The Impact of COVID-19 on a Large Pragmatic Clinical Trial Embedded in Primary Care

Authors

Sarah M Leatherman
Cynthia Hau
Alison Klint
Peter A Glassman
Addison A Taylor
Ryan E Ferguson
William C Cushman
Areef Ishani

Publication Date

6-1-2023

Journal

Contemporary Clinical Trials

DOI

10.1016/j.cct.2023.107179

PMID

37031794

PMCID

PMC10080857

PubMedCentral® Posted Date

4-7-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Aged, Humans, COVID-19, Diuretics, Medicare, Pandemics, Primary Health Care, United States, COVID-19, Pragmatic trial, Clinical trial, Point of care trial, Real world data

Abstract

INTRODUCTION: The COVID-19 pandemic had significant impact on clinical care and clinical trial operations, but the impact on decentralized pragmatic trials is unclear. The Diuretic Comparison Project (DCP) is a Point-of Care (POC) pragmatic trial testing whether chlorthalidone is superior to hydrochlorothiazide in preventing major cardiovascular (CV) events and non-cancer death. DCP utilized telephone consent, data collection from the electronic health record and Medicare, forwent study visits, and limited provider commitment beyond usual care. We assessed the impact of COVID-19 on recruitment, follow-up, data collection, and outcome ascertainment in DCP.

METHODS: We compared data from two 8-month periods: Pre-Pandemic (July 2019-February 2020) and Mid-Pandemic (July 2020-February 2021). Consent and randomization rates, diuretic adherence, blood pressure (BP) and electrolyte follow-up rates, records of CV events, hospitalization, and death rates were compared.

RESULTS: Providers participated at a lower rate mid-pandemic (65%) than pre-pandemic (71%), but more patients were contacted (7622 vs. 5363) and consented (3718 vs. 3048) mid-pandemic than pre-pandemic. Patients refilled medications and remained on their randomized diuretic equally (90%) in both periods. Overall, rates of BP, electrolyte measurements, and hospitalizations decreased mid-pandemic while deaths increased.

CONCLUSIONS: While recruitment, enrollment, and adherence did not suffer during the pandemic, documented blood pressure checks and laboratory evaluations decreased, likely due to fewer in-person visits. VA hospitalizations decreased, despite a considerable number of COVID-related hospitalizations. This suggests changes in clinical care during the pandemic, but the limited impact on DCP's operations during a global pandemic is an important strength of POC trials.

Comments

Clinical Trial Registration: NCT02185417

Associated Data