Main findings and interpretation
The study results show that most of the general practitioners interviewed gave a positive rating to the experience they had gained with the Innovation Fund and saw opportunities in the concept. On the other hand, we sometimes perceived a critical and distanced attitude concerning long-term goal orientation and the actual benefit for primary care from corresponding studies. On balance, project participation generally fetched positive reactions (therapy quality, cost–benefit ratio). Even so, many of the respondents reported stress factors involving documentation requirements and administrative effort, changes in office routine, and remuneration that was not always considered commensurate.
The results from the survey may be seen as confirmation that general practitioners are now more willing to participate in empirical, evidence-oriented studies to optimize healthcare [
16]. Even so, various studies have reported a significant number of general practitioners not being available for research projects of this type [
8‐
10]. This has resulted in a shortage of general practitioner recruitment in complex studies as especially project experience involving the Innovation Fund demonstrates, with studies often failing to reach the target number of physicians and patients originally intended [
17,
18].
The reasons for the hurdles and challenges to recruiting general practitioners for Innovation Fund and other complex clinical studies have hardly been investigated up to now, but there are indications that these projects do not easily combine with everyday primary care. Apart from a fundamental lack of time and resources being an issue [
19], general practitioners have voiced concerns about logistical feasibility and uncontrolled increases in additional workload as well as occasional doubts as to the integrability or compatibility of interventions in everyday primary care and the incentive structure in clinical studies [
19‐
26]. Problems that were widely addressed in the course of the interviews concerned, for example, the commitment of general practitioners to specialist guidelines that did not conform to general practitioners. In addition, interaction with interprofessional actors, who are used in some of the Innovation Fund projects to improve cross-sectoral care, caused interaction and organizational problems.
In one review, Fletcher et al. [
27] identified barriers such as poor communication from study coordinators, difficulties amongst general practitioners in understanding research methods, concerns about possible harm to patients, and a sense of being overwhelmed by too many research requests without being seen as a fully legitimate research partner. Lech et al. [
10] discussed requirements for a specific recruitment of general practitioners. It has been emphasized that this could be optimized in RCT studies with a greater concentration on regional, thematically specialized physician networks [
28,
29].
The wishes and requirements expressed by respondents for participation in Innovation Fund studies agree with other studies, demonstrating possibilities towards recruiting more general practitioners in the future. General practitioners look for more freedom for individual decision-making flexibility and limits to administrative effort while keeping to established office routine from participating not only in research activities, but also in evidence-based structures and instruments [
21]. GP compliance is therefore a crucial factor if the seamless integration of GPs into such research projects and thus their long-term satisfaction is to be guaranteed. An example of this is the involvement of multiprofessional actors such as case managers who interact with general practitioners in the Innovation Fund context and take on specific tasks. Here it must be planned in advance how contacts and contact rhythms can be designed in such a way that the everyday practice of general practitioners is not disturbed as far as possible and synergy effects can be developed [
8,
9,
20]. Apparently, this is not the case for all projects. In addition, it is a reality that Innovation Fund studies are often projects initiated by specialists in which general practitioners are involved (e.g., for subprojects or to test a diagnostic intervention). Accordingly, general practitioners are often given a procedure that originates from the guidelines and evidence-based instruments of other disciplines and therefore causes problems in their own patient care or overwhelms general practitioners (e.g., when thinking of a specialist area such as the clarification of elevated liver values) [
16,
30].
There is also a desire for an opportunity or more of an opportunity to help shape project activities. This tallies with the results from previous surveys in research primary care practice networks (see [
19‐
21,
31,
32] for examples). All this indicates that clinical research projects have still not always been compatible with the primary care setting up to now [
9,
18,
20,
33].
Strengths and limitations
The present study is one of the first to deal with the issue of attitudes and experience of general practitioners towards Innovation Fund studies. However, the study cannot make any representative claims due to the limited number of cases and regional recruiting focus. The present work is unique to date, as it looks at Innovation Fund experiences of general practitioners from a higher-level perspective. A similarly heterogeneous sample was obtained in comparison to specific Innovation Fund projects in which general practitioners were to be recruited. For example, a recently published study conducted in the region of Berlin and Brandenburg described quite similar demographic characteristics of GPs [
14].
Apart from that, all general practitioners recruited were members of a physicians’ network. For the above reasons, the present study cannot make any statements about general practitioners taking part in the Innovation Fund outside these networks or about the large number of general practitioners without previous project experience involving the Innovation Fund. Besides, there is another important reason for potential lack of generalizability of the present results: participants of the present study are GPs who participated in an Innovation Fund project. Thus, it is reasonable to believe that their opinions and attitudes on the Innovation Fund are somewhat more positive than those of GPs who decided not to participate.
The large number of general practitioners not or not yet available for Innovation Fund studies suggests that future studies will need to focus mainly on this group regarding their attitudes, expectations, and desires, while also developing measures to make Innovation Fund participation more attractive. This immediately begs the question as to which attitudes might keep general practitioners from participating in care models.
The present study has not looked into how far the projects the responding general practitioners took part in were implemented, comanaged, or coordinated by primary care institutes. These institutes have gathered a wealth of experience in research collaboration with general practitioners. Future studies should therefore focus on whether the study conditions for general practitioners could be more favorable in cooperation with primary care institutes.
The present study has also not assessed the extent to which settings other than clinical studies involving the Innovation Fund may be more suited to primary care regarding willingness to become involved in scientific research. Studies from primary care suggest that the research practice model may potentially achieve better recruitment and participation [
9,
22,
25,
33‐
35]. In this respect, results from the present study may be compared with results from a survey to be suggested here documenting the experiences of general practitioners specifically in the research practice setting. This type of survey would be feasible on a larger scale in view of the recent emergence of larger research networks coordinated by primary care institutions.