Comparison of electronic physician prompts versus waitroom case-finding on clinical trial enrollment

BACKGROUND: Recruiting patients into clinical research protocols is challenging. Electronic medical record (EMR) systems capable of prompting clinicians may facilitate enrollment. OBJECTIVE: To compare an EMR-based clinician prompt versus a wait-room-based case-finding strategy at enrolling patients into a clinical trial. DESIGN: Cross-sectional comparison of recruitment data from two trials to treat anxiety disorders in primary care. Both studies utilized similar enrollment criteria, intervention strategies, and the same four practice sites and EMR system. PARTICIPANTS: Patients referred by their (primary care physicians) PCPs in response to an EMR prompt (recruited 1/2005-10/2006), and patients enrolled by research assistants stationed in practice waiting rooms (7/2000-4/2002). MEASUREMENTS: Referral counts, patients' baseline sociodemographic and clinical characteristics. RESULTS: Over a 22-month period, EMR-prompted PCPs referred 794 patients and 176 (22%) met study inclusion criteria and enrolled, compared to 8,095 patients approached by wait room-based recruiters of whom 193 (2.4%) enrolled. Subjects enrolled by EMR-prompted PCPs were more likely to be non-white (23% vs 5%; P < 0.001), male (28% vs 18%; P=0.03), and have higher anxiety levels than those recruited by wait-room recruiters (P < 0.0001). CONCLUSIONS: EMR systems prompting clinicians to refer patients with specific characteristics are an efficient recruitment tool with critical implications for increasing minority participation in clinical research.