As you know, patient compliance is a tremendous challenge for the pharma industry. Unfortunately, although all drugs have benefits, many also have potential unwanted side effects. While side effects vary for each drug, we find that the general compliance message is the same: Patients should not stop taking their physician-prescribed medication without talking to their doctor first and, in fact, abruptly stopping medication could produce other side effects as well as be dangerous to a patient’s health.

In all of our patient education programs, we stress the importance of healthy dialogue with a patient’s physician. This certainly holds true with concerns about side effects. It is imperative to inform the doctor if a patient is not following the treatment plan for his or her condition so adjustments can be made if necessary. The doctor may also be able to make recommendations to help a patient cope with adverse effects or to set expectations about which side effects are only temporary.

Patients must remember the health outcomes they are hoping to achieve and why their physician originally prescribed the medication they are questioning. While fear is what drives their non-compliance, education is what will diminish their concern. Understanding the way a medication works to combat their condition, along with talking to their physician about ways to minimize the impact of the side effects, will create a more empowered patient who is ultimately more compliant.

Point-of-care or in-office is where treatment decisions are made; it is where an individual is most focused on their health and where they have THE BEST opportunity to have their questions answered about their health. Effective DTC/P should be leveraging that moment, capitalizing on the relationship between the patient and the doctor. In fact, in a recent DTC Perspectives article it was stated that, “More than 90% of primary care physicians report that patient education materials are important in enhancing the patient-physician dialogue.” Moreover, according to Dr. Anthony Komaroff, a professor of medicine at Harvard Medical and editor-in-chief of the Harvard Health publications division, “Effective direct-to-patient educational programs motivate individuals to take a larger role in their own treatment, leading to better compliance and outcomes.”

Ultimately, though, the communication channel chosen to deliver information is not what’s most important. While we know that individuals all respond differently to different forms of media (which is why our programs offer print, digital animation, mobile messaging for the tech savvy, online, etc.), the real power of in-office is, as Liz O’Neil, VP, director of channel marketing, EvoLogue, says, “The moment of truth for every brand is when a consumer is prepared to take action. The moment of truth for most prescription brands is in the doctor’s office.”

At Healthy Advice Networks, we employ a variety of different research methodologies to determine patient receptivity and the impact of our in-office educational programs.

For example, patients in our network are invited to participate in online surveys regarding their thoughts about health information, products, and education. Respondents do not know who is sponsoring the survey and they are reimbursed for completion. These surveys have yielded results such as the following: 87% Strongly or Somewhat Agree that, “The information was presented in a way that helped me gain a better understanding of the topic,” and 93% Strongly or Somewhat Agree that, “The information screens are a good way to learn useful and interesting health information”

Additionally, we track the impact of our educational segments on patient outcomes. Working with Wolters Kluwer Pharma Solutions, a third-party independent research firm, we quantified the effect on patients who viewed our segments regarding the importance of prostate cancer screening and colon cancer screening versus those who had not. Wolters Kluwer Pharma Solutions reported that patients exposed to the educational segments had a 16.9% increase in prostate cancer screening tests and a 10.6% increase in colonoscopies.

Lastly, we are now able to measure the impact of our in-office programs on patients’ consumer purchases. Linking longitudinal and medical data encrypted to protect patient privacy, OTC and consumer brands can measure the receptivity of their message by tracking consumer purchases, accomplished through Healthscape Consumer, in partnership with Wolters Kluwer Pharma Solutions and AC Neilson.

According to industry consultants, Cegedim Dendrite, that shift is already occurring in the market place. In fact, in their annual DTC Industry Check-Up, published in March 2008, nearly two-thirds of respondents reported that spending should increase for in-office. This trend was highlighted in a press release, “Pharma’s Direct-To-Consumer Marketing Continues to Shift to Physician Offices, Online Programs.” In that release, Lynn Day, director of relationship marketing and analytics, Cegedim Dendrite, says,“Mass media advertising, primarily TV, was once the standard for DTC marketing but that’s no longer the case.”

Additional support for in-office media comes from Anne M. O’Brien, director, client solutions, at The Health Central Network. In a March 2008 article in DTC Perspectives, Ms. O’Brien stated, “While TV and print ads are great at driving awareness, they are only driving 16% of the audience to discuss the condition with the physician. According to Harris Interactive, 52% of consumers take action after seeing an ad at the point of care”.

Clearly, the real key to success for any medium is whether it delivers strong, measurable business results for the client. At Healthy Advice Networks, we certainly have seen the industry trends referenced above (please see our May 12, 2009, press release for more information).

As the leading provider of patient education in physician’s offices, I am not aware of what information pharmacists are providing to patients regarding H1N1. However, patient education about H1N1 is critical and our programming in physician’s offices has provided the following information:

• We alerted patients to the outbreak of the H1N1 virus
• Informed patients how the virus is spread
• Educated patients regarding the best ways to prevent the spread of the virus
• Reminded patients that the # 1defense is frequent and thorough hand washing
• Informed patients of the symptoms of H1N1
• Emphasized seeing their physician at the first sign of symptoms
• Reinforced that if caught early, antiviral intervention can help reduce the severity of symptoms/length of illness.

In addition, with back-to-school approaching we will be launching a new educational series on the H1N1 virus emphasizing the following:

• Prevention; again pointing out the No. 1 defense is frequent and thorough hand washing
• Educating those who are in the “high risk” category – children, teens, young adults (unlike previous flu outbreaks, the elderly population does not seem to be as susceptible to H1N1)
• Encouraging vaccination

To be sure, access to physicians has changed significantly over the last five years. Not only are the percent of no-see docs increasing, but industry analysts also estimate that roughly two-thirds of physicians have restricted access hours (time when sales reps can see physicians). As for pharmaceutical advertising, frankly, there are those practices that are simply philosophically opposed to it, but our experience tells us this is a fairly small minority. (Healthy Advice Networks currently has more than 50,000 physicians enrolled in our nine different networks.) The key to successfully “winning” these doctors over is to help them appreciate the educational value of the program and its content and to understand that it is possible only because of the generous sponsorship dollars of brands that participate in the network. As physicians continue to shift their focus toward patient outcomes, programs that offer real educational value will become even more important to them.

In terms of physician perceptions of in-office patient education being more or less valuable or credible in the future, I would begin by quoting the research from Cutting Edge Information.” Cutting Edge recently conducted research with 18 different pharmaceutical companies regarding patient education and direct-to-patient communication and stated, “One of the best places to reach patients with educational content is the doctor’s office – but medical professionals, though generally eager to provide patients with useful content, hesitate when brochures, handouts, and other so-called educational material looks like marketing in disguise.”

In our experience, when the information provided is easy for their patients to understand, and is written or produced by a credible third-party source, then the physicians are more likely to value and use the information. The average amount of time that the primary care physician spends with a patient in the exam room today is eight to 10 minutes and predictions are that those numbers will only go down. As we look to the future, we believe that physicians will continue to find value in quality educational materials that can help them not only save their time, but deliver useful information to their patients as well.

Patients come from a very diverse mix of backgrounds and characteristics, so clearly one size does not necessarily fit all. As far as educating these patients about certain diseases, conditions, and therapies while in their “trusted” physician’s office, there are a number of guiding principles.

First, the average “health” comprehension level in the U.S. is about the 6th grade level, so the information presented must be easy to understand – as health professionals, we often want to get too complex with our message.

Second, the information should be presented in a very positive way, helping patients understand how they can control, live with, and manage their disease. Scare tactics do not work in educating, motivating, and changing behaviors.

Third, whenever possible, provide information on any rebate programs or special trial offers. The script originates in the doctor’s office, so you want to make it easy for the patient and the doctor to access the appropriate therapy, and cost savings are a definite part of education and compliance.

Fourth, ALWAYS take advantage of where the educational message is being delivered.  Encourage a healthy physician/patient dialogue; go beyond the universally used “ask your doctor” if XXX is right for you,” to more thoughtful comments like “discuss with your doctor if you have any of the following symptoms.”

Regarding what approaches work best for particular therapeutic categories, I would say that in addition to the four points we have already discussed, you also need to consider how and where the information is being delivered. For example, Healthy Advice offers two types of in-office educational programs; one in waiting rooms where educational segments are delivered via an LCD monitor, and one in exam rooms where information is delivered in category specific disease state brochures. As an example, our programs in gastroenterology and urology are exam room (brochure) programs, because the disease states we need to cover for these patients do not lend themselves well to graphic “on-screen” depiction.

On the other hand, our Cardiology Network is a waiting room program. The educational content is effectively delivered on screen (blood flowing through arteries) and 70% of all cardiac patients come with a caregiver. Thus the waiting room allows us to impact both patient and caregiver in a
meaningful way.

A third example could be pediatrics. A waiting room environment where babies and toddlers are fussing, crying, and frankly just being children, is NOT an ideal place to deliver information that you want the parent to focus on or retain. On the other hand, the exam room offers the ideal setting where parents can focus on their child and have a discussion with the pediatrician about their child’s health.