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      Portuguese Primary Care physicians response rate in surveys: A systematic review Translated title: Taxa de respostas dos médicos de família portugueses a questionários: uma revisão sistemática

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          Abstract

          Summary Introduction: Surveys are a useful tool in primary care. However, low response rates can introduce selection bias, impairing both external and internal validity. The aim of this study was to assess the average response rate in surveys with Portuguese general practitioners (GPs). Method: We searched the Medline, Web of Science, Scopus, Embase, PsychInfo, SciELO, IndexRMP, RCAAP, Revista Portuguesa de Medicina Geral e Familiar, Acta Médica Portuguesa and the proceedings of conferences of general practice from incepton to December 2016. We included all postal, e-mail, telephone and personal surveys to primary care physicians without language restrictions. We did not assess risk of bias of included studies, since the main outcome was survey response rate. We performed planned subgroup analyses of the use of monetary incentives, the use of non-monetary incentives, survey delivery modes and prior contact with participants. Results: A total of 1,094 papers were identified and 37 studies were included in this review. The response rate in surveys done to Portuguese GPs was 56% (95CI 47-64%). There was substantial heterogeneity among included studies (I2=99%), but subgroup analysis did not explain this heterogeneity. Conclusion: Consistent with other published studies, the average response rate in surveys done with Portuguese GPs was 56%, with substantial variation among studies. Use of monetary incentives, one of the most effective strategies to increase response rates, was not present in any of the included studies.

          Translated abstract

          Resumo Introdução: Questionários são úteis na investigação em cuidados de saúde primários. Contudo, baixas taxas de resposta podem introduzir um viés de seleção, prejudicando a validade externa e interna. O objetivo deste estudo foi identificar a taxa de resposta média a questionários aplicados a médicos de família (MF) portugueses. Método: Foram pesquisadas as bases de dados Medline, Web of Science, Scopus, Embase, PsychInfo, SciELO, IndexRMP, RCAAP, Revista Portuguesa de Medicina Geral e Familiar, Acta Médica Portuguesa e resumos em conferências de medicina familiar do início até dezembro de 2016. Incluiram-se estudos realizados a médicos de família portugueses independentemente de sua tipologia, do tipo de entrega (correio, e-mail, pessoalmente e por telefone) e do idioma do artigo. Não foi avaliado o risco de viés dos artigos porque o principal resultado considerado foi a taxa de resposta. Foram efetuadas análises de subgrupos sobre a utilização de incentivos monetários, de incentivos não monetários, o modo de entrega e o contato prévio com os participantes. Resultados: Foram identificados 1.094 artigos e incluídos 37 estudos. O número de participantes em cada estudo variou entre 13 e 2.815 participantes. A taxa de resposta média foi de 56% (IC95% 47-64%). Identificou-se uma heterogeneidade substancial (I2=99%) não explicável pela análise de subgrupos. Conclusão: A taxa de resposta média a inquéritos realizados a MF portugueses foi de 56%, o que corresponde aos valores identificados em revisões internacionais, apesar da variação significativa entre os estudos englobados nesta revisão. O uso de incentivos monetários, uma das estratégias mais eficazes para aumentar as taxas de resposta, não foi identificado em qualquer dos estudos incluídos.

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          The effectiveness of recruitment strategies on general practitioner’s survey response rates – a systematic review

          Background Low survey response rates in general practice are common and lead to loss of power, selection bias, unexpected budgetary constraints and time delays in research projects. Methods Objective: To assess the effectiveness of recruitment strategies aimed at increasing survey response rates among GPs. Design: Systematic review. Search methods: MEDLINE (OVIDSP, 1948-2012), EMBASE (OVIDSP, 1980-2012), Evidence Based Medicine Reviews (OVIDSP, 2012) and references of included papers were searched. Major search terms included GPs, recruitment strategies, response rates, and randomised controlled trials (RCT). Selection criteria: Cluster RCTs, RCTs and factorial trial designs that evaluate recruitment strategies aimed at increasing GP survey response rates. Data collection and analysis: Abstracts identified by the search strategy were reviewed and relevant articles were retrieved. Each full-text publication was examined to determine whether it met the predetermined inclusion criteria. Data extraction and study quality was assessed by using predetermined checklists. Results Monetary and nonmonetary incentives were more effective than no incentive with monetary incentives having a slightly bigger effect than nonmonetary incentives. Large incentives were more effective than small incentives, as were upfront monetary incentives compared to promised monetary incentives. Postal surveys were more effective than telephone or email surveys. One study demonstrated that sequentially mixed mode (online survey followed by a paper survey with a reminder) was more effective than an online survey or the combination of an online and paper survey sent similtaneously in the first mail out. Pre-contact with a phonecall from a peer, personalised packages, sending mail on Friday, and using registered mail also increased response rates in single studies. Pre-contact by letter or postcard almost reached statistical signficance. Conclusions GP survey response rates may improve by using the following strategies: monetary and nonmonetary incentives, larger incentives, upfront monetary incentives, postal surveys, pre-contact with a phonecall from a peer, personalised packages, sending mail on Friday, and using registered mail. Mail pre-contact may also improve response rates and have low costs. Improved reporting and further trials, including sequential mixed mode trials and social media, are required to determine the effectiveness of recruitment strategies on GPs' response rates to surveys.
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            Not another questionnaire! Maximizing the response rate, predicting non-response and assessing non-response bias in postal questionnaire studies of GPs.

            Non-response is an important potential source of bias in survey research. With evidence of falling response rates from GPs, it is of increasing importance when undertaking postal questionnaire surveys of GPs to seek to maximize response rates and evaluate the potential for non-response bias. Our aim was to investigate the effectiveness of follow-up procedures when undertaking a postal questionnaire study of GPs, the use of publicly available data in assessing non-response bias and the development of regression models predicting responder behaviour. A postal questionnaire study was carried out of a random sample of 600 GPs in Wales concerning their training and knowledge in palliative care. A cumulative response rate graph permitted optimal timing of follow-up mailings: a final response rate of 67.6% was achieved. Differences were found between responders and non-responders on several parameters and between sample and population on some parameters: some of these may bias the sample data. Logistic regression analysis indicated medical school of qualification and current membership of the Royal College of General Practitioners to be the only significant predictors of responders. Late responders were significantly more likely to have been qualified for longer. This study has several implications for future postal questionnaire studies of GPs. The optimal timing of reminders may be judged from plotting the cumulative response rate: it is worth sending at least three reminders. There are few parameters that significantly predict GPs who are unlikely to respond; more of these may be included in the sample, or they may be targeted for special attention. Publicly available data may be used readily in the analysis of non-response bias and generalizability.
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              Do GPs respond to postal questionnaire surveys? A comprehensive review of primary care literature.

              There is a general consensus that postal surveys of physicians have low response rates. Recent systematic reviews have provided an improved evidence base to help researchers maximize response rates to self-completion questionnaires but to date, there is no comprehensive analysis of whether response rates have improved. To determine a contemporary estimate for the mean response rate to surveys of GPs published in primary care journals over the past decade. Twenty-four primary care journals from January 2000 to summer 2009 were searched for postal surveys of GPs. A total of 2838 abstracts were screened, with 683 full-text articles being examined for eligibility and 355 citations included. Three hundred and sixty-one surveys of GPs were identified. A total of 338 598 questionnaires were distributed during the study period, with 182 256 returned response rate 61% (95% confidence interval [CI] 59-63%). There was some evidence of an association between response rate and journal impact factor, with a statistically significant higher mean response rate for journals in the highest (mean 67%; 95% CI 64-70%) compared to journals in the lowest quartile of impact factor (mean 55%; 95% CI 51-59%). There was no evidence that mean response rate had increased in the period from 2000 to 2009. Postal questionnaires of GPs do not necessarily result in a low response rate. Response rates over the past decade appear relatively unchanged despite the greater evidence base for improving response and further work should explore reasons for this.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ramb
                Revista da Associação Médica Brasileira
                Rev. Assoc. Med. Bras.
                Associação Médica Brasileira (São Paulo, SP, Brazil )
                0104-4230
                1806-9282
                March 2018
                : 64
                : 3
                : 272-280
                Affiliations
                [5] Lisboa orgnameInstituto Politécnico de Lisboa orgdiv1Escola Superior de Tecnologia da Saúde de Lisboa Portugal
                [8] Lisboa orgnameUniversidade Nova de Lisboa orgdiv1Escola Nacional de Saúde Pública orgdiv2Centro de Investigação em Saúde Pública Portugal
                [4] Sydney New South Wales orgnameMacquarie University orgdiv1Australian Institute of Health Innovation orgdiv2Centre for Health Informatics Australia
                [1] orgnameUnidade de Saúde Familiar orgdiv1Family Medicine Physician Portugal
                [7] Lisboa orgnameUniversidade Nova de Lisboa orgdiv1Faculdade de Ciências Médicas orgdiv2Family Medicine Department Portugal
                [2] Lisboa orgnameAgrupamento de Centros de Saúde orgdiv1Unidade de Cuidados de Saúde Personalizados (UCSP) dos Olivais orgdiv2Family Medicine Physician Portugal
                [9] Lisboa orgnameInstituto Universitário de Lisboa orgdiv1Grupo de Investigação em Psicopatologia, Emoções, Cognição e Documentação Portugal
                [3] Lisboa orgnameAgrupamento de Centros de Saúde orgdiv1Unidade de Cuidados de Saúde Personalizados (UCSP) dos Olivais orgdiv2Family Medicine Physician Portugal
                [6] Lisboa orgnameUniversidade Nova de Lisboa orgdiv1Faculdade de Ciências Médicas orgdiv2Chronic Diseases Research Centre Portugal
                Article
                S0104-42302018000300272
                10.1590/1806-9282.64.03.272
                69017f6a-4f64-4b73-a155-eb41921dc865

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 23 August 2017
                : 13 July 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 53, Pages: 9
                Product

                SciELO Brazil


                Medicina de Família e Comunidade,Portugal,Surveys and Questionnaires,Primary Health Care,Family Practice,Physicians,Inquéritos e Questionários,Atenção Primária à Saúde,Médicos

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