Details on the processes of recruitment of clinicians for public health sentinel surveillance activity have not been reported in the literature. In an era of enhanced interest in, and significant threats of emerging infections and biological terrorism, efforts to efficiently and rapidly assemble sentinel surveillance networks are of major public health importance. This study examined the process of creating a functional sentinel surveillance network in Wisconsin. Moreover, the study was designed to identify potential differences existing among groups of clinicians with varying experience with cooperative efforts, including a practice-based research network [20
] and an existing influenza sentinel surveillance network [14
In this study, recruitment of clinicians to participate in a sentinel surveillance project required an average of three hours per participant. The amount of effort was not, however, equivalent across groups. This is consistent with our hypothesis that the timeliness and success of recruitment would vary by group. Because both WREN and WISCP are clinician networks with experience in responding to data gathering protocols that extend beyond those normally associated with standard patient care, we expected these groups to respond more quickly to requests for participation than would non-affiliated clinicians as represented by the general WAFP membership. We believed that WAFP members would be less likely than the other two groups to have a clear understanding of the research process and the time commitment involved in data gathering efforts. Thus they might adhere to the notion that they are simply too busy to participate in surveillance endeavors. Finally, as this was a WREN study, we expected rapid recruitment among the WREN membership.
As we expected, WREN members tended to respond more quickly to calls for participation, whether willing to participate or not, than WISCP and WAFP. In addition, WREN members were more likely to respond positively to our request for participation, thus resulting in high recruitment efficiency. This response both underscores a limitation within the study and highlights an important conclusion. That WREN clinicians are likely to respond to a WREN request for participation may limit the generalizability to other situations. Creating and maintaining established relationships among clinicians within PBRNs, however, serves as a model that can be replicated. For example, more than one hundred primary care PBRNs currently exist in the United States [21
WISCP ranked second in time and effort needed for recruitment, followed by the WAFP group. A slower rate of recruitment among the WISCP members was due, in part, to the initial difficulty in acquiring accurate and complete contact information. WISCP contact information was least complete and primarily consisted of phone and fax numbers, with very few e-mail addresses available. Contact information was most complete and accurate for the WREN group. We found that we had the most success contacting clinicians using a combination of phone, email, and fax messages due to each method having several pros and cons.
WISCP members responded more quickly and required fewer reminders in returning signed consent forms. WISCP clinicians may have performed better than the other groups in returning consent forms because retention in this group is based on consistently high compliance; non-compliant sentinels are replaced annually. In contrast, WREN has a long-standing core membership who would be expected to comply quickly, as well as a number of newly recruited, relatively untested members. Hence, while WISCP participants may have lagged behind WREN in joining the study, they performed very well once recruited. The WAFP participants, serving as the control group, were not expected to, and did not respond as quickly as the other groups to either recruitment efforts or in returning consent forms.
Overall, we found that recruitment efforts with busy clinicians were most effective when using phone, fax, and e-mail in combination, and in contacting potential participants often. Weekly contact did not elicit negative feedback. Possibly the single most valuable recruitment tool was buy-in and direct participation of the directors of each organization. The importance of their participation and endorsement cannot be over-estimated.
Once clinicians were recruited and consented to participate in surveillance protocols, few differences in initial performance were noticed among clinicians groups. All three groups performed similarly in the response time and number of reminders needed to complete the demographic survey. Potential differences between groups were likely minimized through the selection and voluntary participation process. Clinicians who were not interested in participation were self-excluded. Consequently, the major difference identified in this study centered on rate of recruitment.
Rapid recruitment for sentinel surveillance requires connectivity, an established willingness to participate in data gathering, and the endorsement of organizational leadership. To this end, established networks of primary care physicians, such as practice-based research networks and existing influenza sentinel surveillance networks, offer preexisting conditions that facilitate rapid response to emerging public health threats. Efforts to establish additional networks of practicing clinicians are encouraged not only for translational research [22
], but for unexpected future needs for surveillance activities. Moreover, the demonstrated value of connectivity should serve to prompt state divisions of public health, state medical societies and departments of licensing and regulation to jointly collect and maintain accurate and up-to-date clinician contact information to facilitate rapid response to public health urgencies and emergencies.