UnMotivated Patients Challenge Traditional Market Research

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Un-Motivated Patients Challenge Traditional
Market Research
Presentation by Insight International Arlene
Cohen Nigel Griffiths Guy Spencer President,
Director Consultant Insight USA May 2005
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Our Themes 3 Contemporary Issues in Qualitative
Research

Patient Compliance
Adherence
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Adherence Behavioral Phenomena, Health and
Financial Repercussions
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Adherence Behavioral Phenomena, Health and
Financial Repercussions
Proportion of pts on Product X

• The financial burden of non-adherence has been
  estimated to cost 100 billion each year in the
  United States.

Donovan JL, Blake DR. Patient non-compliance
deviance or reasoned decision-making? Soc Sci
Med. 1992 3450713.
...in spite of marketing activity?
Time since Rx started
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Benefits to the Pharmaco (and the Health System)
of Maintaining Adherence

• Benefits for Pharma Companies

Retain hard won patients over longer periods
Doctors experience more consistent product
performance
More return on marketing spend
Chances increase of positive feedback for both
patient and prescriber

• Benefits for Patients and health system

Reduces waste of healthcare resources
Direct effect on disease-related morbidity and
mortality
Overcomes impact of eroding public health
improvement goals
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Adherence and the Doctor Customer Relationship
Management

• We view the relationship between doctor and
  patient within an office visit as a system

DOCTOR
PATIENT

• Each influences the other, in terms of attitude
  and behaviour
• need to understand more about this relationship
• and how it affects...

attitudes
beliefs
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Breaking the System Down
DOCTORNESS
a core set of beliefs, drivers, feelings and
emotions which affect doctor behavior1
PATIENT
1 MRS 2004 Paper Doctors Eat Ice Cream Too
Insight Research Group
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Doctor Patient Relationships The Virtuous,
Disconnected and Vicious Circles

• Success of doctor patient relationship variable
  based on extent to which both parties are
  motivated and actively involved in treatment and
  management of condition

• Key to understanding is to unpick the beliefs
  behind the behaviors and understand the
  consequent interplay

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Doctor Patient Relationships The Virtuous,
Colluding and Disconnected Circles

• Patient is motivated, listens and takes the
  doctors advice
• Doctor is open, engaged and informs them honestly
  
• The overall effect is doctor and patient work
  together for holistic management of the patients
  condition

• A relationship based on pretence doctor and the
  patient collude together to pretend that things
  are fine
• Patient pretends to listen and says they are
  making lifestyle changes
• Doctor may know they are not telling the truth
  but does not argue or raise the issue

• Patient is not prepared to play an active role in
  the management and treatment of their own
  condition and makes no pretence about their
  ability to change or begin to take an active role
• Doctor disengages quickly or doesnt engage at all

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Breaking the System Down
DOCTORNESS
PATIENT TYPOLOGY
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Study Adherence of Patients to Statins
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Theres More to Qualitative Healthcare Research
Than Asking Doctors What They Think They Think

• Conventional Research

The moderator holds the power, the doctor holds
the answers
Doctor, whats your view of?

• has problems recognizing

Inability to articulate deep seated beliefs and
motivations
The influence of the sub-conscious and non-
rational on decision making, world view, etc
Choice/ Decisions are situational and
multifactorial . Easier to generalize via
idealism and linear cause effect models
The unreliability and selectivity of recall
The influence of real patients with diverse goals
and needs
Cultural influences, public values
The Doctors relationship with the patient is not
linear but systemic
Personal blindspots, credibility barriers, coping
mechanisms
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Methodology TriSight Research
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Methodology TriSight Research

• ANALYSIS Agency identifies particular
  behaviors, interactions and patient behavioral
  archetypes

Final step

• Validation of Agencys analysis with Physicians
  involved in Phase 1

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Methodology Collaborative Inquiry

• Conventional approach
• Led by the moderator
• Doctors are realistic surrogates on which we try
  our ideas
• Objectivity obtained through blinding
  respondents
• Moderator explores the business issues
• Puts questions to doctors which we go away and
  interpret

• Collaborative approach
• Facilitated by two moderators
• Doctors are experts who contribute an insiders
  view on the system
• Objectivity considered unattainable, extra
  research brains welcomed
• Moderator and respondents are co-researchers
  jointly exploring issues
• Invites doctors to participate in addressing our
  problem with us

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Patient Typologies are a Key to Differentiating
Likely Outcomes
Patient Profiles
Behavioral / attitudinal
Clinical
NB. Doctors are instinctively very good at this.
A major part of their job.
NB. More difficultDoctors recognize and respond
to behaviors attitudes but may need help
formulating these
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Focus on Statin Market
(Benner et al 2002)
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More Statin Adherence Numbers in the Literature

• Petersen McGhan - Pharmacoeconomic impact of
  non compliance with statins (Review)
  Pharmacoeconomics 2005, 23(1) 13-25
• Data from two studies suggest that gt75
  compliance results in decreased coronary events
  such as myocardial infarction. However,
  retrospective database analyses indicate that the
  average compliance rate hovers around the 65
  mark.

• Abughosh SM, et al - Persistence with
  lipid-lowering therapy influence of the type of
  lipid-lowering agent and drug benefit plan option
  in elderly patients.J Manag Care Pharm. 2004
  Sep-Oct10(5)404-11.
• Among patients prescribed a statin at initial
  prescription (n 182), the 12-month
  discontinuation rates were 33 for those with
  full drug benefit coverage and 50 for those
  with 1,000 dollars per year maximum coverage,
  while the 21-month discontinuation rates were 60
  and 86.

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Sample Patient Profiles
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Attitudinal / Behavioral Patient Typology No 1

• Compliant / Pleasing

EASY GOERS
Doctor beliefs Patients easily satisfied and
sometimesboring Ill do the bare minimum

• Patient beliefs
• I have to do as mydoctor tells me

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Attitudinal / Behavioral Patient Typology No 1
Theyre the doormats arent they
EASY GOERS
They are relatively boring
And as I said, because their numbers look quite
good who cares if they forget the odd one, dare I
say
Its not that they dont bother us. They turn up
when theyre supposed to. They come and see the
practice nurse when theyre supposed to. They
have their blood tests when theyre supposed to
They forget the odd tablet but theyre pretty
reliable
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Attitudinal / Behavioral Patient Typology No 2

• Helpful / Actively Seeking Support

CO-OPERATORS

• Doctor beliefs
• Patients who care about their condition and want
  to be informedpatients

• Patient beliefs
• If its going to be,its down to me

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Attitudinal / Behavioral Patient Typology No 2
CO-OPERATORS
They do what theyre told but they ask more
questions and theyre generally more inquisitive
and interested in their condition
They are interested and politely enquiring but at
the end of the day still relatively submissive
This person says well what is this for? I
expect you to tell me what this pill is for
theyre just going to ask more questions
Ask this group what theyre on and theyll tell
you
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Reconvened Group Typology Groupings
CO-OPERATORS
TIME EATERS
CHALLENGERS
EASY GOERS
SELF-DESTRUCTS
PRETENDERS
CANT WINS
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Concluding Thoughts
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Recommendations How to change the System
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Summary Is This the Same For Every Chronic
Therapy Area?

• Respiratory Conditions highly dependent on
  commitment and readiness to engage of patient as
  well as the degree of empathy and judgement
  coming from the doctor
• OA patients characterised by their stoicism
  which clearly impacts on doctors interaction
  with them
• Diabetes doctors may show less sympathy for
  patients, seeing them as incurable, lazy,
  self-inflicted
• Incontinence patients motivation and
  expectation highly variable, doctors investment
  proportional to patients investment

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Summary Everyone Wins from improved adherence!
Pharmaco
Increased sales, improved ROI
Appropriate marketing Increased brand affinity
Recognition of Adherence, practical markers to
improve
Insurance
Reduction in long term morbidity mortality
Patients
Better engagement, more holistic care
Healthcare practitioners
Bringing the end customer into focus enhances
marketing investment and reduces waste and
disease burden
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Adherence Helping Doctors to engage with more
patients!
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Thank you!