Evidence map›Paper›PMID 32710671›Full record

ArticleJournal of the American Geriatrics Society2020

Recruitment Challenges for Low-Risk Health System Intervention Trials in Older Adults: A Case Study.

Kathryn Anzuoni, Terry S Field, Kathleen M Mazor, Yanhua Zhou, Lawrence D Garber, Alok Kapoor, Jerry H Gurwitz

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Geriatrics Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.3field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 3 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Kathryn AnzuoniMeyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.ORCID 0000-0002-5339-0896
Terry S FieldMeyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.
Kathleen M MazorMeyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.
Yanhua ZhouMeyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.
Lawrence D GarberMeyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.
Alok KapoorMeyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.ORCID 0000-0003-1300-7124
Jerry H GurwitzMeyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts, USA.
University of Massachusetts Chan Medical School · US

Funding

Improving Safety after Hospitalization in Older Persons on High Risk MedicationsR18HS023774 · AHRQ · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI GURWITZ, JERRY H · 2015 to 2017
$1.5M
AHRQ HHS 18HS023774AHRQ HHS R18 HS023774
6 · The paper itself

Abstract

objectiveTo assess factors associated with trial participation in the context of a low-risk intervention intended to reduce adverse drug events in recently hospitalized older adults.

designMixed methods: analysis of data collected during enrollment efforts and focus groups.

settingA large, multispecialty group practice.

participantsIndividuals 50 years and older, recently discharged from the hospital and prescribed at least one high-risk medication, were eligible for the trial. Enrollees, decliners, and their caregivers were eligible to participate in focus groups. MEASUREMENTS: Reasons for declining to participate during the initial invitation as well as reasons for not providing consent were recorded. Focus groups were conducted with eligible individuals to explore reasons for enrolling or declining. We conducted multivariable logistic regression to compare characteristics (including sex, age, healthcare proxy, number and type of medications, visiting nurse services, reason for admission, and length of hospital stay) of those who enrolled with those who did not enroll.

resultsOf 3,606 individuals determined eligible, 3,147 (87%) declined, 98 (3%) verbally consented to participate but did not complete written consent, and 361 (10%) provided written consent and were considered enrolled. Individuals 80 year and older (odds ratio (OR) = 0.44; 95% confidence interval (CI) = 0.30-0.65) and those with visiting nurse services (OR = 0.64; 95% CI = 0.48-0.85) were least likely to enroll. Among those who provided a reason for declining (2,473), the most common was the belief they did not need additional medication assistance (18%). Another 332 (11%) declined because they were receiving visiting nurse services.

conclusionRecruiting older adults recently discharged from the hospital to participate in trials of low-risk, system-level interventions is challenging and may underenroll the oldest individuals and those potentially at the highest risk for adverse events, limiting generalizability of study findings. Alternative study designs may be more effective than individually randomized trials in assessing low-risk, system-level interventions.

Indexed as

Patient SelectionRandomized Controlled Trials as TopicAgedEligibility DeterminationFemaleFocus GroupsHumansMaleMiddle AgedPatient Participationcare transitionsclinical trialshealth system interventionmedication

Identifiers

PMID32710671
PMCPMC7722200
OpenAlexW3043853914

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.