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LETTERS: Arnold G Zermansky Including care home residents in clinical research is fraught BMJ 2005; 331: 1271-c-1272-c [Full text]

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Addressing disincentives to care home participation in research

Paul J Rooney, Anne Loughrey, Maureen O'Leary, Brian Smyth, Philip Donaghy   (2 December 2005)

Addressing disincentives to care home participation in research 2 December 2005
Paul J Rooney, Consultant Medical Microbiologist Belfast City Hospital BT9 7AD, Anne Loughrey, Maureen O'Leary, Brian Smyth, Philip Donaghy Send response to journal: Re: Addressing disincentives to care home participation in research	Zermansky and colleagues note that their research in care homes needed the agreement of home managers before residents could be approached. We have encountered similar problems in an ethically approved study of infection control provision and the spread of resistant E.coli in local care homes. The majority of care home managers agreed to participate and we are very grateful to them.However, there can be important disincentives that may discourage managers from participation. There are financial disincentives as participation in a study will divert staff time away from care delivery activities. Furthermore, issues arising from research could potentially generate adverse publicity and extra workload either for the individual care home or for care homes in general. The positive incentives to participate can be more nebulous e.g. making a contribution to the advance of medical science or investigation of an issue of particular concern to that home. When a care home manager declines to participate study bias can arise e.g. a home that is exceptionally busy or trying to cope with staffing problems may feel unable to take on the extra burden of research. However in a study of infection control practice it would be important to avoid the bias of excluding such homes. Researchers rely on the goodwill of care home managers to participate in studies and thereby incur associated costs. It will become increasingly difficult to undertake research to benefit patients in care homes unless the disincentives to private sector participation are addressed. This could take the form of a contractual obligation on homes treating publicly funded patients perhaps combined with a mechanism for re -imbursement of additional costs. As current government policy is to encourage greater private sector involvement in a wider range of services to NHS patients similar issues will arise in other contexts. Competing interests: The authors are currently engaged in a study of infection control issues in care homes