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Non-physician prescribers–the new marketing frontier

Published by Brenda Rizzo on January 9, 2012.

We seem to forget about this very influential group of prescribers who make independent decisions based on their assessment about how to treat a condition. Across all 50 states nurse practitioners (NP) and physician’s assistants (PA) are able to prescribe. Each state has their own specific rules that can limit or expand those roles, but they are all able to prescribe. So now that you have considered this audience, how do they want to be marketed to?

That depends on their specific specialty. An NP who works in long term care may be more focused on reimbursement channels and routes of administration, given the population they serve. NP’s who work in family practice may be looking for educational support for a busy and varied practice. NP’s who work in women’s health may be looking for assessment tools as they manage health concerns of women in transition to menopause. We don’t know until we have asked.

Here at GSW we have assembled a group of NPs and PAs to consult with a variety of specializations that we can contact to get their opinion. Sometimes it can be as easy as a phone call, or we can survey them as a whole. We can even get them together on a chat room online or do a focus group. This has become a very valuable tool. We have found insight into the way they practice, how they make prescribing decisions and how they would like to get information on new drugs. We have asked them to suggest tools that would be helpful to their practice and evaluate tools along the way as we develop them. We had nurses involved in advising us about an online educational tool that has been valued by several of our clients, and adapted for their use.

Our panel includes NPs and PAs from all across the country with areas of specialization from neonates to geriatrics, from inpatient settings to outpatient clinics, from doctor’s offices to operating rooms. It is a temptation to guess what they need or want from a pharmaceutical company, but when we ask them we are often surprised at what they really value. This has helped us to stay focused on creating value added materials/benefits that help them to serve their patients as well as see the value of what we are trying to sell.

Some overall themes that I have observed in working with NPs and PAs are:
 • They are very passionate about the patients they serve. It is not enough to put a patient on birth control; they also have to talk with her about how to avoid sexually transmitted diseases. It is not enough to put someone on an anti-hypertensive, they also educate on how to change their lifestyle to improve their blood pressure. It is not enough to treat their acne; they want to know how their breakouts are affecting their self-esteem. They tend to consider the whole patient, not just the disease state they are treating.
• Affordability is a big issue. If the benefits of the drug outweigh the additional expense then they will help the patients to understand this. But if their perception is that there is an alternative that is more affordable then they probably will not consider the more expensive option. Giving a patient a more expensive drug that they can’t fill, due to the cost, when there is an alternative that is generic does not fit well with their point of view.
• Patient Education is an aspect of patient care that they “own.” Tools to help them be more effective are an added value to their practice. They don’t mind if it has a brand name on it or is specifically about a particular product as long as it is not trying to tear down or bring a bad light to competing products/points of view. They do not expect all educational tools and support to be unbranded.
• They value being viewed as experts in their area of specialization. Anything that can promote acknowledgement of that expertise is desired. Train the trainer, speaking engagements, certifications, or awards are valued. They feel a lack of recognition in general and when they obtain recognition it elevates their visibility in their community.

Finally each area of specialization utilizes NPs and PAs in a very unique way. You don’t gain insight in asking a NP that works with adults what a NP in pediatrics would need. Asking a PA that works in palliative care would not know what a PA in the operating room needs. So seek out insight from NPs or PAs that actually work in the area where you are interested in influencing.

NPs and PAs are organized; they belong to professional groups, both locally and regionally. Many participate in online chat rooms, or visit educational websites. But ask them, “where do you get your information?” Then you know what they want or need and where they will look for it.
Have you created any programs for non-physician prescribers? How did you develop it? Any insights from your programs that you would be willing to share? This is a rich area that needs to be explored for effective communication.

Categories: Healthcare marketing innovations
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Is your body trying to tell you something? Are you listening?

Published by Brenda Rizzo on December 5, 2011.

Many of us deal with stressors every day. Stressors are confirmation that we are alive! There is no such thing as a stress-free life, but being able to integrate or adapt to stress can help us to reduce the damage that stress can exert on our health. And your body often tries to tell you when you are experiencing too much stress but we often ignore it. Let me explain.

Dr. Hans Selye, an endocrinologist, first began to describe stress in 1936. His observations led to a three-stage model of the body’s response to stress. He called his theory the general adaptation syndrome (GAS). The first phase is an alarm reaction, the second stage is one of resistance or adaptation, and the final stage is one of exhaustion.

  • In the alarm stage the body responds to a stressor, which could be physical or psychological. With the release of adrenaline your heart could begin to beat fast, or you might include butterflies in your stomach, a rise in your blood pressure, heavy breathing, dilation of your eyes, dry mouth, and the hair on your arms might even stand on end.
  • During the resistance stage of a stress reaction, your body remains on alert for danger. When this part of the GAS is prolonged, your immune system may become compromised and you may become susceptible to illness. And with prolonged stress changes take place that weaken your body’s ability to fight off disease.
  • The final stage of Selye’s GAS is the exhaustion stage. As your body readjusts during this period, hormones are released to help bring your body back to normal, to the state of balance called homeostasis. Until balance is reached, the body continues to release hormones, ultimately suppressing your immune system, contributing to illness.

Over time, these hormonal changes can lead to ulcers, high blood pressure, arteriosclerosis, arthritis, kidney disease, and allergic reactions. His seminal work “A Syndrome Produced by Diverse Nocuous Agents” was published in 1936 in Nature.

He described two different kinds of stress, eustress or “happy stress” and distress or “disturbing stress.” We have to integrate and respond to that stress in our lives, we have no choice.  However Selye noticed that changes we feel upset about (distress) cause much more biological damage than changes we feel good about (eustress).

How does stress affect health?

In the short term stress can affect your health by disturbing your digestion (desire to eat more than usual, or eat less, diarrhea or constipation) or affect your immune system (ever notice how you get a cold after a stressful period in your life?). But there can be some not so obvious deleterious health consequences. You may have a rise in blood pressure (which can affect your kidneys, cause a stroke, or contribute to heart disease) or you could have an increase in acid secretion in your stomach (which can cause irritation, or lead to gastroesophageal reflux disease or ulcers). These are just a few examples.

Short-term, the stress response can be normal – the body does this for survival. However a chronic or habitual stress response can lead to a “weak organ response”. For example, some of us have recurrent chronic back pain, while others may notice they go through periods of intestinal discomfort. Chronic hypertension can be your body’s response to long term stress, chest pain, leading to heart disease. Some people get asthma, or are susceptible to lung infections. Everyone has a body system or organ that responds to too much stress over an extended period of time.

What can you do about it?

Start to pay attention to your body. What is your weak organ that always responds to too much stress? When do you know you have had enough? Here are some tips to help you adapt to stress:

  • Journal, this will help you clearly identify your stressors and how your body responds.
  • Exercise increases your ability to handle stress and boost your immune system.
  • Eating healthy can maintain energy and reduce digestive disorders.
  • Keep good sleep hygiene, maintain the same bedtime, the same amount of sleep, and keep your sleep routine calm and similar.
  • Just say “no” when people ask you to do more than you know you can take on, say, “I am flattered that you thought of me, but no I can’t right now.”
  • Identify your support system and use it. Do you have friends or families that can help you out? Sometimes they just need to know.
  • Talk about the stressor, either with a counselor, minister, or close friend that can help you get perspective.
  • Know your limitations, listen to your body and slow down.
  • Set aside time for yourself for a warm bath, or a good book, or whatever helps you escape for a moment.

So what do I do over the holidays?

  • Avoid unnecessary stress, like people who stress you, or unrealistic expectations you set on yourself.
  • Avoid hot button topics that you know could upset you (politics, religion, economy).
  • Be willing to compromise to get along.
  • Don’t try to control the uncontrollable.
  • Try to forgive, long-term grudges can waste a lot of energy.
  • Look for humor, maintain perspective, shrug it off.

Remember stress may be not only having a psychological affect but also a weak organ response that could be even more damaging.

Categories: Health and wellness marketing
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The healthcare dating game–finding the right doctor

Published by Brenda Rizzo on October 4, 2011.

I was recently reading an article in JAMA entitled “Do nice patients receive better care?” and was appalled at the title. How can we suggest that there are different types of care in the health care delivery system based on “niceness”? Could those differences be based on how a patient “behaves”? How do clinicians define “nice”?

The article went on to state that each healthcare provider defines “nice” differently, but when asked they definitely can identify patients in their practice as “nice” patients. Some prefer patients who come to their appointment well informed, others like patients who always comply with the treatment, while others find patients who are challenging medically but willing to discuss options as “nice.” Healthcare providers are human too, so they have human responses to their patients. In fact this article wondered if the relationship between patient and healthcare provider affect the level of care they receive.

Often in my job I get asked for healthcare provider referrals by my colleagues. When they ask for a referral, I ask them a series of questions: do you prefer female or male healthcare providers, are you looking for someone for you or your whole family, do you have any language needs (family members that are non-English speaking), do you have geographic needs, etc. As I make referrals I share things like, “this healthcare provider is not warm and fuzzy, but very matter of fact,” or “this healthcare provider will take the time you need,” or “this practice is very responsive,” etc. People have preferences for what type of healthcare provider they want. Then I have a list of healthcare providers that I tell people about either from personal experience, from having worked with them, I know health care provider colleagues that work in the practice, or based on other co-workers experiences.

Sometimes the physician works out, and sometimes it doesn’t but the bottom line is, if you don’t like the healthcare provider then you should stop going to them. The healthcare provider you see to coordinate your care must fit with your personality type; they must meet your expectations. If the office staff is not responsive this too could disrupt the satisfaction with his or her practice. Don’t be afraid to change healthcare providers. I tell people, if you have a plumber to your house and they didn’t do the job you wouldn’t ask them to come back. If you go to a healthcare provider and they don’t meet your needs then don’t go back.

And based on this article in JAMA, the relationship with your clinician and how you connect could affect the level of care you are receiving. Patients should seek out clinicians they prefer just as clinicians seek out patients that they prefer. Some clinicians like working with young people, so they go into pediatrics, some like the elderly so they focus their practice on that population. The article in JAMA even stated that some healthcare providers like to interview the patient before they decide if they are going to be their healthcare provider. This seems extreme, but it brings home the point that you need to connect to your healthcare provider to get the most out of your health care. In the article they conclude, “Nice patients and patients with nice families probably do receive a level of care that is perhaps at times well above the professional standard. Pretending that this phenomenon is not so is probably not helpful, and raises the next question―is it wrong?” What do you think?

Categories: New ideas and approaches
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Disclosure of calorie content–can you trust it?

Published by Brenda Rizzo on September 6, 2011.

The passage of the US Patient Protection and Affordable Care Act requires that restaurants and food vendors with more than 20 locations publish caloric content. This has made calorie counting easier than ever for those who are trying to reduce their weight. But what are the pitfalls to watch out for:

1. Look at the serving size. You may think that one bag of almonds would be one serving size. But actually the label states there are 4 servings, so you have to multiply by 4 if you eat the whole bag.

2. Omitting ingredients that are commonly used is another way for a food item to appear to be fewer calories than it is. For example the calorie content of a salad does not include dressing. Or the calorie content of a sandwich does not include mayonnaise.

3. Fat free does not mean lower calories. In fact many times ingredients that have less fat have higher carbohydrates as a trade off.

4. Less calories are often touted on the labels. But you have to ask yourself less than what? Many times it is just less than what they used to do. So a potato chip that is lower in fat just means that it is lower than the potato chip they used to make, not that it has a healthy amount of fat.

In the July issue of the Journal of the American Medical Association (JAMA) Urban, et al, randomly selected low- and high-energy content foods from 7 quick-serve restaurants and 7 sit-down chain-type restaurants across 3 states. Of the 269 foods collected from 42 restaurants:

  • 40% were found to have at least 10 cal/portion higher than the stated amounts
  • 52% were found to have at least 10 cal/portions lower than the stated amounts
  • 19% contained at least a 100 cal/portion higher than the stated amounts

These discrepancies were greater and more frequent in sit-down restaurants that featured foods with lower stated calorie contents.

So who can you trust? Until there is regular monitoring of calorie contents, accuracy will be less than ideal. However, publishing the calorie content is the first step in helping consumers of food become more informed. Tools to help health care providers teach their patients about improving their health with weight loss can be directed toward understanding and interpreting calorie counts and content of food.

I applaud these efforts for full disclosure. But food packages need to be more transparent about the serving size or specific when it comes to “less”, less than what. There needs to be regular monitoring of restaurants reported calorie contents with consequences if the information is not accurate, as well as all restaurants regardless of size should be publishing this information. But this is a good first step.

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Therapy based on genetics–one step closer

Published by Brenda Rizzo on August 18, 2011.

Traditionally, in advertising we tout the benefits of a new drug to market by the results of their phase 3 clinical trial, reporting on the efficacy and safety of a given compound. In some cases the clinical trial might be set up to compare against the “gold standard” therapy, but most often it is compared to placebo. Depending on the size of the affected population most studies are expected to be large, multi-centered, and patient’s are evaluated for an appropriate length of time as dictated by the condition being treated. In a few studies “responder rates” are reported which describe what percentage of the population actually responded favorable in comparison to those that the effect was not significant.

Individualized drug therapy allows us to identify populations that based on genetic variants, may be higher responders, or may have higher propensity toward an adverse reaction. This new science, called Pharmacogenomics identifies how potential gene drug interactions can better predict a patient’s response to therapy. This could eliminate having to endure a course of therapy that may not work, before the next level of intervention is considered. This type of assessment could help to target therapy to the individual that will best respond. In a recent Journal of American Medical Association (JAMA) article they described Pharmacogenomics as a decision support strategy that will allow physicians to individualize drug therapy, maximize the likelihood of response, and minimize risk for adverse reactions.

But can we afford to determine every ones specific genetic code before any therapy decision is made? Who will be paying for this expense? Clinical adoption of this science will be influenced by regulatory recommendations, and third-party payment. Until a cost/benefit story can be told, use of this science universally will be slow. However, with the transition to electronic medical records (EMR) there are more opportunities to look for trends and discoveries with different treatment categories across populations. For example in the Asian culture, there is a gene variant that is strongly associated with a very debilitating skin reaction when given certain seizure medication. Identifying population based responses can help us to predict response and avoid serious adverse events. With EMR there can be better follow through and record keeping of an individual’s response to therapy and sensitivities that might apply across categories. There may also be an opportunity to share patient experiences among clinician’s so trends can be observed, and population variants can be identified.

So what does this mean in advertising? Well responder rates might become one of the pivotal messages of our communication platforms. Drugs that are efficacious across a broad range of patients will become an important component of early adoption. And looking for trends with serious adverse events might help the clinician to determine which population to avoid using this medication in, rather than blanketing their concern toward every potential patient.

This is going to be a new and exciting frontier for medicine and for individualizing therapy. As is often true in science, sometimes the data collection does not answer the question but helps to identify where further exploration needs to be developed. This is a new and exciting time for more exacting pharmaceutical treatments.

Categories: New ideas and approaches
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“Moving in” to the Medical Home Model–Is your practice considering the change?

Published by Brenda Rizzo on July 5, 2011.

Have you noticed a difference in the way you receive your healthcare? Does your doctor belong to a Medical Home Model (MHM)? How would you know?

In July 2011, Ohio will be converting 44 practices into Patient Centered Medical Home models. What does this mean? MHMs will move from the traditional fee-for-service model where healthcare providers (HCP) get paid based on the number of patients they see per day to a new model which requires quality, thoughtful, healthcare and promotes more time spent with the patient. Wouldn’t it be nice to know you don’t have to hurry up and get everything in that you wanted to talk to your HCP about in 15 minutes because that is all they have to spend with you?

In order to be considered at Medical Home Practice (MHP), certain criteria must be met. Providers must have same day appointments available to reduce costly ER visits, for example. Practices will have social workers call after a patient visit to make sure they have completed blood tests or X-rays. A patient advisory council must be formed to inform the practice and discuss delivery of care. MHPs will be measured on their accessibility to patients, whether or not the patient sees the same doctor with each visit and how they manage chronic conditions like asthma or diabetes.

Diabetes management will be evaluated for appropriate care on steps such as hemoglobin A1C testing, a measure of glucose control. MHMs will be expected to conduct or refer for eye exams, foot exams and assure flu shots are given for diabetic patients in their practice. They will be tracked on outcome measures such as the number of avoidable hospitalizations for long-term diabetes complications, short term diabetes complications, uncontrolled diabetes without complications or amputations related to diabetes.

Other chronic disease conditions have similar measures of quality healthcare, with similar requirements to be considered as a MHM. Disease states are not the only focus of these  models. There are models based on types of care, as in preventive, acute and chronic; based on settings of care such as home health, hospital care, nursing home care and ambulatory care. Other clinical areas can be cancer, heart disease, maternal and child, and respiratory diseases.

The Agency for Healthcare Research and Quality (AHRQ) is evaluating states performance on these measures as well. They are also looking for cost savings based on the benchmark of state employee usage of services. They do this by first determining the number of covered lives with diabetes by age, gender, and race/ethnicity.  Based on some benchmarking data they will be looking for excess costs associated with poor control of blood glucose.  Benchmarking data shows that if an HgbA1C is kept under 6%, less complication will occur. They know that carefully designed programs can expect reductions in HgbA1C by .48% and more intensive disease management programs can achieve a 1.09% reduction. So they will be looking for examples and implementations of these types of programs.

Finally AHRQ will be looking for disparities in treatment offered among non-Hispanic black, Hispanic, and non-Hispanic white groups. Currently the state of Ohio is rated at the low end of average in overall health care quality, with a very weak performance in diabetes management. Let’s hope the new models in July will help us to improve the quality healthcare for our citizens in this state.

How are these new models being paid for you ask? Insurers and employer groups are funding these new models of care and are paying doctors more for their extra work.  Their hope is that through these MHMs, health care costs will diminish and therefore they too will realize a benefit.  In Ohio, Anthem Blue Cross and Blue Shield, Humana, Medical Mutual of Ohio, Partners for Kids, OSU Health Plan, and UnitedHealthcare have all signed on to participate in this collaboration. Ask your insurer or employer group if they plan on participating in a MHM if you think it sounds like a great new model, and has potential for better healthcare.

But most importantly as we consider marketing and communication of new products for healthcare, do our strategies and tactics fit into this new model? Do we propose turnkey programs that help to educate, monitor care and provide follow-up? How can we be partners and advocates for better healthcare delivery and respond to the needs of the MHM?

For more information visit:

http://statesnapshots.ahrq.gov/snaps10/map.jsp?menuId=2&state

http://www.medicalhomeimprovement.org/projects/national.html

http://www.ncqa.org/tabid/631/default.aspx

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Calling Dr. Google…

Published by Brenda Rizzo on April 20, 2011.

Healthcare providers often express frustration over the third person in the exam room, “Dr. Google.” Now they have to not only listen, examine and determine a proper diagnosis and treatment plan but also have to dispel myths and re-educate on treatment suggestions that patients have read about on line. The problem is not that healthcare providers are frustrated that patients are educated and informed, but that patients can’t delineate between what is a reputable source of information and a questionable source of information. So here are some good tips for consumers of health information on line:

  • Wikipedia may seem like an encyclopedia that you used at the local library, but the truth is anyone can post information to the site. There is no one checking credentials of the authors, and assuring that information is accurate. Someone who has a hidden agenda, like trying to sell you a product, can post to this site and present biased information.
  • Google searches produce results based on popularity not on the quality of the information provided. In fact it is possible to pay to get to the top of the list in response to certain key words.
  • Look for government sites or url addresses that end in .gov. Pubmed data base houses more than 19 million citations for biomedical articles in peer reviewed journals. (www.ncbi.nlm.nih.gov/pubmed). You can view the abstracts and get the conclusions of the studies to discuss with your health care providers.
  • Look at national sites like the National Institutes of Health (NIH), Food and Drug Administration (FDA) or Centers for Disease Control (CDC) . They are well funded to provide credible and reliable information on diseases and conditions.
  • Look for a seal of approval like HON code. Health on the Net (HON) Foundation was founded to encourage the dissemination of quality health information for patients and professional and the general public, and to facilitate access to the latest and most relevant medical data through the use of the internet. Websites must comply with a code of ethics to receive certification.
  • Look at professional organizations like the American Academy of Pediatrics (aap.org), American College of Obstetrics and Gynecology (http://www.acog.org/) or North American Menopause Society (http://www.menopause.org/) for consumer education. They all have a free section on their website for health information.

Remember that your healthcare provider will have more information about you specifically than any of the websites will know. So your situation is unique and your treatment plan should be specific to your needs. So become informed, come with a list of questions, and have a discussion with your healthcare provider. Just be more discriminating about what information you are seeking on the internet using these simple guidelines, and less time will have to be spent in dispelling myths and bad information on your next appointment.

Categories: Marketing trends and best practices

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Could a health advocate help you?

Published by Brenda Rizzo on March 18, 2011.

What is a health advocate?

A health advocate is someone who believes in a cause or action that improves health. For example a health advocate could be someone who takes action to improve her own health or someone else’s health, who they care for.  Advocates just don’t make claims like, if you would exercise more you would feel better. They say, “Want to take a hike with me at the park?”

A health advocate would ask what challenges you face and what has worked for you to improve your health. In other words, she would have a conversation with you about your health, not just a monologue telling you what steps to take. Because every person is unique, a prescribed action plan is doomed for failure where enlisting the input of the individual for whom the plan is designed has a greater chance of success. instead of developing a plan with participation of the individual ,is doomed for failure. But a plan of action that is developed and agreed upon by the health advocate and the health seeker has greater chances of being successful.

The health advocate could be your ambassador, guiding you in the right direction to get the help you need. Our current health care delivery system is overwhelming at best. Having someone help to navigate that system when you are in a crisis is a valuable asset. They offer support and advice just when you need it most.

Who is your health advocate?

Is it a friend, a co-worker, a family member? It could be a professional, a counselor, a fitness trainer or primary care provider. Anyone can be your health advocate. Approach them and ask them to help, ask them to share your goals of a healthier lifestyle. Ask them to enquire about your successes and challenges in a non-judgmental manner. Ask them to be authentic realizing that even with the best intentions you may fail, but your health advocate will help you refocus, and can be the one who helps you get back on track.

If you have a health advocate will you be completely free of any health issues? Is there a guarantee you will reach your goals? No, but it means that there is always someone you can turn to when you need to talk, to refocus, or to share frustrations. You don’t have to be a super athlete or the most physically fit person to seek out healthier goals. There are degrees of wellness. Some have chronic illnesses  but that doesn’t mean they can’t be healthy, they too can reach health goals within the parameters of their current health condition.  Some struggle with health issues that are completely self -induced, and yet can’t seem to gain control. But they too can reach higher levels of wellness within the confines of their struggles.

My own experience with a health coach

I have been seeing a counselor that specializes in caring for people with obesity. I have struggled with obesity my whole life. Together we are trying to establish goals that contribute to a healthier lifestyle, with the hopes that I will gain control over my eating and improve my health. Has it worked? Well I am still obese, but is that the measure of my success? I am not exercising enough, but is that a measure of my success? Do I need a measureable outcome?  What I can tell you is I have examined the emotional components of my life that lead to lack of control. I can tell you that I am examining my food intake and what are the triggers that lead to poor eating habits. I am writing down everything I am eating. I have not gained weight, which is a new trend. But I have someone who I can share my frustrations with; I have someone who has the same goals in mind for me. She is non-judgmental, acknowledges my challenges and frustrations and continues to encourage me to face those challenges realistically. Has all of my health challenges related to obesity gone away? No, but I am in a better state of health than I was when I was just ignoring what was going on. My health coach is what is right for me right now. So I plan to continue to work with her, as long as I need to, and continue to strive for an improved state of health.

I encourage everyone to consider who their health coach can be. Who knows, maybe you can choose a partner and you can both encourage each other. It is always better to work with someone else, the commitment to each other is harder to ignore. Or you may choose an on-line health partner, programs like Lose-it.com® or Weight Watchers®. As long as you make a commitment to using it every day, there are lots of helpful apps for making a commitment to your health. But set realistic goals and break down your journey into small steps so you can celebrate the successes along the way.

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Why the Biggest Loser?

Published by Brenda Rizzo on February 22, 2011.

I love Biggest Loser. I watch it faithfully every season. My husband wonders why. Is it because of the game playing, or tips on eating or the tips on exercise? Do I watch it faithfully because I love the hostess (can’t even remember her name right now, so clearly that isn’t it)? Do I like the game playing and the strategy? Do I like the advertising, of products useful to healthy living? Is it because weight loss has become a national movement, in the midst of record levels of obesity?

The Dr. and his evaluation are fascinating to me, especially when they have the follow up visit after they have lost the weight and allot of their medical issues have disappeared. You see hope return in their faces. Is that why I like the show? The scenery and locations are beautiful. I travel in that area for business so I like see the locations. I like the different challenges they come up with. But it always seems that one of the players each season wins all of the challenges. That doesn’t seem fair.

And what about those outfits? Why do they make the men take their shirts off to get weighed when they are at their heaviest? And then when they start to lose a significant amount of weight they leave their shirts on? And those sports bras that the women have to weigh in? What is up with that? It clearly isn’t the outfits that compel me to watch.

I do love the make overs, watching people blossom into beautiful and trendy looks, when all they ever considered themselves was fat and frumpy. I do love the amazement in their families’ faces when they see them for the first time.

But the real reason I love Biggest Loser is for the sheer fact that it works. I have struggled with weight my whole life and I just love to see someone have success with weight loss. For the most part – the past contestants have kept it off. Who else has statistics like that? I just love to see someone overcome the life of obesity and all that it entails.

I wonder how they pay the bills while they are off work for 3 months while they are on the show. I wonder how their families survive with them being gone for 3 months. But once I set those concerns aside I marvel in the accomplishments and celebrate with them each and every season. No matter how little or great their success is, they have had success and each pound off is a victory. Now if I could just stop eating, get off the couch, and work out while I am watching it, I too may realize the success.

Categories: Healthcare marketing innovations

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What is non compliance?

Published by Brenda Rizzo on January 12, 2011.

As a health care provider I often here frustration in my colleagues discussion, “they just won’t do what I tell them to” or “how am I supposed to help them if they don’t follow my advice.” But it is never that simple. As a healthcare provider working in pharmaceutical advertising we are often asked to consider tactics or programs that will increase compliance. But what is compliance, or non-compliance?

Compliance (or adherence) is a medical term that means the degree to which a patient correctly follows medical advice. Following medical advice can be anything from smoking cessation, losing weight to taking a medication correctly. Often HCPs pass out medical advice, such as “you need to lose 20 pounds” but then don’t offer any practical steps to accomplish that goal. Or they state, “The best thing you can do for yourself is to quit smoking” and yet don’t identify a smoking cessation method. Then they wonder why the patient does not follow their advice. When HCPs write a prescription for a medication often they don’t explain how the drug should be taken, what are the consequences of not taking the drug or stopping abruptly, what are the side effects you should expect, and how do the benefits outweigh the risks. This is all important information that should be shared to promote compliance to therapy.

Non compliance is defined as not following treatment and or not taking medications as prescribed. Health Care providers often blame the patient for non-compliance and don’t consider their role in the success of a given therapy. Often in pharma advertising we are asked to consider how to improve compliance for a particular therapy. But in order to do that effectively we must understand some basics about the patients we serve:

  1. Patients need tools to achieve compliance to your medical advice. If it is smoking, then where can they find a smoking cessation class or an on-line program? It is weight loss, connect them with a viable weight loss program, and exercise regime. If it is a medication, do they have enough information?
  2. Patients must understand the benefits and risks of complying or not complying with medical advice. Every medication has a side effect, but knowing what to expect minimizes the patient’s reaction to that side effect. And if they understand the benefits of a therapy they can make an educated determination if complying with the dosing regimen is more beneficial than coping with the side effects. They may think that taking “half” of the dose prescribed is good enough, they have to understand what is therapeutic dosing to achieve the desired outcome and what is not. Patients may decide they don’t want to take the medication, and stop it abruptly; this could have serious consequences they didn’t anticipate.
  3. Complying with a new treatment needs to become a habit. Suggest ways to tie timing of medications with a habit they already have, like tape your oral contraceptive to your tooth brush; or pick the same day each month to take a monthly medication (have it be the day of your birthday, ie, if your birthday is Jan 5 then take it on the 5th day of every month).
  4. Know what your patients are hearing “on the street.” Leaf through popular media or look on line at discussion boards. Or ask the patient “what have you heard about this therapy?” You can enlighten the patient about the truths and myths, addressing concerns and educating them based in scientific data.
  5. Patients may have limited resources. Sometimes they have the best intentions but are forced to prioritize. As HCPs we must be realistic about this. Tell them what is most important, what has immediate implications. As marketers we must acknowledge this and share information about financial assistance programs, or patient support groups that may be able to help.
  6. Patients may not understand that when a medication makes something go away, if you stop taking that medication it will come back. For example I have had patients with high blood pressure take the medication and check their blood pressure a couple of times to make sure it is working. Then they come back in months later and it is back up and I ask about the medication. They stated, “I took it and then the high blood went away, so I stopped taking it”. Clearly they didn’t understand that you have to keep taking the medication to maintain the desired outcome. Besides teaching patients about the benefits and risks of a given therapy we must all be clear about the commitment we are asking from them, ie, you need to complete taking all of the prescription even though you may feel better after the first couple of doses; or this is a lifelong commitment, you must take this the rest of your life.

Patient’s health outlooks can be very different. I tend to see patients who fall into one of three buckets.

  • Some patients feel that they can take an active role and improve their health outcomes. These patients are often very compliant, follow directions well and are very engaged in their health.
  • Some patients feel that they can do whatever they want to their bodies and if something goes wrong there will be a pill to fix it. So they will be compliant with their medications but may not adopt new lifestyle behaviors to improve their health.
  • Some patients feel that no matter what they do, their health destiny is out of their hands. These patients tend to rationalize their unhealthy behaviors. They will say things like, “I know I should quit smoking, but I have a friend whose mother has smoked all of her life and she is 82 now”; or “everyone in my family is overweight, that is just how we are”. These type of patients take the most work in convincing that they can make a difference in their health by complying with medical advice and taking medications as prescribed.

It is important to consider a patient’s outlook on their health, and tailor patient education and level of engagement to assure compliance with their motivation. Pharma industry can support the HCP with tools to assess health outlooks and support the various levels of engagement needed for compliance. Instead of throwing your hands up in frustration, or blaming the patients, we need to meet them where they are educationally and motivationally.

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