Marketing Community-based Interventions to Primary Care

Practices: Lessons Learned from Audience Research

Teresa J. Brady, PhD

Senior Behavioral Scientist

Arthritis Program

U.S. Centers for Disease Control and Prevention

Agenda How we did the audience research Five key findings (and a bonus) Recommendations based on the

research Turning the research into action

Background Community-based programs complement

clinical care Audience research suggests

Dr. referral/recommendation powerful influence on Patients

Patients expect Dr.’s to tell them about self management education programs

Few patients are referred to community-based programs by their Primary Care Provider (PCP)

Attempts to elicit referrals have had limited success

SME recommended

10%

(3.7 million)

SME attended

10%

(3.7 million)

SME recommended & attended

5%

(1.8 million)

The Importance of Provider Recommendation

N= 2500

Patients who receive recommendation 18 times more likely to go than those who don’t get recommendation. --Murphy 08

Increasing Recommendations from Provider Offices Purpose: Develop strategies to entice

primary care providers (and their staff) to refer patients to SME and PA programs

Process: Literature Review Formative Research

In-depth Interviews (32 providers, 8 managers)

Survey (400 providers and staff)

Increasing Referrals from Provider OfficesLiterature Review Results PCPs have limited awareness of

exercise guidelines and community resources

PCPs lack confidence that their recommendations will result in behavior change

Non-physician staff play crucial role in getting word of community programs out

Qualitative Methods: In-depth Interviews 31 in-depth interviews with PCPs Recruited from pre-existing

database of research volunteers Inclusion criteria: see 20 or more

patients per month with arthritis 20-40 minute telephone interview All conducted by same interviewer

In-depth Interview Methods Stratified by

Profession (MD, NP, PA) Specialty (Internal Med.; Fam. Practice) Practice size (small, med. large) Location (urban, suburban, rural) Geography (NE, S, MW, W) Pt Race/Ethnicity (Cau., Minority)

Paid incentives $90/MD; $75 NP/PA

Interviews taped, transcribed, thematically analyzed by question

PCP Interview Respondents 68% MDs

16% each NP, PA 42% Small practices

29% each Mid-size, Large practice 45% Urban

42% Suburban, 16% Rural 29% each, Northeast, South

26% West; 16% Midwest 64% serve mostly Caucasian patients

Quantitative Methods: On-line Survey On-line survey of MDs, NP, PA, Office

managers Recruited from same database Same inclusion criteria Same incentive rates Data analyzed with SPSS

Missing data not included Open ended responses thematically

coded

Online Survey Respondents N = 404

51% MDs 25% PA/NP 25% Practice/Office Managers

54% family practice 47% small offices (less than 5 pro.staff) 52% suburban settings 22% at least half minority pt. population Average 130 arthritis patients/month

PCP Audience Research

Key Learning #

Don’t call it a referral.

PCP Audience Research

Insurance company rules govern referrals

“if program low cost rather than covered by insurance…free to recommend it unfettered”

PCP Audience Research

Key Learning #

PCPs welcome information about

community programs.

In-depth Interview ResultsAwareness and Use of Local Programs See referral to community resources as

part of their job PCP’s likely making referrals to PT,

weight loss programs and exercise facilities (YMCA)

Unaware of community based-arthritis programs, but idea “very warmly received”.

In-depth Interview Results Impression of Community-based Programs After hearing description of programs:

“Great!” Near unanimous belief programs would

help them care for patients How likely to refer? (1=not, 10= definitely

would) Average rating 8.5; 87% rated 6 or greater

On-Line Survey Results: Awareness and Use of Local Programs 80% recommend community programs

at least several times per month 60% several times per week

56% reported being aware of programs for arthritis YMCA, medical facilities, senior centers PA/NP more aware (71%) than MD

(51%) and Office managers (50%) 20% aware of E-B programs described

PCP Audience Research

Key Learning #

Providers top concerns about community-based programs:

• Cost• Convenience• Credibility

On-Line Survey Results:

Factors Influential in Decision to Recommend Low cost (average rating = 4.64)

1= not influential; 5 = very influential) Convenient location (4.63) Convenient times (4.49) Led by trained instructors (4.49) Evidence-base/effective (4.43) Small recommendation influential (4.15) Not for profit/not sell anything (4.14)

Low cost – 47% Benefits to patients – 24% Program qualities -- 21% Location/access -- 14% Evidence-base -- 12% Trained instructors – 12%

On-Line Survey Results: Which features influence most?

On-Line Survey Results:

What questions do you have about these programs? 28% Logistics

class time, location, transportation 17% Cost 14% Instructor training/credentials 6% Program effectiveness

PCP Audience Research

Key Learning #

Preferred method to learn about community programs: 1:1 visits from people

knowledgeable about program(academic detailing)

In-depth Interview Results:Learning about Local Programs Top Sources for general arthritis info

Medical journals, conferences, other professionals, pharma. representatives

Learning about local programs In-person meeting with program

representatives Follow up with print materials Print materials without personal contact

not effective

On-line Survey Results:How to Introduce the Program to the Practice

Bring materials to the office (average rating 4.17) 80% very/somewhat effective

Conferences (3.21) 41% very/somewhat effective

Newsletters/e-mail/journals (3.15) 39% very/somewhat effective

Send materials by mail (3.7) 36% very/somewhat effective

On-Line Survey Results: When bringing materials to office…

61% make appointment in advance 21% drop in without appointment; ask

to speak to someone 18% drop off materials to be given to

staff Note: 6% mentioned bring food

On-Line Survey Results: Who to contact at the Practice

42% Office/Practice Manager 31% Physician 16% PA/NP 8% Front Desk/Referral Desk 5% Medical assistant

PCP Audience Research

Key Learning #

Need to foster facilitators and reduce barriers to recommendation.

In-depth Interview Results:Recommendation Facilitators and BarriersFacilitators Convenient times,

locations Low cost Knowledge of:

program details, staff Easy to hand-out

pt.materials

Barriers• lack of awareness• cumbersome process• need to write info

On-Line Survey Results: Value of Endorsements Patient word of mouth (average rating 4.22;

greatly influence 47%) Arthritis Foundation (4.06; 40%) Local rheumatologists (3.99; 37%) Local PCPs (3.93; 30%) Am. Coll. of Rheumatology (3.90; 34%) AAFP (3.78; 28%) CDC (3.53; 21%) AMA (3.50; 21%)

Key Learnings from PCP Audience Research 1. Ask for recommendation, not referral

2. PCPs welcome info

3. Emphasize cost, convenience, and credibility in your pitch

4. Make personal visits to provider offices

5. Use strategy and materials to address facilitators and barriers

Recommendations: Strategy Brief in-person visits to targeted PC Practices Make appointment with Office Mgr or

Practitioner Brief presentation to address cost,

convenience, credibility Leave-behind print materials Easy to use recommendation process Repeat contacts over time

Recommendations: MaterialsPractitioner Oriented Program fact sheet

Cost, Convenience, Credibility What happens in program Benefits (evidence)

Patient Oriented Brochures/Flyers/Tearoff sheets

Translating Research into Action

The 1.2.3 Approach to Provider Outreach

Marketing Arthritis Interventions to Primary Care Practices

Pilot-test 2010-2011 Currently being revised Release late 2012/early

2013

Bonus Learning: (…from the pilot test)

Key Learning #

PCPs prefer interventions that address

multiple chronic diseases

Provider Outreach Guide

Marketing Chronic Disease Interventions to PCPs…

Teresa J. Brady, PhD

Senior Behavioral Scientist

Arthritis Program

Centers for Disease Control and Prevention

4770 Buford Hwy MS K-51

Atlanta, GA 30341

770-488-5856

tob9@cdc.gov

Questions: