RT Journal Article
SR Electronic
T1 Recommendations for clinical research in children presenting to primary care out-of-hours services
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP bjgpopen20X101154
DO 10.3399/bjgpopen20X101154
A1 Anouk Weghorst
A1 Gea Holtman
A1 Pien Ingrid Wolters
A1 Heleen Russchen
A1 Freek Fickweiler
A1 Henkjan Verkade
A1 Johan Post
A1 Karin Vermeulen
A1 Boudewijn Kollen
A1 Irma Bonvanie
A1 Marjolein Berger
YR 2020
UL http://bjgpopen.org/content/early/2020/12/07/bjgpopen20X101154.abstract
AB Background: Research in primary care is essential, but recruiting children in this setting can be complex and may cause selection bias. Challenges surrounding informed consent, particularly in an acute clinical setting, can undermine feasibility. The off-protocol use of an intervention nearing implementation has become common in pragmatic randomized controlled trials (RCTs) set in primary care. Aim: To describe how the informed consent procedure affects study inclusion and to assess how off-protocol medication prescribing affects participant selection in a paediatric RCT. Design: A pragmatic RCT evaluating the cost-effectiveness of oral ondansetron in children diagnosed with acute gastroenteritis in primary care out-of-hours services and a parallel cohort study. Method: Consecutive children aged 6 months to 6 years attending primary care out-of-hours services with acute gastroenteritis were evaluated to assess the feasibility of obtaining informed consent, the off-protocol use of ondansetron, and other inclusion/exclusion criteria. Results: The RCTs feasibility was reduced by the informed consent procedure because 39.0% (325/834) of children were accompanied by only one parent. General practitioners prescribed ondansetron off-protocol to 34 children (4.1%), whereof 19 children were eligible for the RCT. RCT-eligible children included in the parallel cohort had fewer risk factors for dehydration than children in the RCT despite similar dehydration assessments by general practitioners. Conclusion: The informed consent procedure and off-protocol use of study medication affect the inclusion rate but had little effect on selection. A parallel cohort study alongside the RCT can help evaluate selection bias, and a pilot study can reveal potential barriers to inclusion.