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By Joseph C. Avellone

March 10, 2003 | Early misguided approaches to recruiting patients over the Web for clinical trials have given way to effective — and replicable — methods for using this technology. However, many trial teams lack sufficient knowledge about how and when to apply e-recruitment. The following guide will help.

Determine if the Internet makes sense for your protocol.
Online recruitment works best for clinical conditions that are chronic, affect quality of life, and are treated primarily in the ambulatory setting. Examples include diabetes, depression, anxiety, arthritis, select cardiovascular and neuromuscular diseases, and some types of cancer. It's particularly useful for conditions with an element of social stigma (e.g., overactive bladder), as people feel more comfortable exploring their health options in a user-controlled manner.

2 Develop e-recruitment plans during the prelaunch phase.
Industry surveys show that principal investigators won't meet their patient quota 80 percent of the time. Online campaigns with screening Web sites work best over a long period. Given the real-time data generated, early implementation lets trial teams and their advisors evaluate initial results and make midcourse corrections when necessary. Early deployment also saves time and work educating clinical sites, integrating other recruitment activities, and obtaining requisite review board approvals.

3 Build your enrollment campaign from the ground up.
Pick the most efficient recruiting tools first, determine their likely yield in the context of your budget, and then add tools as needed. For example, a diabetes-patient recruitment strategy might begin with placing brochures in the investigator offices, then incorporating a campaign Web site, and including a radio campaign to attract additional patients if necessary.

4 Use screening Web sites as an adjunct to media campaigns.
Campaign Web sites are a very cost-effective adjunct to traditional media campaigns. Because they're user-controlled, have memorable site addresses, and maintain anonymity, they can dramatically leverage traditional media. Typically, a campaign site will increase referrals by 10 percent to 50 percent.

5 Deploy multitrial screening Web sites and databases.
More than 90 percent of patients screened for a specific protocol through a traditional or an online recruitment campaign won't make the cut. However, screening these "failures" against other trials creates large efficiencies. With as few as three other protocols in the relevant area, a screen failure can be matched to another trial more than half the time. A multitrial screening Web site with a proprietary patient database and call center/trial site connections can save millions of dollars annually. Such e-recruitment systems can be built, hosted, and maintained by outside vendors, resolving regulatory concerns about in-house patient data and organizational limitations of multiple study teams.

Joseph C. Avellone, M.D., is CEO of Veritas Medicine in Cambridge, Mass. He may be reached at

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