Technology & Best Practices for Recruitment

Nariman A. Nasser, Director UCSF Participant Recruitment Service

SOCIAL MEDIA & EMERGING TECHNOLOGIES

What is Social Media? The use of web-based and mobile technologies to turn

communication into interactive dialogue

1. Collaborative projects

2. Blogs and Microblogs

3. Content communities

4. Social networking sites

5. Virtual game worlds

6. Virtual communities

Kaplan and Haenlein, Business Horizons, 2010

The Power of Social Media

• Recommendations by family/peers are more influential

• Reach wide number of motivated/interested individuals in a short time

• Encourages empowerment and proactive behavior

• Able to communicate in real-time

• Ideal for AE reporting and post-marketing surveillance (FDA/NIH Safety Reporting Portal)

Clinical Trials Networking Sites

The Unwieldy Power of Social Media

• Unless social media is used for real-time communication it is no different than a traditional media advertisement

• Real-time communication in the context of clinical trials recruiting must be carefully moderated

• FDA regulations are not conducive to brevity, no guidance to date (Novartis widget incident failed to communicate risk information, implies superiority)

Emerging Technologies

• Electronic personal health records (Google Health, HealthVault)

• Research volunteer registries (Volunteers for Health, ResearchMatch.org, TrialX)

• Electronic communication methods (text messaging, emailing health professionals, online screening tools)

• Telemedicine

TEXT MESSAGING FOR RECRUITMENT

Mobile phones are changing the way people interact with the world around them MOBILE FACTS POTENTIAL

5.5 billion Global Subscribers* Mobile devices are now practically ubiquitous

Penetration rates >80%* in most countries (US = 285M subs or 91%)

Worldwide Tool - large metropolitan areas to rural developing world

Mobile Phone within arms reach of average users for 19 hours per day †

Mobile phone users read messages within

15 minutes of receipt†

Mobile is the most effective and natural way to maintain contact with clinical trial

participants

Mobile communications are immediate, verifiable and actionable

Mobile phone users respond within 60 minutes†

Average mobile phone users send/receive 4x as many text messages as voice calls†

Clinical trial participants will use their mobile phones to provide information

to clinical sites

•* Merrill Lynch Q3-2009/CTIA 2010 † Nielsen Q4-2008/10 ‡ Luth Research 2009.

Teens text, and so do their parents

parents text twice as much as they call

SMS Recruitment – Data points

70% prefer to inquire via text message

90% response rate = highly engaged

Significant ROI 3 months traditional method followed by 3 months with text messaging

• Cost per Response decreased by 15% • Cost per Referral decreased by 32% • ROI > 650%

OmniScience Mobile

0%20%40%60%80%

100%

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2

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CallCenterTextMessaging

60% of those who use SMS are referred “I contacted a subject who responded by text message and it went great! She is scheduled for a visit within the week.” study coordinator within 2 hours of receipt

“…it was very easy to maneuver.” anonymous patient

SMS for Recruitment

How NOT to Run an SMS Campaign

MOBILE APPS FOR RECRUITMENT & RETENTION

Mobile Apps for Recruitment Have Limitations

•Limited Reach – Smartphones only – Used by only 36% of US mobile subscribers / 14% international subscribers

•Expensive – software app must support all major platforms: iOS, Android, Windows, RIM,

Nokia – significant cost for development & maintenance

•Highly Inefficient as Direct Response option – Promotional materials driving traffic to an app there are too many steps:

1. Go to your phone’s app store 2. Find our app 3. Download it 4. Figure out where the app is on your phone 5. Click on the app to learn more about this study

Reference Apps Don’t Really Generate Referrals Clinical Trials Mobile app

Who will take the time to find this app and use it to search for clinical trials?

QR CODES

The Good and the Bad

• Inexpensive

•Only work for smartphone users

• Few have incorporated QR scanning into behavior

• Execution is tricky – You can’t remember a QR code and ‘text’ it later – Challenging for outdoor advertising

21

The Ugly

• No cell signal in NYC subway

• Creative design blocks code

VOLUNTEER REGISTRIES & RECRUITMENT PROTOCOLS

Other Technologies

San Francisco General Hospital Recruitment Pilot

• Investigators want to extend their reach

• 1 year pilot program for 10 studies – 24/7 staffed phone line – Weekly craigslist posting – Outgoing calls to follow-up as needed

• Outcomes – 692 volunteers (validated unique) – 25% contacted for screening visits – BMI was most beneficial data field for search criteria

Airway Clinical Research Center Asthma Recruitment Database

• Local disease-specific database

• Used as recruitment protocol/registry

– Characterize asthma severity

– Recruit for current studies real-time

– Register for contact regarding future studies – already prequalified

•UCSF Airway Clinical Research Center (ACRC)

Recruitment Trends by County

San Francisco 52%

Alameda 16%

San Mateo 11%

Contra Costa 7%

Santa Clara 4%

Marin 3%

Sonoma 2%

Solano 1%

•UCSF Airway Clinical Research Center (ACRC)

BEST PRACTICES

Performing Initial Analyses

Study Design Site-specific protocols for study-specific and SOC

procedures Placebo arms, excessive inclusion/exclusion criteria

Site-specific Staff resources Location(s): accessibility, interoperability, features /

disadvantages

Competing Trials

Planning & Budgeting

Screen Failure Rate

Budget for the unexpected Design revisions Increased production & shipping costs over time Protocol revisions impacting recruiting

methods/materials

Implementing the Plan

Staged approach

Multiple simultaneous advertising efforts

Plan on changing your plan – analyze relatively often

Communication Plan Sponsor/Site Staff Primary contacts Secondary contacts

Identify screening appointment schedule workflow, tools and conflicts

Ensuring High-Quality Participants

Start by casting a wide net Think about a wide number of things or people when choosing the

thing or person you want*

Don’t skip the prescreening step

Ask the right questions at the right stage of the recruitment process

*Idioms by The Free Dictionary

Monitoring Progress

Set realistic expectations up front

Identify benchmarks for success/failure

Simple tracking tools go a long way

Receiving logs & reports is not enough – they have to mean something and be actionable

THE UCSF PARTICIPANT RECRUITMENT SERVICE

Create a centralized service to facilitate the enrollment of research participants into UCSF clinical studies

Assume a large part of the burden of recruitment efforts

Provide expertise in recruitment materials development

Ensure materials meet regulatory guidelines and requirements

Offer an economy of scale for many recruitment activities

Use established vendor relationships

Increase the volume of high quality volunteers

Facilitate a wider catchment and more robust networks

Recruitment Analysis and Planning

Robust recruitment plan Analysis of recruitment landscape

Protocol complexities, procedures, SOC Competing studies Geographic/demographic population Marketing & Outreach methodologies

Suggested strategies Timelines Budgets for suggested strategies

Cohort ID and Direct Mail

Identify cohorts from inpatient medical records (UCare and ThREDS) ICD-9 codes Demographics

CHR modification

Coordinate data extract services from ARS

Print and mail direct mail letters to cohort

Recruitment Materials Toolkit

Future Services/Resources

Recruitment Plan Implementation Centralized call center, text messaging, online

screeners Marketing & outreach Referral networks

Searchable database of actively recruiting studies – matching

Real-time recruitment from EMR

THANK YOU