Recruitment rates and reasons for community physicians' non-participation in an interdisciplinary intervention study on leg ulceration

The first recruitment phase stressed the recruitment of GPs, the second the recruitment of specialists. Throughout the recruitment process data were collected through phone conversations with GP practices who indicated reasons for non-participation.Despite great efforts to recruit physicians, the recruitment rate reached only 26 out of 1549 contacted practices (1.7%) and 12 out of 273 (4.4%) practices during the first and second recruitment phase respectively. The overall recruitment rate over the 16-month recruitment period was 2%. With a target recruitment rate of n = 300, only 45 patients were enrolled in the study, not meeting study projections. Various reasons for community physicians' non-participation are presented as stated spontaneously during phone conversations that might explain low recruitment rates. The recruitment strategy utilised is discussed against the background of factors associated with high participation rates from the international literature.Time, money, and effort needed during the planning and recruitment phase of a study must not be underestimated to avoid higher than usual rates of refusal and lack of initial contact. Pilot studies prior to a study start-up may provide some evidence on whether the target recruitment rate is feasible.Current Controlled Trials ISRCTN42122226.Unlike the UK, for instance, where common leg ulcers are diagnosed, treated, and followed up in nurse-run leg ulcer clinics, in Germany these patients are solely in the hands of physicians. Traditionally, the German health care system has no gatekeeping functions; instead patients are free to select a doctor of their choice (GP or specialist) who is located in the community. Since there is no mechanism to control this "self-selected" gatekeeping, patients frequently choose specialists directly. There are only a few incentives for patients to first contact a GP in Germany; none of them apply to leg ulcer patients. For German GPs it is financially rather unattractive to