Primary Care Research Is Hard to Do During COVID-19: Challenges and Solutions

Stop recruiting patients for a weight management study temporarily because wellness visits are paused due to needing improved access for sick visits

Stop recruiting clinics for an implementation study because clinics are trying to implement new telehealth workflows and to stay afloat with income reductions

The project period can be reasonably stretched

There is just no way the settings or personnel can complete the work at the time

There is reason to believe the challenges will resolve and the research can resume

Can spend time working on “offline” activities during the pause such as literature review, analysis of data already collected, etc

Regional outreach to support clinic recruitment expanded from a single state to a tristate region

The topic is relevant and if you expand the opportunity, new sites may benefit

This provides opportunities to compare how uptake of the program varies based on regional variation in COVID-19 surges

Reduce the sample size of practice participants

Reduce data collection for various aspects of a study (such as eliminating mid-point interviews and surveys)

Complete fewer research results papers

Funders accept changes

Changes in sample size will not significantly alter study power

Changes in data collection will not critically reduce the understandings produced from the study

Study staff is stressed with increased demands and there are not enough of them/enough time to complete additional analysis or collect more data

Complete qualitative interviews and/or deliver intervention activities via Zoom or Webex and telephone instead of in person

Change instruments or procedures (such as moving from focus groups to 1:1 interviews)

Alter the personnel such as have research team members conduct screening assessment procedures, vs integrate into existing clinic workflows

The alternative method allows for the research to continue without undue reductions in the quality of the data collection or intervention effectiveness

There is simply no other way to conduct the activities without risk or harm of exposure

There is added value by conducting activities remotely, such as by adding additional clinic or research staff to meetings

The new methods or designs can maintain the integrity of the core project but offer the opportunity to look at new questions

Adjust intervention length to accommodate delays resulting from paused recruitment during various COVID-19 waves (eg, 12 months to 15 months) or to better align with clinic capacity (9 months to 6 months)

Expand the intervention focus to include attention to COVID-19–related consequences (eg, vaccine hesitancy, behavioral health)

Study implementation and adaptions: the context for them, their characteristics and impact

The funder has flexibility and willingness to acknowledge the pressures on primary care. Being part of a multi-site collaborative where all partners are experiencing challenges can help

Projects focused on individual conditions like HPV vaccination or unhealthy alcohol use can become “more relevant” if they add content related to general vaccine hesitancy or addressing behavioral health needs broadly (eg, screening for depression too)

Depending on the goal of your project, you may be able to alter the mode of gathering data and still achieve your primary outcomes

Pivot to providing instruction and resources for completing medical visits using telehealth

Add learning collaboratives or Extension for Community Health Outcomes (ECHO) program services to help deliver education on COVID-19 protocols

The program and funder accommodate alterations in the goals and outcomes for the project. This may be more possible with quality improvement and contractual work than investigator-initiated research

An opportunity to strengthen research partnerships with state public health, to provide just in time support to complement the longer scale research timeframe