Communication is the Key to Success in Pragmatic Clinical Trials in Practice-based Research Networks (PBRNs)

Susan Bertram; Deborah Graham; Marge Kurland; Wilson Pace; Suzanne Madison; Barbara P. Yawn

doi:10.3122/jabfm.2013.05.120352

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Table 1. Tools to Facilitate Communication in Practice-based Research Network (PBRN) Studies

1. Delineation of duties among researchers and sites (develop an administrative map).

2. Centralized training for the practice teams.

a. Initial training for study should be done with all team leaders (see #5) and central staff in-person at a central site.

b. Future training for study, such as moving from usual care to intervention arm, may be completed by telephone or video conferencing.

3. Use video conferencing when feasible to enhance interaction.

a. Video can be used when reviewing or teaching techniques such as spirometry or use of inhaled medications.

b. Video allows sites to demonstrate what they have learned.

4. Designate central liaisons to guide each site.

a. Physician leader: one of study investigators (physicians)

i. Usually only requires 1 or 2 research physicians to do this

b. Central liaison: one of central study coordinators

i. Each coordinator has responsibility for 3 to 15 sites, depending on the complexity of the study

5. Designate physician and nursing practice site leaders as primary contacts.

6. Use weekly FAQ to disseminate uniform information in a simple format based on actual practice questions whenever possible.

7. Hour-long weekly central team meetings

a. Review issues identified at each site.

i. Identify and celebrate successes.

ii. Discuss problems and brainstorm possible solutions.

8. Develop a topic of the week (or month) for each liaison to discuss with their assigned sites.

9. Use a listserv to allow sites to interact with each other.

10. Consider site visits for remedial actions.

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Table 2. Lessons Learned from Pragmatic Trials in Practice-based Research Network (PBRN) Clinics

Actions	Implementation
Create a communication plan	Create a plan that includes a plan for the flow of communication between the central team members and clinic sites and for the dissemination of information to the central team and all clinic sites.
Know what message you want to communicate	Be brief. Stick to the message you wish to convey. Repeat the message. Do not expect all messages to be heard and understood the first time they are communicated.
Be respectful of time	Physicians, nurses, and clinics are primarily engaged in the care of patients. Set meeting times in advance. Be on time. Be understanding if a meeting must be rescheduled.
Identify each site's preferred communication mode and use it	Ask how the physician or nurse prefers you to communicate with them. Not everyone views E-mails throughout the day. Use listservs, FAQs, text or phone messaging, faxes. Provide all with your phone number, E-mail address, and fax number with each electronic communication.
Pictures are worth 1000 words!	Pictures in E-mails help convey your message. Use maps and a contact list with photos to help you remember to whom you are speaking. Use a clock to mark the time zones where clinics are located. Send photos. Ask for photos from the clinic when you send treats or buy them lunch.
Make phone calls free	Establish toll-free phone line for patients enrolled in the study and clinic staff. Be available to sites 24 hours a day if necessary for site calls regarding concerns, especially medication issues. Maintain a study E-mail for patients.
Be flexible but consistent	Be persistent but patient. Convey your message in a palatable way.
Celebrate successes, big or small	Send cards, eCards, E-mails to site coordinators and lead physicians. Congratulate all successes! Notify clinics when they have reached goals or done something out of the ordinary. Share in the personal successes of individual physicians, nurses, and clinics. Provide certificates when goals are reached. Send small rewards throughout the year to encourage continued good will.
Expect change—it is inevitable	Be prepared for personnel changes within the central team and at the clinic sites. Plan for training of personnel who are new to the study.
Set realistic expectations	Do all that you can to help everyone to succeed, but be prepared that not all will be successful.