A Comprehensive Guide to Clinical Recruitment Strategies

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Cerebral Inc. May 5, 2022

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According to ACRP, 30% of individuals withdraw from a clinical study prior to completion, and recruiting a replacement costs an average of $19,533. Psychiatry has been poised for disruption for decades, and pharmaceutical companies are looking for solutions to bridge the gap between participant recruitment and drug research and development. This blog highlights a modernized approach to patient recruitment strategies to increase the volume of qualified participants that are more likely to remain active and engaged throughout the duration of the study.

Decentralized clinical trials

Conducting decentralized clinical trials is by far the most strategic and inventive avenue for pharmaceutical companies to distinguish themselves in a space that struggles with quick and thoughtful recruitment. Traditional clinical trial settings do not allow for convenience and significantly limit the pool of qualified participants simply due to the physical location of the study site, whereas the modern approach allows pharma companies to collect data remotely, from wherever the patients are located.

Current clinical trial recruitment challenges

There are four major obstacles that traditional, in-person clinical studies fail to achieve:

Accessibility and convenience
Efficient and cost-effective recruitment
Diversity among participant groups
Strategic digital recruitment campaigns

TechCrunch reported nearly 70% of participants live more than 2 hours away from the clinic center, and 80% of clinical trials are canceled because they fail to meet the deadline to enroll patients on time.

Decentralized clinical recruitment for precision psychiatry

In December 2021, Alto Neuroscience and Cerebral announced a first-of-its-kind partnership for a decentralized study in precision psychiatry that will change pharmaceutical trial recruitment forever. Amit Etkin, M.D., Ph.D., founder and chief executive officer of Alto Neuroscience said:

“The introduction of this first-ever decentralized clinical trial in precision psychiatry broadens our formerly narrow view of drug discovery and development in mental health, allowing us to quickly deploy effective, accessible treatments in a way not previously possible.”

This study has leveraged Cerebral’s 200,000+ member network to recruit 200 eligible participants to undergo in home-evaluations using EEG, remote assessments at milestones of the study, clinical outcomes (i.e. depression scales), and at-home visits.

Patient-centric clinical trials

Logistically speaking, considerations around the participants’ needs are not at the forefront when traditional clinical trials are designed. Whether it's commuting to the study sites or paying out-of-pocket for expenses, site-based clinical trials burden participants and hinder the possibility of successful recruitment. In other words, patient-centricty could be significantly enhanced beyond the current traditional clinical study design.

As noted by a recent PubMed article aimed to define patient centricity for patients as it related to clinical research studies, patient-centricity was outlined as“'Putting the patient first in an open and sustained engagement of the patient to respectfully and compassionately achieve the best experience and outcome for that person and their family. Important principles for patients focused on education/information, cocreation, access, and transparency.”

Patient engagement is an essential aspect of all healthcare avenues, including the research and development of biopharmaceutical products. Patient-centric clinical trial frameworks are designed with a deep understanding of medical conditions, experiences, needs, and patient priorities (i.e. convenience, compensation, accessibility).

Leveraging an existing database

Traditional clinical trial recruitment strategies partner with labs and EHR systems to collect data on patients that could potentially qualify to participate in clinical trials.

Reaching out to patients that meet trial eligibility criteria by using these third-party databases is a step in the right direction, but leaves your team with the responsibility to create and maintain the time-intensive recruitment campaign with quick deadlines, and participants can still be disqualified based on more specific eligibility requirements.

Clinical trial recruitment tools like Cerebral with proprietary EHRs offer an immensely competitive edge to pharmaceutical companies because of the incredibly refined data slicing and reporting capabilities. Cerebral’s structured data aggregated across prescriptions, diagnoses, labs, self-report surveys, medication fill rates, and better enables Cerebral to more rapidly and accurately identify candidates that likely meet trial eligibility criteria.

For example, in the Alto precision psychiatry study, Cerebral searches its patient pool for potential participants who are taking specific antidepressants, yet haven’t seen improvement in their major depressive disorder symptoms. To support further in-depth analysis of whether an individual will be a strong candidate for participation in the trial, Cerebral is able to pull details on individuals’ prescriptions, therapy frequency, comorbidities, and more. Cerebral is able to target individuals who are more likely to meet trial eligibility criteria, enabling individuals who have historically not seen any improvement in their depression systems to try a new approach to treatment, while also enabling Alto to analyze how an individual's distinct biology impacts their response to treatment.

Recruit quickly and thoughtfully

A decentralized clinical trial program will rapidly advance the time to development of novel targeted medicines, specifically within psychiatry, a vertical in healthcare ripe for change and evolution.

By leveraging an existing database of patients and structured patient data, you can recruit quickly by creating a customized list of individuals that meet trial criteria within hours.

Software for recruitment of patients for pharma trials

Software for recruitment of patients for pharma trials has the capability to tap into proprietary patient databases, to select pre-qualified patients that meet the eligibility parameters of the clinical trial. Utilizing an EHR to identify relevant medical history, diagnoses, etc, allows pharmaceutical companies to target outreach to individuals who might be a good fit for a trial.

Marketing Strategy

Building a digital recruitment campaign comes with its own set of challenges. You have to know what it takes to raise awareness and educate around clinical research, which marketing channels and formats to leverage based on your audience, and how to strategically target audiences to participate in studies.

Internal recruitment

In Cerebral’s case, our proprietary EHR and data collection capabilities enable powerful internal recruitment by having granular, detailed data about the patient base for pharmaceutical clients. Internal recruitment as one avenue in your marketing strategy leads to much more relevant outreach and ultimately faster recruitment.

Example of a marketing campaign for clinical recruitment

Here is an example of a marketing campaign you might launch within your digital recruitment strategy:

You want to target individuals who are currently diagnosed and taking medication for bipolar I or II. Your company is conducting a clinical study for a new bipolar medication that could ease the side effects that these individuals are experiencing. You need to consider what and where individuals are searching for when looking for alternative solutions to the current medication they are taking. Maybe they are using Google and searching “new medication for bipolar I” or “best medication for bipolar disorder”). You launch ads on Google targeting these keywords to drive individuals to the recruitment sign-up page.

This is just one example of what could be part of a comprehensive digital recruitment campaign. Cerebral deeply understands the relationship between a robust data infrastructure and how it can be leveraged to strategically recruit participants.

To learn more about the capabilities and partnership opportunities with pharmaceutical companies, visit our pharmaceutical services page.

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Telehealth and the Power to Revolutionize Access to Mental health care

The mental health care system is in crisis – overwhelmed in the pandemic’s wake, with patients nationwide suffering from rising cases of anxiety, depression and other disorders. As a result, they are frequently left unable to find psychiatric and behavioral care. Telehealth companies like Cerebral are leading the way in addressing that need, but like any new innovation in health care, there is resistance. Traditional mental health providers feel threatened by this new model, which exponentially improves access for patients across the U.S. The fact is that there’s room and need for both traditional in-person care and telemedicine. Without both modalities, there’s no way we will make a dent in the acute challenges facing people from every walk of life and across the country. Telehealth isn’t a panacea, but it undoubtedly improves access and reduces the stigma associated with services that are out of reach for far too many people. Americans do not have adequate access to mental health care. Nearly one-third of Americans live in an area that has a shortage of mental health care professionals and 60 percent of all U.S. counties – including 80 percent of all rural counties – do not have a single psychiatrist. If patients are lucky enough to secure an appointment, they often have to wait months before their first session. However, it is typical for non-psychiatrists to treat mental illness. In conventional health care, 79 percent of antidepressants are prescribed by primary care doctors, so it’s a misconception to think that psychiatrists are prescribing the lion’s share in traditional settings. Nurse practitioners have a critical role to play. A key to improving access to care is to use experienced clinicians – often nurse practitioners – who play a vital role in the health care system, especially in underserved communities. As front-line clinicians, nurse practitioners are practiced hands in dealing with many aspects of mental health care, and Cerebral’s nurse practitioners are particularly well-equipped and supported to manage mental illnesses. Besides being carefully screened and interviewed before joining the Cerebral team, our nurse practitioners receive additional training and clinical support for the treatment of the psychiatric conditions we see most frequently, including depression, anxiety, bipolar disorder, insomnia, and PTSD, among others. Should they want to discuss a challenging clinical situation, they can easily get in touch with a staff psychiatrist within minutes; this ‘second opinion’ line, which we call Curbside Consults, is an innovation that is available to our NPs 12 hours a day, 7 days a week They are well positioned to monitor and counsel patients throughout the process of initial evaluation, treatment, and recovery. A new study out this month (September 2022) found that the ranks of psychiatric mental health nurse practitioners (PMHNPs) are surging as caseloads increase. Notably, the number of PMHNPs who care for Medicare patients jumped 162 percent between 2011 and 2019, compared to a 6 percent decline in psychiatrists, which further underscores how important nurse practitioners are to match the burgeoning demand for care. By utilizing nurse practitioners and telehealth, we are democratizing access to care, and supporting patients who have historically been disenfranchised by the mental healthcare system. . Indeed, nearly 2/3 of Cerebral patients have never had the privilege of receiving mental health care prior to coming to Cerebral. We can only improve what we measure. The vast majority of mental health professionals do not measure clinical outcomes. This would be unacceptable in any other field of medicine: you wouldn’t trust a diabetes doctor who did not regularly check your labs in order to monitor the progression of the disease. Why should depression or anxiety disorders be treated so differently? Telehealth allows us to measure clinical outcomes using tools that are integrated within the care experience. By monitoring how patients are doing via surveys, we are able to better understand whether treatment plans are working, or whether adjustments need to be made. Overall, knowing how patients are doing helps us improve clinical quality and maintain patient safety. Collecting patient outcomes data at scale can also be a benefit. It can establish new baselines for what is most effective for different types of patients, paving the way for the kind of precision medicine approach that has transformed cancer care and other specialties. The bottom line is that the current mental health care system can’t improve access for desperate patients who desperately need care. While there have been missteps and necessary learnings along the way, telehealth has a vital role to play in this process. For tens of millions of Americans who need our help, their well being, and their lives, are on the line.

Sep 14, 2022

For Enterprise

How Telehealth Can Increase Access to Mental Healthcare for College Students

Millions of students are set to return to college campuses all over the country over the next few weeks. While this is an exciting time for many students, it can be a challenging one as well, and one that has only been complicated by the effects of the pandemic. According to the CDC, three out of four Americans between the ages of 18 and 24 now report poor mental health resulting from the pandemic. This is among a population that is already more prone to mental health issues, with significantly greater portions of young adults in college reporting struggling with conditions such as anxiety and depression than their unenrolled peers. For example, a recent survey conducted by Fortune found that 43% of college students report struggling with anxiety and 33% report struggling with depression, compared to 29% and 27%, respectively, of US adults in general. Suicide and suicidal ideation rates are also especially high in college students: according to the National College Health Risk Behavior Survey, 10.3% of respondents reported seriously considering attempting suicide, 6.7% had made a suicide plan, and 1.5% reported they had attempted suicide one or more times in the 12 months preceding the survey. The good news is that many students suffering from these conditions see the value in seeking support from mental health care providers. According to a recent survey, 60% of prospective college students now say that mental health services are a very important factor in their search for a university, a statistic that has jumped significantly in the wake of the pandemic. University presidents and leadership also recognize the need: according to the American Counsel on Education, 68% of university presidents view student body mental health as one of their most pressing issues. The bad news is that, despite that awareness, many universities struggled for years to adequately meet that demand, making access challenging for students and creating barriers to care for many. The reason for this gap is largely due to resourcing issues. Most schools only offer in-person counseling options, and there are simply not enough credentialed providers to go around. Colleges have attempted to address this in the past by triaging patients through a “stepped care” model, under which students initially receive the least resource-intensive form of care and are only allowed a more fulsome approach if it is deemed necessary. Other schools have capped the number of sessions an individual can schedule with a provider in an attempt to free up appointment time. Either way, it is clear that there are not enough traditional mental healthcare resources to meet the needs of America’s college students. This is where telehealth and Cerebral come in. As a telemental health care provider, Cerebral can help plug the resourcing gaps that many colleges are experiencing. Cerebral provides students suffering from mental health issues with the ability to book an appointment with a provider within days, alleviating some of the historically lengthy wait times for college counseling services. Cerebral is also able to quickly adapt to a patient’s needs, allowing students to increase or decrease their care as needed and without restrictions. Furthermore, students can now receive care in the comfort and privacy of their dorm, which will lower the threshold for seeking care. Some students find it intimidating or shameful to walk into the counseling centers. We already actively partner with a number of universities to offer this kind of hybrid approach to mental health care for students. For example, we partnered with Arkansas Colleges of Health Education (ACHE) to provide all students access to Cerebral’s telehealth services. A hybrid approach such as the one deployed by ACHE should be considered the future of mental health care on college campuses as university officials continue to look for ways to expand access and meet demand among their student populations. College is a stressful and intense time for many, and adequate mental health support can make navigating it all the more manageable.

Sep 9, 2022

For Enterprise

Age Verification and What it Means for Access to Care

At Cerebral, we work hard to implement one of the best age and identity-verification processes in the telehealth industry, one that meets or surpasses legal requirements while helping patients access mental health care within days. Our process is an improvement over your typical brick and mortar facility, where ID checks are done manually by front-office staff. The verification process is not without friction, however, so it is our goal to create a seamless process that doesn’t restrict access for the patients who need it most. Improving the verification system is not a simple undertaking but we are working closely with providers and using the latest technology in-house to ensure we treat only those who are eligible for care. Our process begins with a manual ID review for new patients by clinicians, who also verify identifiers such as birthdate and address, and then compare photos to prospective patients by video. If a health care provider can’t definitively confirm the data, we direct providers to let prospective patients know we cannot serve them, and promptly cancel their account and make refunds. As an additional level of security, we ask individuals to upload images from a government-issued identification document (such as a passport or driver’s license), which we then compare to live photos of their face using Persona, a sophisticated software program that is a further safeguard in recognizing accounts of those who are under 18. This system is an important part of any new patient experience at Cerebral, but it is especially critical to ensure that we do not provide services to patients under the age of 18. Psychiatric and behavioral issues affect people of all ages, not just adults, and access to mental health care for those under the age of 18 is especially complicated. In many states, children are prohibited from receiving care without the consent of their parents or legal guardian. At Cerebral, we do not work with patients under the age of 18. The advent of telehealth has brought new possibilities to our field, but also new challenges, such as age verification. We are dedicated to improving access to mental health care services wherever we can, while going above and beyond to ensure compliance with all applicable laws. We are constantly refining and improving our safety and quality measures to ensure we deliver best-in-class care so that our patients can feel better, sooner, and so that we can help our patients achieve positive clinical outcomes.

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