PATIENTS WITH MULTIPLE MORBIDITIES:

Refocusing the Communications Lens on a DTC “Blind Spot”

A P R I L 2 4 T H , 2 0 1 4

2

A Condition-Centric Paradigm DIABETES

3

Flip the lens to a patient-centric view,that takes multi-morbidity as a fundamental axis of analysis

Diabetes

HeartDisease

Hypertension

OA

Depression

HighCholesterol

4

Over 65s

• 12% US population in 2000 20% by 2030

• Healthcare costs will account for 25% of US economy by 2037

• 50% are living with 2+ chronic health conditions

Sources: U.S. Census, Congressional Budget Office, CDC

5

Hypotheses:

≠Need to address them in very different ways, to connect with

and motivate them via effective marketing strategies.

Diabetes

HeartDisease

Hypertension

OA

Depression

HighCholesterol

Diabetes

6

• Unmet needs from the healthcare community and pharmaceutical companies

• Relationships with HCPs

• Treatment attitudes and behaviors including compliance and adherence

• Receptivity and response to DTC communications.

Implications for their…

7

1. Thought leader interviews with academic physicians

2. Psychologically oriented focus groups

3. Art hypnosis groups

4. Survey (n=2,000 Type II diabetes patients)• Diabetes Only• Diabetes +1 other Condition• Diabetes + 2-3 other Conditions• Diabetes + 4-5 other Conditions• Diabetes + 6 or more other Conditions

Methodology – Type II Diabetes Test Case

8

• All diagnosed with Type II Diabetes

• 9 out of 10 diagnosed with at least one additional condition

• Average # diagnosed health conditions = 4.1

MOST COMMON CO-MORBIDITIES

• High Cholesterol• Hypertension/

High Blood Pressure• Obesity• Sleep Apnea• Osteoarthritis• Depression• Heart Disease• Asthma• Neuropathy

9

10

NUMBER OF CONDITIONS

COMPLIANCE & ADHERENCE

NUMBER OFCONDITIONS

COMPLIANCE& ADHERENCE

11

Diabetes Only Diabetes +1 Diabetes +2-3 Diabetes +4-5 Diabetes +6 or more

65

51 49 50

40

% of Patients Compliant with Rx Directions

Just adding one additional condition on top of diabetes impacts compliance dramatically

Diabetes Only

Diabetes +1

Diabetes +2-3

Diabetes +4-5

Diabetes +6 or More

12

% of Diagnosed Conditions Being Treated

And, as more conditions are diagnosed, patients begin to prioritize which ones they’ll treat

Diabetes Only

Diabetes +1 Diabetes +2-3

Diabetes +4-5

Diabetes +6 or more

90

8074

7066

Diabetes Only

Diabetes +1

Diabetes +2-3

Diabetes +4-5

Diabetes +6 or More

13

14

Hours per Month Attending to Conditions

Nearly one full workday a week

Diabetes Only

Diabetes +1 Diabetes +2-3

Diabetes +4-5

Diabetes +6 or more

10.5 10.912.7

19.1

22.9

Diabetes Only

Diabetes +1

Diabetes +2-3

Diabetes +4-5

Diabetes +6 or More

“I get angry and I just want to explode. So many drugs you have to handle, and doctors

you need to see.”

15

I went to the drug store to pick up high blood pressure medication, $146 for 30 days. I finally said no I'm not taking it.

All of the different meds are expensive. I have had to prioritize drugs. Sometimes that even means missing meals.

16

18

“Diabetes restricts my lifestyle”

Diabetes Only Diabetes +1 Condition

51 AGREE%26 AGREE

%

19

Diabetes +6 or moreDiabetes +4-5Diabetes +2-3Diabetes +1

69%

49%

37%

27%

45%

30%26%

20%

38%

30%24%22%

It limits my social life and activities It causes insomnia and difficulty sleeping It hinders my sex life and intimacy

% Reporting Practical Impact ofMulti-Morbid Conditions on their Lives

20

% Reporting Emotional Impact of Multi-Morbid Conditions on their Lives

Diabetes +6 or moreDiabetes +4-5Diabetes +2-3Diabetes +1

56%

44%

32%

24%

42%

31%

18%23%

42%33%

17%15%

32%29%

18%16%

26%23%

14%9%

35%

19%

9%5%

29%

20%

9%12%

It creates uncertainty or unpredictability in my life

It impacts my relationships

It undermines my identity and how I see myself

It has a social stigma attached to it

It makes me feel guilty, like it was my fault

It hinders my ability to care for others who need me

It makes me feel isolated

21

If it came to life as an animal, diabetes would be…

“Keep having to think about it”

“Irritating”“Nagging”

“Annoying”

“Distracting”

DIABETES-ONLY:

22

If it came to life as an animal, diabetes would be…

“Terrifies me”

“Threatening”

“Lethal”

“Sinister”

“Deadly”

DIABETES + 6

23

“Diabetes impacts my self-image”

Diabetes +6 Conditions

63 AGREE%

Diabetes Only

28 AGREE%

24

Social self impacted

Sexual self impacted

“I want to feel like a whole person, a full man, I've always been able to protect and defend myself

and family and now with these ailments, I'm concerned about that.”

“My libido is not nearly what it once was, and it does affect my manhood. It bothers the hell out of me.”

25

“ Everything is being ripped apart. I'm ready to lose it. I'm at the breaking point.

Fear and anger at the same time. I feel like screaming at the top of my lungs from the highest mountain.

It's heart breaking. I feel like I’m beyond help.

I'm stressed, I feel like any moment I'm going to explode emotionally. I'm not taking any more pills.

I felt as though it was going to be a hard road. It was too overwhelming, it was so long. And there was really nothing at the end of the road.

I feel like I have failed at health.

26

+ 6 or more+ 4 - 5+ 2 - 3+1

49%

40%

21%

16%

47%

35%

26%

18%

32%

28%

14%

8%

33%

22%

15%

10%

33%

22%

14%

8%

32%

20%

15%

10%

29%

19%16%

11%

Weighed down Loss of control Vulnerable and helpless “Less than” – not a whole person Imprisoned Broken Failed at health

% Reporting Emotional Impact of Multi-Morbid Conditions on their Lives

Diabetes +1

Diabetes +2-3

Diabetes +4-5

Diabetes +6 or More

27

“I have been entirely open in sharing how it has impacted me emotionally”

Diabetes +6 Conditions

27 AGREE%

Diabetes Only

54 AGREE%

“Nobody knows what is going on.”

28

“Strength”“Mindfulness”

29

“Awareness” “Focus”“In control”

30

“Not Giving Up” “Hopeful”“Courage”

31

“Lost”“Life washed away”“No safe place”“Overwhelmed”“Hopeless”

32

“Sadness” “Disintegrating”“Lost the life force”

33

“Lonely”“In need”“No anchor”“Welcoming the relief of death”

34

DIABETES ONLY DIABETES +4

Draw how you see yourself, living with diabetes/diabetes and your other conditions

35

Degree to Which Ads Make Them Feel Understood

The more conditions they live with, the less understood they feel by advertisers

Diabetes Only Diabetes +1 Diabetes +2-3 Diabetes +4-5 Diabetes +6 or more

76

6154 54 51

Diabetes Only

Diabetes +1

Diabetes +2-3

Diabetes +4-5

Diabetes +6 or More

“If I heard messages about people living with multiple conditions I’d feel less alone.”

“The ads aren’t talking to me - they have no idea what it is like for me.”

36

DIABETES

Diabetes

HeartDisease

Hypertension

OA

Depression

HighCholesterol

DIABETES

THANK YOU!