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Patient Information in an Era of Change
Louis A. Morris, Ph.D.
Senior Vice President
PRR, Inc.
Communications Change• Source
– from HCP to Manufacturer
• Channel– from personal and print to mass customization– internet
• Message– from health education to marketing
• Audience– from dumb terminal to active decision maker
Thesis• Redefinition of communications structure
creates new opportunities• We need new thinking
– marketing approach to patient education
• Implications for Pharmacy– public health advocates– implementers of cultural change– who pays?
Patient Info Sources: Traditional
Manufacturer
Independent
Face to Face Mass Media
ThroughHCPs
Through HCPs
Help Seeking/Reminder Ads
PublicService Ads
Patient Info Sources: Modern
Manufacturer
Independent
Face to Face Mass Mass Media Customization
1-800 #s
HCPs
DTCA
PSA/En-dorsemts
DatabaseMarketing
Infotisements
Registries
HCP/Com-mercial
HCPs - Start Kits
PublicRelations
Blending
– Starter Kits - info packages– Disease/Drug Newsletters– Registries – Clinical Experience Trials– Direct mail– Ads in direct mail pubs– Ads in patient information at Pharmacy
Blending on the Internet
• Is it independent content or an ad?• What is the Source?• Search Engine Results?• Paid Linkages?• Future Increase in Internet Use
– Multimedia Content– Faster Access, Smart Slaves, Always On less
active search, more passive use
Blending - Resch Questions
• How important is source credibility in patient information?
• How important is face-to-face?– Hi tech/Hi touch
• How does this affect pharmacy?– Pharmacist rated highest in credibility– Pharmacists viewed as most accessible– Ability to take advantage?
Why DTCA?
HCPs MCOs Pat’s
Gatekeeper + + ++
Influencer +++ + ++
Therapy Selector +++ + +
Buyer + +
User + ++
Message Evolution
• User:– “Finish all your medicine, even if you feel
better”
• Gatekeeper: – “The doctor has treatment programs that can
help”
• Influencer: – “Easy to swallow”
New Messages
• User: Medication Compliance - Will there be a rebirth?– Barrier Assessment Tools– AARDEX (MEMS Monitor) as a feedback tool
• Influencer: Quality of Life– FDA barriers– Implicit, “benefit-related” messages– symbolism
Message / Audience Interaction: Patient Information Processing
• Willingness and Ability to Learn– Motives - Message Involvement/Goals– Ability - Literacy/Self-efficacy– Opportunity - Task Constraints
• Perceived and Actual Cognitive Load– Simplification– Signals
Audience Tailoring - Stages
• Smoking Cessation:• Precontemplation, Contemplation, Preparation, Action,
Maintenance
• Abstinence at 18 mo:– Single Brochure 11.0– Individualized to Stage 18.5– Interactive feedback 25.2– Personalized (calls) 18.0
Velicer et al., 1993
Information Search ClustersFactors Ambivalent Uncertain Risk Assertively
Learners Patients Avoiders Self-Reliant n=140 n=132 n=200 n=153
InformationInvolvement .502 .069 -.275 -.160
Self-Care Orientation -.124 .575 -.483 .249
Regimen Barriers .170 1.056 -.563 -.365
Information Avoidance 1.167 -.603 -.327 -.121
Risk Aversion .239 .056 .302 -.664
Question-Asking .013 -.163 -.542 .838
New Role for Pharmacy• Message Tailoring
– New “diagnostic” tools?
• Feedback Provider (Compliance Coach)– Computer records to measure refill compliance
• Financial Barriers– Can this be provided through manufacturer– mass customization? - privacy favors Pharmacy– Pharmacist user fees?
New Role for Pharmacy (2)
• Location for services:– in pharmacy (face to face)– in central location (mass customization)
• Activity– initiator or responder to patient requests– passive or active service implementation
Health Education and Marketing• Health Education:
– combination of interventions to change behavior (info transfer)
– select by “what works”• focus on trials to establish efficacy
• Marketing– facilitating equitable exchanges (2 way flow)– select by communications goal
• focus on efficient resource use
Marketing Perspective
Health Behavior Change is more likely if:– people are involved with healthcare decisions
• educate and empower patients
– people actively plan how to comply• planning helps overcome barriers
– health professionals teach and explain treatment• people do what MDs and RPhs tell them to do
3 Inverse Relationships
Behavior Change
Low Involvement High Involvement
Persuadable (weak messages)
Ease of Adoption
Thought/Planning
Behavior Maintenance
Complex Messages
Frequency/ Reach
Behavior Change
Marketing Insights• People Change Behavior
– when it is easy– when they want to – when it serves their needs/interests
• People Maintain Behavior– when they internalize beliefs/culturally driven
• Population Interventions: Cost-effectiveness• Targeting/Relationships/Market tests
When is 7% change successful?
• Health Education– significantly better than control– depends on sample size
• Marketing– major success– define in terms of $$ made, share of market,
meeting projections
Relationship Era
Time Era Attitude20’s Production A Good Product Sells Itself
50’s Sales Creative Advertising
80’s Marketing Find a Need and Fill it
90’s Relationship Long-term Relationships
Pharmacy
• Pharmacy as Cultural Change Agents– technology, cross-(sub)cultural, dramatic events
– intercept strategies for nonsearchers– tailoring interventions
• Take advantage of relationships– database marketing
• How to make it pay?
Why Pharmacy?
• Credibility (Expertise and Trust)– Decision making - Framing
• Accessibility
• Close to the Consumer– understand people’s interest
• Existing relationships– keep info private
Segmentational Bases
• Demographics- age, gender, literacy
• Disease- severity, stage, timing
• Geographies- location, Prizm characteristics
• Psychographics- Customized AIOs, VALS
• Volume- % consumed, concurrent therapy
• Outcome- responders, compliers, QoL
• Benefits Sought- motives for therapy, info
Implications for Pharmacy
• Credibility
• Economics - little face-to-face– lost opportunity - OBRA ‘90
• New Switches– renewed call for 3rd class of drugs
• Nutrition Supplements
Historical Perspective“Let no physician teach the people about
medicines or even tell them the names of the medicines, particularly the potent ones, such a purgatives, opiates, narcotics, abortifacients, emetics or any other which are particularly dangerous: for the people may be harmed by their improper use. This under penalty of forty shilliings” - Royal College of Physicians, 1555
Why Advertise to Consumers?
DTC Promotion
PatientMD
RPh
Manufacturer
Objectives
• Why advertise to consumers?
• How is consumer marketing different?
• What role does FDA play?
• What will be the ultimate effect of DTC?
8 FDA Concerns• Reminder/Institutional
• Implied Claims
• Disclosure Adequacy
• Contextual Fair Balance
• Limits on Effectiveness
• Overall Fair Balance
• Unsubstantiated Claims
• Distractions“RID the CLOUD of DDMAC Response”
DTC Considerations• Hot, Hot, Hot
– FDA Guidance relaxes TV disclosures– $800 mil in 1997, $1.3 bil in 1998
• Multiple Media– TV, magazines, internet, professional distribution,
direct mail, outdoor
• Different Challenges and Still Learning• FDA Very Sensitivity to TV: 11 of 20 DTC ads
had an FDA letter
What Evidence Suggests: Hypotheses
• DTC increases MD visits (Pravacol)
• DTC increases patient requests for drugs
• People want risks but info may be confusing
• Physicians still don’t like it (fluid)– MCO hate DTC
• Risk information may be problematic– may also detract from benefits
• Additional disclosures may be problematic– information overload, supers have min impact
What Evidence is Needed: Too Early to Form Hypotheses
• How are TV claims interpreted?– Uses / risks / info availability
• How prices/costs/liability will change?• Impact on consumer as influencer, user • Cumulative effects (trivialization)• What is a “positive/negative” outcome?
– Eye of the beholder, consensus needed– Need research agenda
Truthfulness, Balance, Disclosure• Roth:
– 1/3 of ads lack fair balance (unclear what definition was used)
• General Concerns– Multiple streams of info (see pictures, hear/see words,
hear background)/ Limited take away (only 49% of supers are comprehended)
– Explicit and Implicit Claims– Limited internal “context-availability”
• Disclosure as a remedy?
Future of DTC
• More, More, More– Patient as central in future marketing– Marketing as part of drug development
• Mixed Media– campaigns designed to “move through process”
• Pharmacists as Implementers– passive or active role?
Audience Evolution
• Information Hungry Segment– Remains Stable for 2 Decades (about 12%)
• Heterogeneous Elderly– Multiple Meds– Aging Boomers– More willing to question HCPs– Service Directed