Covering the results of our survey on the use and cost effectiveness of recruitment and retention tools, this presentation was given at the MRN\'s first Director\'s Dinner on October 28th. Comments are welcome.

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Recruitment and retention
survey results and analysis

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Survey objective
• To ascertain the perceived importance of
Recruitment and retention as issues facing
trials today
• To determine the perceived cost effectiveness
of tools and techniques used to enhance
recruitment and retention today

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Objective One
Importance of the Recruitment
and Retention compared to other
issues facing trials today

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Tools assessed in order of
frequency of use
1 = In house Investigator database
2 = Site training
3 = Site resources
4 = Creating a referral network
5 = Referrals form advertising in medical press
6 = Site administration tools
7 = Research Networks
8 = Direct to Patient advertising
9 = 3rd party investigator databases
10 = Patient reminders
11 = Call Centres
12 = Direct to patient websites
13 = Trial specific web sites
14 = In house patient databases
15 = 3rd party patient databases

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Boston Chart results
1
2
3
4
5
68 98
10
11 12 713 7
14
15
Percentage of respondents
reporting perceived as
moderately to very cost
effective
Percentage of
respondents
expecting
improvement in
recruitment of
40% or more
30
20
10
50 1000
X X = type of tool
Size = frequency of use

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The Questions
• Please list what you would consider the three
most important issues/challenges in clinical
trials today.
• Free text in three boxes labelled I, II, III
• Please rank patient recruitment as an issue
• High importance, moderate importance, average
importance and low importance
• Please rank patient retention as an issue
• High importance, moderate importance, average
importance and low importance

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Results
Answers were were grouped into 24 groups within 4 classes.

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Results
We analysed all the issues reported both together and in tiers (I,II and III). Results
are shown in table 2 for the top 7 issues raised.

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Conclusions
• Recruitment comes out as the major challenge of all, occurring 53 times
(25%) in the 212 responses.
• The top 3 accounted for 103 or 48% of the total. In addition to recruitment,
these were Cost and Delays
• When only looking at the second tier answers, Retention rises to 2nd and
Site Quality to 3rd (Cost and Delays having mostly been reported as the
first tier issue).
• Cost, although 2nd overall was 3rd as a first tier challenge and 1st as a third
tier issue – perhaps indicating that cost is important but not to the exclusion
of success or quality
• Leading to the second objective of the survey, tools and techniques which
focus on recruitment and retention (often the same tools) are targeted at two
of the top 6 issues facing trials today

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Objective Two
Cost Effectiveness of tools for
Recruitment and Retention

11. w w w . t h e m r n . c o . u k© Medical Research Network 2007
Tools assessed in order of
frequency of use
1 = In house Investigator database
2 = Site training
3 = Site resources
4 = Creating a referral network
5 = Referrals form advertising in medical press
6 = Site administration tools
7 = Research Networks
8 = Direct to Patient advertising
9 = 3rd party investigator databases
10 = Patient reminders
11 = Call Centres
12 = Direct to patient websites
13 = Trial specific web sites
14 = In house patient databases
15 = 3rd party patient databases

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Boston Chart results
1
2
3
4
5
68 98
10
11 12 713 7
14
15
Percentage of respondents
reporting perceived as
moderately to very cost
effective
Percentage of
respondents
expecting
improvement in
recruitment of
40% or more
30
20
10
50 1000
X X = type of tool
Size = frequency of use

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Results 1
• The most effective tools reported, scoring highly
for frequency of use and cost- effectiveness
and absolute effectiveness.
– In house Inv database
– Site training
– Site resources

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Results 2
• Creating referral networks scored highly for
effectiveness but was less cost effective and used less
frequently
• Patient reminders are cost effective and have high
absolute effectiveness, but are used less frequently
• Patient databases are seen as effective but expensive
and used less frequently.

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Results 3
• In the moderately effective category were site
admin tools – also seen as moderately cost
effective and used a moderate amount of the
time.
• Similarly effective but less commonly used and
less cost effective were direct to patient
advertising and third party investigator
databases

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Results 4
• Least effective and least commonly used were
– Call Centres
– Direct to patient web sites
– Trial specific web sites for enrolled patients
– Third party patient databases
– Research Networks
• Oddly this last group, although regarded as ineffective
and with low cost effectiveness, they are moderately often
used.

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Results – Cutting edge survey
• Only 50% of companies incorporate recruitment
strategies in protocol design – and only 17% for
devices companies
• Only 15% of companies have a dedicated
patient recruitment group
• Most (90%) large Pharma keep the role
responsible for recruitment in house
• 50% of all other companies give this role to
their CRO

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Results – Cutting edge survey
5
6
7
8
Somewhat
effective
3.6 to 6.9
Very Effective
7 to 10
Evaluating the site
Training the site
Recruit at point of care
Patient referrals contacts actively
Referral Networks
Population research
Medical Liaison
News paper ads
Recruitment kits
Advocacy groups
Community Outreach
Web advertising
On line patient resources
Radio advertising
Call centres
Score

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Results – Cutting edge survey
• Patient Motivators reported as
– Increased access to or improved therapy or medical care
– Convenience of sites
– Free medications
– Low number or frequency of visits
– Short trial duration
– Transport compensation
– Monetary compensation
– Non monetary incentive

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Results – Cutting edge survey
• 6 of the 17 tools evaluated had NO focus on
any of the patient motivators
• 5 more effected only one motivator – increased
access to therapy or care
• 4 more affected two motivators
• 1 affected three motivators – Referral Networks
• 1 affected four motivators – Home Trial Support

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Results – Cutting edge survey
• Looked at the other way
– Increased access to therapy was addressed by 7
tools
– Transport cost reduction / compensation was
addressed by 4 tools
– Convenience and non monetary compensation was
addressed by 3 tools
– Frequency of visits was addressed by one tool
– Free meds, monetary compensation and short trial
duration were not addressed by any tool

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Conclusion – combined
• Tools used tend to focus on increasing patient
numbers
• This is expensive and therefore becoming
outdated
• The patient funnel needs to be widened at
every level,
– not just have more patients chucked in the top
– but opening up the bottle necks at the bottom
– both together could impact hugely

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Recruitment Funnel
20 remain
Lab Screening
10 remaining
1000 total pool
Protocol restrictions
Consent and
Resource limitation
5 remain
Retained
4 finish
Patient
Motivators and
Site Resources
Number of patients
at each level

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Hierarchy of Need
Recruitment
Minimum patients in core site
database
Maximum patients in core site
database
Patients accessed through
extending site reach
Totalpatientrecruitmentpotential
1
2
4 5 6 7
1 – Open up protocol restrictions
2 – Add resources to site to
manage available patients
- Site Support,
- Some software tools
- Recruitment kits
3 – Train Sites
4 – Create extended patient
referral network
5 – Advertise – radio, newspapers etc
6 – Web presence / tools
7 – Home Trial Support
3

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Hierarchy of Need
Retention
Minimum patients retained for full
therapy period
Maximum patients retained for full
therapy period
Totalpatientretention
potential
8 9 10
8 – Improve interaction with patients
Pt reminders
Pt support materials
Rx Follow up
Transport assistance
Caregiver support
9 – Improve site motivation / commitment
10 – Home Trial Support