Mkt Research Presentation Psyma Web.ppt

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Factors Impeding the Practical Implementationof
Cardiovascular Prevention An international
market research project in 6 countries Germany,
France, Italy, Spain, the United Kingdom and
Poland This study was commissioned by European
Society of Cardiology (ESC) Cardiovascular Round
Table (CRT) Task Force 4 Sponsors AVENTIS /
BAYER / BOSTON SCIENTIFIC / GLAXOSMITHKLINE /
NOVARTIS / MERCK-SCHERING PLOUGH / PFIZER The
study was carried out by Psyma
International Alexander Rummel Monica Bach Dr.
Britta Meyer-Lutz
Psyma International Medical Marketing Research
GmbH Gartenweg 2 90607 Rückersdorf/Nürnberg German
y phone [phone] fax [phone]
785-33 e-mail info_at_psyma-international.com websi
te www.psyma-international.com
Study No 41057021 December 2002
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Main Objectives

• To understand the practical hurdles of CV risk
  prevention in daily practice.
• Identify how physicians assess and manage risk
• Obtain baseline data on guideline usage
• Reveal barriers why guidelines are not applied
• Determine what changes can be made to make them
  more readily adopted

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Methodology Sampling
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Screening Criteria

• Work in outpatient care
• lt 60 years of age
• Practicing as a PCP or cardiologist gt 3 years
• Must initiate drug treatments for patients
  presenting or at risk of CV disease
• Work full-time (i.e. gt 6 hrs per day)
• Not participating in clinical trials on CV
  disease
• Not working as a CV consultant for the
  pharmaceutical industry
• GPs only
• Must see and treat patients in at least 4
  different indication areas

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Assessing Patients for CHD/ CV Risk
FOCUS GROUPS

• All physicians ...
• simple questioning examining lifestyle (e.g.
  smoking, drinking, exercise)
• measure BP
• cholesterol tests
• weight
• PLUS

Q. 13./15. Discussion Guide - Focus Groups
6
Patient Types Perceived at Greater Risk of a CHD/
CV Event
UK 73UK 71 PL 20 UK 13 PL
10 F 62 E 13 UK 10 PL 3 E
Card 44
Combined risk factors
Q. 5.c (o) Base n 220 physicians in 6
countries responses lt 8 not included
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"Total" or "Global" Risk on CHD/ CV Risk
Prevention
What do these terms mean to physicians?
PL 67 UK 20 PL PCPs 32 D 43 I
2UK 50
"Patients already suffering from coronary
diseases" (E Cards)
Q. 5.d (o) Base n 220 physicians in 6
countries
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"Total" or "Global" Risk
? 25 of target sample don't know or can't
explain terms ? D 43
UK 50
EDUCATIONAL NEED
9
"Total" or "Global" Risk on CHD/ CV Risk
Prevention
VERBATIMS
SUM OF RISK FACTORS "... it's a group of factors
which is important and not each factor taken
individually ..." "... it's ignoring the value of
individual risk factors and using a table or
calculator estimating the effect of interactions
of the various risks ..." "... means the
possibility to become ill as a result of an
accumulation of risk factors ..." RISK OF FUTURE
CV EVENT "... total means an individual risk of
major cardiac events over 10 years ..." "... risk
of an CV event within 5 years ..." SEVERITY OF
RISK FACTORS "... we don't use these terms - we
use high, moderate or low risk ..." "... risk gt
20 of developing CV events ..."
Q. 5.d (o) Base n 220 physicians in 6
countries
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Assessment of CV Risk
85 physicians base assessment on all the risk
factors (D Card 44)
Why?
E Card 56 E PCPs 33UK PCPs 38
Q. 6.a (c), 6.b (o), 8. (o) Base n 220
physicians in 6 countries responses lt 8 not
included
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Risk Factors Considered when Assessing CV Risk
Spontaneous - Unprompted
UK 100 UK 100 E 47 PL Cards
75PL Cards 63
Q. 7.a (c) Base n 220 physicians in 6
countries responses lt 15 not included
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Risk Factors Considered when Assessing CV Risk
Recall increases when prompted
Prompted
(66)
(58)
(44)
(31)
(30)
(15)
(8)
Q. 7.b (c) Base n 220 physicians in 6
countries responses lt 15 not included
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Why Special Attention is Required with Specific
Risk Factor Combinations

• Hypertension diabetes (n28)
• Smoking hypertension diabetes (n20)
• Smoking hypertension dyslipidemia (n19)
• They are the worst combination
• Development of arteriosclerotic/ vessel damage
• "Diabetes" in a combination is an important risk
  factor
• Statistical data
• Interactions/ synergistic effect

Q. 9.c (c) Base n 220 physicians in 6
countries
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Treatment Goals for Persons at High Risk of a CV
Event (Overview)
Q. 13. (o) Base n 220 physicians in 6
countries responses lt 9 not included
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Factors Perceived Most Important/ Concerning in
CV Risk Assessment
Prompted list of 11 Factors
PL 40 PL 7 F 88 UK 43E
93 PL 27
Q. 17.a (c) Base n 220 physicians in 6
countries responses lt 15 not included
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Preferred Method for Total Risk Assessment
Q. 18. (c) Base n 220 physicians in 6
countries
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2.Awareness/ Usage of Guidelines
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Awareness of CV Risk Prevention Guidelines
E PCPs 71UK PCPs 67 I PCPs 43 D PCPs
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6 of physicians mention ESC guidelines (D Cards
22 E Cards 22)
Q. 19.a (o) Base n 220 physicians in 6
countries responses lt 9 not included
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Where did physicians find out about these
guidelines?
Q. 19.b (o) Base n 220 physicians in 6
countries responses lt 6 not included
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Physicians Viewpoints on Guidelines(country-speci
fic)
FOCUS GROUPS
Q. 18.a - 20. Discussion Guide - Focus Groups
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Guidelines Currently Used
Usage corresponds with awareness
E PCPs 67UK PCPs 57 I PCPs 37 D
PCPs 52F PCPs 46
4 of physicians use ESC guidelines (D, Cards
22)
Q. 19.c (o) Base n 220 physicians in 6
countries responses lt 5 not included
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Usage of Guidelines when Assessing CV Risk
Physicians ...
I 70 D 10 E 43 D PCPs 48F PCPs
43
59 of physicians use routinely/ 20 only on
occasion
Q. 24., 25. (c) Base n 220 physicians in 6
countries
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Reasons for Not Using CV Risk Prevention
Guidelines
19 of physicians indicate not using CV risk
prevention guidelines

• Doesn't fit to my patients
• Decide according to my own experience
• Difficult to use/ values often change
• Don't trust them
• Not used by colleagues
• Used guidelines in the past

Q. 19.c, 22. (o) Base only physicians not using
guidelines (n34)
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Obstacles Preventing Usage and Implementation
FOCUS GROUPS
TIME COST OF PREVENTIVE MEDICINE
Q. 20./21. Discussion Guide - Focus Groups
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Improving Guidelines to Increase Future Use
FOCUS GROUPS

• Easy to understand easy to use
• Include back-up data of latest scientific studies
• Regular updates
• Short
• Realistic - possible to implement
• Clear objectives - quick to implement
• Solve gap between prevention (doctors) and lack
  of awareness (population)
• Universal
• Source must be credible trustworthy

Q. 25./26./27. Discussion Guide - Focus Groups
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Improving Guidelines to Increase Future
Use(country-specific)
FOCUS GROUPS
Q. 25./26./27. Discussion Guide - Focus Groups
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Barriers Preventing Physicians fromImplementing
CV Guidelines (unprompted)
E 50 UK Card 44 D Card 44PL 67UK
Card 44E Card 33
Q. 30. (o), 16.b (o) Base n 220 physicians in
6 countries responses lt 8 not included
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Most Important Barriers in the Implementationof
CHD Prevention Guidelines
Scale 1 "small/ unimportant" - 10 "large/ very
important" Top Box 8 - 10
19 prompted statements
Policy Remuneration Time Policy Interest
PL 77 F 16 PL 93D 57D 60 F
8PL 67 E 10PL 70
Q. 31.a (c) Base n 220 physicians in 6
countries responses lt 19 not included
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Barriers Preventing Proper Assessment of CV Risk
FOCUS GROUPS
In all countries TIME LIMITATIONS is the main
barrier

• also ...
• Consultations not rewarded sufficiently
• Lack of resources
• Discrepancy between goals and reality
• Depends on patients (emotional/ social aspects)
• Patients non-compliant in changing lifestyle
  (unmotivated)
• Situation difficult in rural areas (PL)
• Financially weak patients (cost) (PL)
• Public healthcare patient does not stay with one
  doctor (PL)
• Insufficient availability of tests (PL/ D)

"Working time must be paid" (D)"Secondary
prevention is easier because there are obvious
conditions to treat" (PL)
Q. 12./12.a Discussion Guide - Focus Groups
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Barriers are Important because ....

• There is little or no financial reward for
  prevention as opposed to treatment in my
  healthcare system
• No extra payments for prevention
• Not enough money in the healthcare system
• Lack of incentives/ campaigns to support patients
  in prevention
• Budget constraints prevent me from implementing
  guidelines for all patients
• Budget problems with prescribing drug"... if one
  wanted to comply to the guidelines we would run
  into big problemsin regards to the budget ..."
• Treatment only at high risk
• Impossible to implement prevention for all
  patients
• Lack of money for screening examinations

Q. 31.b (c) Base n 220 physicians in 6
countries
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Barriers are Important because ....

• I don't have time with each patient to undertake
  practical prevention
• Prevention is time intensive
• Too many patients
• Need time to motivate patients
• "... it is difficult to find time for patients if
  there is a crowd of patients in thewaiting room
  ...""... I have too many patients, therefore I
  focus on the ones with the most important risk
  factors ..."
• Hospital/ local policies do not help me to
  develop prevention
• No cooperation between docs hospital
• No prevention in hospitals/ only treatment of
  urgent cases
• Rising costs are limiting
• "... Patients always have to become really sick
  before anything happens andthen things become
  really expensive ..."
• "... local policy means reduction of examination
  costs ..."
• "... they are not interested because they are
  more involved in treating acute events ..."

Q. 31.b (c) Base n 220 physicians in 6
countries
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Most Important Aspects in Making Practical
Prevention Easier
Scale 1 "would not make it easier at all" - 10
"would make it a lot easier" Top Box 8 - 10
12 prompted statements
E Card 89 F 8UK 73PL 87 PL
93 E 70 PL 80 PL 90
Q. 33. (c) Base n 220 physicians in 6
countries responses lt 37 not included
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Most Important Aspects in Making
PracticalPrevention Easier (2)
Scale 1 "would not make it easier at all" - 10
"would make it a lot easier" Top Box 8 - 10
12 prompted statements
PL Card 63UK Card 67UK 60E PCP 48

• more time needed
• see less patients
• Spanish risk charts, protocols and guides

Simpler, shorter, more training
Q. 33. (c) Base n 220 physicians in 6
countries
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Most Influential Sources on (New) Guidelines
(prompted)
UK 57 E 40
Q. 36. (c) Base n 220 physicians in 6
countries multiple choice responses lt 5 not
included
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SUMMARY

• CHD ASSESSMENT
• Awareness that global risk approach is
  necessary to assess risk, yet physicians
  dont fully understand the principle and they
  revert back to individual risk factor
  assessments
• GUIDELINES
• National guidelines are the predominant
  reference for recommendations
• Uniform recognition of guidelines seem linked
  to a clearer source and consistency of
  guidance
• Current use understanding of guidelines
  does not necessarily translate into an
  understanding of the principles of global risk
• Scoring systems seem to convey global risk
  more directly
• Many BARRIERS TO IMPLEMENTATION
• FUTURE AREAS OF FOCUS
• Different countries may require focus on
  slightly different areas of
  implementation
• Improving implementation goes beyond just
  developing a new set of guidelines