 (4) 436-445; DOI: 10.3122/jabfm.2009.04.090017
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