marketing community-based interventions to primary care practices: lessons learned from audience...
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Marketing Community-based Interventions to Primary Care
Practices: Lessons Learned from Audience Research
Teresa J. Brady, PhD
Senior Behavioral Scientist
Arthritis Program
U.S. Centers for Disease Control and Prevention
Agenda How we did the audience research Five key findings (and a bonus) Recommendations based on the
research Turning the research into action
Background Community-based programs complement
clinical care Audience research suggests
Dr. referral/recommendation powerful influence on Patients
Patients expect Dr.’s to tell them about self management education programs
Few patients are referred to community-based programs by their Primary Care Provider (PCP)
Attempts to elicit referrals have had limited success
SME recommended
10%
(3.7 million)
SME attended
10%
(3.7 million)
SME recommended & attended
5%
(1.8 million)
The Importance of Provider Recommendation
N= 2500
Patients who receive recommendation 18 times more likely to go than those who don’t get recommendation. --Murphy 08
Increasing Recommendations from Provider Offices Purpose: Develop strategies to entice
primary care providers (and their staff) to refer patients to SME and PA programs
Process: Literature Review Formative Research
In-depth Interviews (32 providers, 8 managers)
Survey (400 providers and staff)
Increasing Referrals from Provider OfficesLiterature Review Results PCPs have limited awareness of
exercise guidelines and community resources
PCPs lack confidence that their recommendations will result in behavior change
Non-physician staff play crucial role in getting word of community programs out
Qualitative Methods: In-depth Interviews 31 in-depth interviews with PCPs Recruited from pre-existing
database of research volunteers Inclusion criteria: see 20 or more
patients per month with arthritis 20-40 minute telephone interview All conducted by same interviewer
In-depth Interview Methods Stratified by
Profession (MD, NP, PA) Specialty (Internal Med.; Fam. Practice) Practice size (small, med. large) Location (urban, suburban, rural) Geography (NE, S, MW, W) Pt Race/Ethnicity (Cau., Minority)
Paid incentives $90/MD; $75 NP/PA
Interviews taped, transcribed, thematically analyzed by question
PCP Interview Respondents 68% MDs
16% each NP, PA 42% Small practices
29% each Mid-size, Large practice 45% Urban
42% Suburban, 16% Rural 29% each, Northeast, South
26% West; 16% Midwest 64% serve mostly Caucasian patients
Quantitative Methods: On-line Survey On-line survey of MDs, NP, PA, Office
managers Recruited from same database Same inclusion criteria Same incentive rates Data analyzed with SPSS
Missing data not included Open ended responses thematically
coded
Online Survey Respondents N = 404
51% MDs 25% PA/NP 25% Practice/Office Managers
54% family practice 47% small offices (less than 5 pro.staff) 52% suburban settings 22% at least half minority pt. population Average 130 arthritis patients/month
PCP Audience Research
Insurance company rules govern referrals
“if program low cost rather than covered by insurance…free to recommend it unfettered”
In-depth Interview ResultsAwareness and Use of Local Programs See referral to community resources as
part of their job PCP’s likely making referrals to PT,
weight loss programs and exercise facilities (YMCA)
Unaware of community based-arthritis programs, but idea “very warmly received”.
In-depth Interview Results Impression of Community-based Programs After hearing description of programs:
“Great!” Near unanimous belief programs would
help them care for patients How likely to refer? (1=not, 10= definitely
would) Average rating 8.5; 87% rated 6 or greater
On-Line Survey Results: Awareness and Use of Local Programs 80% recommend community programs
at least several times per month 60% several times per week
56% reported being aware of programs for arthritis YMCA, medical facilities, senior centers PA/NP more aware (71%) than MD
(51%) and Office managers (50%) 20% aware of E-B programs described
PCP Audience Research
Key Learning #
Providers top concerns about community-based programs:
• Cost• Convenience• Credibility
On-Line Survey Results:
Factors Influential in Decision to Recommend Low cost (average rating = 4.64)
1= not influential; 5 = very influential) Convenient location (4.63) Convenient times (4.49) Led by trained instructors (4.49) Evidence-base/effective (4.43) Small recommendation influential (4.15) Not for profit/not sell anything (4.14)
Low cost – 47% Benefits to patients – 24% Program qualities -- 21% Location/access -- 14% Evidence-base -- 12% Trained instructors – 12%
On-Line Survey Results: Which features influence most?
On-Line Survey Results:
What questions do you have about these programs? 28% Logistics
class time, location, transportation 17% Cost 14% Instructor training/credentials 6% Program effectiveness
PCP Audience Research
Key Learning #
Preferred method to learn about community programs: 1:1 visits from people
knowledgeable about program(academic detailing)
In-depth Interview Results:Learning about Local Programs Top Sources for general arthritis info
Medical journals, conferences, other professionals, pharma. representatives
Learning about local programs In-person meeting with program
representatives Follow up with print materials Print materials without personal contact
not effective
On-line Survey Results:How to Introduce the Program to the Practice
Bring materials to the office (average rating 4.17) 80% very/somewhat effective
Conferences (3.21) 41% very/somewhat effective
Newsletters/e-mail/journals (3.15) 39% very/somewhat effective
Send materials by mail (3.7) 36% very/somewhat effective
On-Line Survey Results: When bringing materials to office…
61% make appointment in advance 21% drop in without appointment; ask
to speak to someone 18% drop off materials to be given to
staff Note: 6% mentioned bring food
On-Line Survey Results: Who to contact at the Practice
42% Office/Practice Manager 31% Physician 16% PA/NP 8% Front Desk/Referral Desk 5% Medical assistant
PCP Audience Research
Key Learning #
Need to foster facilitators and reduce barriers to recommendation.
In-depth Interview Results:Recommendation Facilitators and BarriersFacilitators Convenient times,
locations Low cost Knowledge of:
program details, staff Easy to hand-out
pt.materials
Barriers• lack of awareness• cumbersome process• need to write info
On-Line Survey Results: Value of Endorsements Patient word of mouth (average rating 4.22;
greatly influence 47%) Arthritis Foundation (4.06; 40%) Local rheumatologists (3.99; 37%) Local PCPs (3.93; 30%) Am. Coll. of Rheumatology (3.90; 34%) AAFP (3.78; 28%) CDC (3.53; 21%) AMA (3.50; 21%)
Key Learnings from PCP Audience Research 1. Ask for recommendation, not referral
2. PCPs welcome info
3. Emphasize cost, convenience, and credibility in your pitch
4. Make personal visits to provider offices
5. Use strategy and materials to address facilitators and barriers
Recommendations: Strategy Brief in-person visits to targeted PC Practices Make appointment with Office Mgr or
Practitioner Brief presentation to address cost,
convenience, credibility Leave-behind print materials Easy to use recommendation process Repeat contacts over time
Recommendations: MaterialsPractitioner Oriented Program fact sheet
Cost, Convenience, Credibility What happens in program Benefits (evidence)
Patient Oriented Brochures/Flyers/Tearoff sheets
Translating Research into Action
The 1.2.3 Approach to Provider Outreach
Marketing Arthritis Interventions to Primary Care Practices
Pilot-test 2010-2011 Currently being revised Release late 2012/early
2013
Bonus Learning: (…from the pilot test)
Key Learning #
PCPs prefer interventions that address
multiple chronic diseases
Teresa J. Brady, PhD
Senior Behavioral Scientist
Arthritis Program
Centers for Disease Control and Prevention
4770 Buford Hwy MS K-51
Atlanta, GA 30341
770-488-5856
Questions: