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Technology and Best Practices for Recruitment


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Presented by Nariman Nasser, Director of UCSF Participant Recruitment Service, in May 2012 at CHR sponsored workshop on the UCSF Campus. This presentation on ‘Recruitment: What Methods Are Appropriate’, discusses the use of social media in clinical trial recruitment, as well as emerging technologies such as SMS text messaging for patient recruitment and retention.

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Technology and Best Practices for Recruitment

  1. 1. Technology & Best Practicesfor RecruitmentNariman A. Nasser, DirectorUCSF Participant Recruitment Service
  3. 3. What is Social Media?The use of web-based andmobile technologies to turn communication into interactive dialogue1. Collaborative projects2. Blogs and Microblogs3. Content communities4. Social networking sites5. Virtual game worlds6. Virtual communitiesKaplan and Haenlein, Business Horizons, 2010
  4. 4. The Power of Social Media• Recommendations by family/peers are more influential• Reach wide number of motivated/interested individuals in a short time• Encourages empowerment and proactive behavior• Able to communicate in real-time• Ideal for AE reporting and post-marketing surveillance (FDA/NIH Safety Reporting Portal)
  5. 5. Clinical Trials Networking Sites
  6. 6. The Unwieldy Power of Social Media• Unless social media is used for real-time communication it is no different than a traditional media advertisement• Real-time communication in the context of clinical trials recruiting must be carefully moderated• FDA regulations are not conducive to brevity, no guidance to date (Novartis widget incident failed to communicate risk information, implies superiority)
  7. 7. Emerging Technologies• Electronic personal health records (Google Health, HealthVault)• Research volunteer registries (Volunteers for Health,, TrialX)• Electronic communication methods (text messaging, emailing health professionals, online screening tools)• Telemedicine
  9. 9. Mobile phones are changing the way people interact with the world around them MOBILE FACTS POTENTIAL 5.5 billion Global Subscribers* Mobile devices are now practically ubiquitous Penetration rates >80%* in most countries Worldwide Tool - large metropolitan areas to rural (US = 285M subs or 91%) developing world Mobile Phone within arms reach Mobile is the most effective and natural of average users for 19 hours per day † way to maintain contact with clinical trial participants Mobile phone users read messages within 15 minutes of receipt† Mobile communications are immediate, verifiable and actionable Mobile phone users respond within 60 minutes† Clinical trial participants will use their mobile phones to provide information Average mobile phone users send/receive to clinical sites 4x as many text messages as voice calls†•* Merrill Lynch Q3-2009/CTIA 2010 † Nielsen Q4-2008/10 ‡ Luth Research 2009.
  10. 10. Teens text, and so do their parents parents text twice as much as they call
  11. 11. SMS Recruitment – Data points70% prefer to inquire via text message90% response rate = highly engagedSignificant ROI 3 months traditional method followed by 3 months with text messaging • Cost per Response decreased by 15% • Cost per Referral decreased by 32% • ROI > 650% OmniScience Mobile
  12. 12. 100% 80% 60% Call 40% Center 20% Text 0% Messaging Day 1 Day 2 Day 3 60% of those who use SMS are referred“I contacted a subject who responded by text message and itwent great! She is scheduled for a visit within the week.” studycoordinator within 2 hours of receipt“…it was very easy to maneuver.” anonymous patient
  13. 13. SMS for Recruitment
  14. 14. How NOT to Run an SMS Campaign
  16. 16. Mobile Apps for Recruitment Have Limitations• Limited Reach – Smartphones only – Used by only 36% of US mobile subscribers / 14% international subscribers• Expensive – software app must support all major platforms: iOS, Android, Windows, RIM, Nokia – significant cost for development & maintenance• Highly Inefficient as Direct Response option – Promotional materials driving traffic to an app there are too many steps: 1. Go to your phone’s app store 2. Find our app 3. Download it 4. Figure out where the app is on your phone 5. Click on the app to learn more about this study
  17. 17. Reference Apps Don’t Really Generate ReferralsClinical Trials Mobile appWho will take the time to find this app and use it to search for clinical trials?
  18. 18. QR CODES
  19. 19. The Good and the Bad• Inexpensive• Only work for smartphone users• Few have incorporated QR scanning into behavior• Execution is tricky – You can’t remember a QR code and ‘text’ it later – Challenging for outdoor advertising 21
  20. 20. The Ugly• No cell signal in NYC subway• Creative design blocks code
  22. 22. San Francisco General Hospital Recruitment Pilot• Investigators want to extend their reach• 1 year pilot program for 10 studies – 24/7 staffed phone line – Weekly craigslist posting – Outgoing calls to follow-up as needed• Outcomes – 692 volunteers (validated unique) – 25% contacted for screening visits – BMI was most beneficial data field for search criteria
  23. 23. Airway Clinical Research Center Asthma Recruitment Database • Local disease- specific database • Used as recruitment protocol/registry – Characterize asthma severity – Recruit for current studies real-time – Register for contact regarding future studies – already prequalified•UCSF Airway Clinical Research Center (ACRC)
  24. 24. Recruitment Trends by County San Francisco 52% Alameda 16% San Mateo 11% Contra Costa 7% Santa Clara 4% Marin 3% Sonoma 2% Solano 1%•UCSF Airway Clinical Research Center (ACRC)
  26. 26. Performing Initial AnalysesStudy Design  Site-specific protocols for study-specific and SOC procedures  Placebo arms, excessive inclusion/exclusion criteriaSite-specific  Staff resources  Location(s): accessibility, interoperability, features / disadvantagesCompeting Trials
  27. 27. Planning & BudgetingScreen Failure RateBudget for the unexpected  Design revisions  Increased production & shipping costs over time  Protocol revisions impacting recruiting methods/materials
  28. 28. Implementing the PlanStaged approach Communication Plan  Sponsor/Site StaffMultiple  Primary contacts simultaneous  Secondary contacts advertising effortsPlan on changing Identify screening your plan – analyze appointment relatively often schedule workflow, tools and conflicts
  29. 29. Ensuring High-Quality Participants Start by casting a wide net Think about a wide number of things or people when choosing the thing or person you want* Don’t skip the prescreening step Ask the right questions at the right stage of the recruitment process*Idioms by The Free Dictionary
  30. 30. Monitoring ProgressSet realistic expectations up frontIdentify benchmarks for success/failureSimple tracking tools go a long wayReceiving logs & reports is not enough – they have to mean something and be actionable
  32. 32. Create a centralized service to facilitate the enrollment of research participants into UCSF clinical studies  Assume a large part of the burden of recruitment efforts  Provide expertise in recruitment materials development  Ensure materials meet regulatory guidelines and requirements  Offer an economy of scale for many recruitment activities  Use established vendor relationships  Increase the volume of high quality volunteers  Facilitate a wider catchment and more robust networks
  33. 33. Recruitment Analysis and PlanningRobust recruitment plan Analysis of recruitment landscape Protocol complexities, procedures, SOC Competing studies Geographic/demographic population Marketing & Outreach methodologies Suggested strategies Timelines Budgets for suggested strategies
  34. 34. Cohort ID and Direct MailIdentify cohorts from inpatient medical records (UCare and ThREDS) ICD-9 codes DemographicsCHR modificationCoordinate data extract services from ARSPrint and mail direct mail letters to cohort
  35. 35. Recruitment Materials Toolkit
  36. 36. Future Services/ResourcesRecruitment Plan Implementation Centralized call center, text messaging, online screeners Marketing & outreach Referral networksSearchable database of actively recruiting studies – matchingReal-time recruitment from EMR
  37. 37. THANK YOU