Patient Information in an Era of Change

1
Patient Information in an Era of Change

• Louis A. Morris, Ph.D.
• Senior Vice President
• PRR, Inc.

2
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

3
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?

4
Patient Info Sources Traditional
Face to Face Mass Media

Help Seeking/ Reminder Ads
Through HCPs
Manufacturer
Through HCPs
Public Service Ads
Independent
5
Patient Info Sources Modern
Face to Face Mass Mass Media
Customization

1-800 s
Registries
Manufacturer
DTCA
HCPs - Start Kits
Public Relations
Database Marketing
Infotisements
Independent
PSA/En- dorsemts
HCP/Com- mercial
HCPs
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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

7
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

8
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?

9
Why DTCA?

• HCPs MCOs Pats
• Gatekeeper
• Influencer
• Therapy Selector
• Buyer
• User

10
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

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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

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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

13
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

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Information Search Clusters Factors Ambivalent
Uncertain Risk Assertively
Learners Patients Avoiders
Self-Reliant n140 n132 n200
n153 Information Involvement
.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
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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?

16
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

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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

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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

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Behavior Change
Persuadable (weak messages)
Low Involvement High Involvement
20
Behavior Maintenance
Ease of Adoption
Thought/Planning
21
Behavior Change
Frequency/ Reach
Complex Messages
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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

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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

24
Relationship Era

• Time Era Attitude
• 20s Production A Good Product Sells Itself
• 50s Sales Creative Advertising
• 80s Marketing Find a Need and Fill it
• 90s Relationship Long-term Relationships

25
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?

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Why Pharmacy?

• Credibility (Expertise and Trust)
• Decision making - Framing
• Accessibility
• Close to the Consumer
• understand peoples interest
• Existing relationships
• keep info private

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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

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Implications for Pharmacy

• Credibility
• Economics - little face-to-face
• lost opportunity - OBRA 90
• New Switches
• renewed call for 3rd class of drugs
• Nutrition Supplements

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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

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Why Advertise to Consumers?

• DTC Promotion

MD
Patient
Manufacturer
RPh
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Objectives

• Why advertise to consumers?
• How is consumer marketing different?
• What role does FDA play?
• What will be the ultimate effect of DTC?

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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

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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

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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 dont 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

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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

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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?

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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?

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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