Primary care
Primary care
Hub-and-spoke rides
to the rescue
E
ast of England Primary Care Local Research Network uses a hub-andspoke study set-up model to improve the research experience for
patients with Chronic Fatigue Syndrome and improve recruitment to an
under-performing study.
Chronic Fatigue Syndrome or Myalgic Encephalopathy (ME)
includes chronic, often severe mental and physical exhaustion,
widespread muscle and joint pain and headaches.
Originally, patients for a study exploring ME in the East of England
were seen by occupational therapists at the central ME specialty
service clinic in Great Yarmouth. This meant a 40 mile commute
across Norfolk and Suffolk for some patients which was not only
inconvenient, but onerous and challenging for anyone with the
condition. In addition, only one set of equipment was available to
make essential measurements for the study.
Sponsored by London School of Hygiene & Tropical Medicine
(LSHTM), the study was struggling to meet the recruitment target
of 105 participants.
A third of the recruited participants in the study were required
to be healthy controls and further, the existing study method
for recruiting healthy controls was not working. As all referred
patients to the clinic already had the condition, friends and family
of the patients were asked to get involved as controls, but the
uptake was poor.
With study recruitment well below the target of 105 at 69
participants during the four months (61 cases and eight healthy
controls), and the research contract with the ME specialty
service clinic about to expire, Primary Care Research Network
coordinator, Heather Leishman, contacted the study team:
“As coordinator for East of England, I contacted Dr Eliana
Lacerda, the project lead, to discuss how the Network could
further support the study and what resources were available to
address the low recruitment numbers. I recommended a huband-spoke model as it was a low-cost way of maximising the
recruitment potential from local practices as set-up was required
in just one practice, “the hub”. Recruiting from hub-and-spoke
practices meant patients could see a Network research nurse at a
practice local to them.”
Primary Care Research Network East of England was waiting for
an opportunity to pilot a hub-and-spoke model and this was the
first study where the circumstances were right:
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•
It was a relatively straight-forward academic study only
requiring blood and physical measurements to be taken
•
There was a suitable research active practice with sufficient
space and resources in Lowestoft who, from previous
Hub and spoke rides to the rescue
conversations with the Network, were
willing to act as a “hub’ where the
clinical assessments would take place
•
There were five local practices within
a five mile radius of the hub to act as
“spokes”
•
The Network was able to provide
research nurses with relevant skills
•
The area would provide sufficient
recruitment opportunity for the size of
the study
In just two months
of using the hub and
spoke model, 62
patients were recruited,
almost doubling the
recruitment rate.
ethics and research governance committees
to reflect the new hub-and-spoke practices.
A database search and mailing to the
appropriate patients was then undertaken,
initially by the hub and then by the five spoke
practices. Heather confirms:
“Staggering the mailings in this way prevented
the study team from being overwhelmed by
responses and should we have hit a problem
after the first mailing was issued it would have
been restricted to one site.”
the patients who in this instance have had the
chance to contribute to a study where there is
limited treatment or indeed understanding of
their condition so far.
At the time of writing, a further 40 patients
have consented to participate. Pleased with
the results Heather looks to the future:
“With Network support the study received a
funding extension as the recruitment rate had
dramatically improved. Hopefully this success
will strengthen the study team’s position for
securing funding for the next phase.”
Responses were returned directly from
patients to the study sponsor who booked the
patient into a clinic at the hub with a Network Study project lead at LSHTM, Dr Eliana
Lacerda, says the collaboration with the
research nurse.
Network was a positive experience:
In just two months of using the hub-and“The adoption of our research study by the
spoke model, 62 participants were recruited
Primary Care Research Network has been
almost doubling the recruitment rate. By
a rewarding experience for our research
the recruitment deadline, October 2012,
team. The use of a hub and spoke model
although the target had not yet been met, a
has improved our recruitment rate; and, not
further funding extension of twelve months
only have we achieved our target for enlisting
was agreed on the basis that recruitment
cases in the first year, but we have also greatly
had been much improved. Network research
improved the enrolment of healthy controls.
nurse, Sue Allen said:
“This experience has also proven to be
“The hub-and-spoke model enabled us to
see more patients. Patients could travel locally very efficient, as it allows the combination
of resources from the research team with
which was particularly beneficial to those
those of the Network team to be used in an
with conditions that affected their mobility.
optimal way. Therefore, we consider this to
There were benefits for the spoke practices
be a reproducible model, which may help
too because the study provided a gentle
to improve similar studies being carried out
introduction to working in a new way and
within the Primary Care Research Network.”
an opportunity for neighboring practices to
Working with the study sponsor, Heather
coordinated the set up of the hub-and-spoke
sites. This meant the six practices would invite
potential cases and healthy controls to take
part in the study and the clinical assessments
would be carried out by Network research
nurses in one central practice “the hub”.
Heather had a great working relationship
with the Practice Manager at the hub and
commends the Practice Manager for her efforts work together.”
in helping the model get off the ground:
For spoke practices this experience has
“Lisa Andrews, the Practice Manager, was very opened the door to a research active
supportive of the Network and helped to guide future. Being a spoke gives the practice the
confidence to pursue other research projects.
the spoke practices through the process.”
This not only benefits the practice by giving
Study information and the patient invitation
staff the opportunity to up skill, but benefits
letter were updated and approved by the
Primary Care Research Network East of
England is looking forward to using the
hub-and-spoke model in future studies and
plans to pilot the model with a more complex
commercial study when the opportunity arises.
www.pcrn.org.uk
“This experience has...proven to be very
efficient, as it allows the combination of the
research team and those of the Network
team to be used in an optimal way.”
Hub and spoke rides to the rescue
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