I spent two days in Mexico City last October, tying up the final details of InfoMedics' new partnership with Signufarma, a provider of medical education to doctors and patients throughout Latin America.

With a population of over 20 million, Greater Mexico City is immense, and flying over it takes your breath away. It was my first visit, and much was unfamiliar: the language, the money, the customs, the weather, etc. It was confusing, certainly, however thanks to my hosts, who provided guidance and suggestions along the way, all went smoothly. When I said good-bye less than 48 hours later, I had a different perspective.

As I flew home that night, it occurred to me that patients who begin a pharmaceutical treatment program also experience a changing perspective over the course of their "journey," and also benefit immensely from well-informed guidance and information. Whether it's the heightened fears of the newly diagnosed at the beginning, a familiarity with the treatment process in the middle, or a new appreciation for pharmaceuticals (if not life itself) as they regain their health at the end of treatment, the mindset of a given patient is continually evolving.

But there's a disconnect. As an industry, pharma's view of the patient and treatment has been binary: There's not being on therapy (before the drug) and being on therapy (during the drug).

	It's an "on/off switch" mentality, which oversimplifies what the patient is going through, and as a result, leaves an enormous amount of potential (and profit) on the table.

Instead, if you think about the different opportunities for education and communication with a patient over the course of treatment, you start to realize all the beneficial byproducts for patient, doctor and your brand:

1. Improved credibility. This is one of the most important assets a pharma company can have, and yet we miss an opportunity to enhance it when we spend so much of our resources on front-loaded, DTC campaigns which are designed for the initial sale. If, instead, we took a long range view — one that is mindful of the patient journey — and built ongoing relationships with patients through useful, personalized, two-way communication, we'd improve our credibility…

   …with doctors, who want desperately to improve patient outcomes, but who lack the time, inclination and training to offer in-depth information and attention to patients which evolves over the course of their treatment.

   …with patients, who see us primarily as the providers of highly polished, one-size-fits-all advertisements, filled with cryptic fine print in six point type. With increased patient communication that offers information on the "whole drug picture" (side effects, timing, things to look for, next steps, etc.) we have an opportunity to regain the credibility as "health provider" that our important work deserves.

2. Improved compliance. Two people with an identical condition may go to the same doctor and get the same medication, and yet six months later, it's likely that only one will still be in compliance. Indeed, with 50% of patients discontinuing drug therapy entirely by month six, it's clear that something isn't working properly.

   To me, it all comes down to prevention. Just as we all understand the benefits of detecting an illness early — so that it can be treated before growing into a full-blown disease — noncompliance requires action from the very beginning. It's much harder to get patients back on a treatment regimen once they've lapsed, and frequent, personalized communication is a key to compliance.

   Not only does this suit the patient better — after all, the drug in which you've invested so much time and money only works to the extent that someone continues to take it — it increases profits which are otherwise lost as the compliance curve drops towards zero with each passing day.

3. Improved information. The individual experiences of a given patient represent a map of the treatment journey. As we as an industry enrich this Dynamic Data Asset, there are more opportunities to leverage it — both within the particular patient's experience, as well as on a macro level that can be tied back to the development process (for the next new indication or generation of those same drugs).

   Indeed, as the interactions between physician behavior, drug effectiveness and patient responses are more precisely understood, this information can be leveraged to produce better treatment outcomes; good news for all involved.

Taken together, credibility, compliance and information stand to make a tremendous impact on profitability, and there are significant advantages to taking a step back, and thinking about what the patient's journey might be like with your product.

By focusing only on the writing of the prescription at the front end, on the other hand, you're leaving profit on the table, as well as an opportunity to make a difference in patients' lives. And while it's fine (and necessary) to carefully track your DTC spending and results, if you view this initial encounter with your product as the entire picture, you may as well be selling detergent.

The patient mindset — like that of a first time visitor to a foreign country — evolves over time, and it's the sophisticated (and profitable) pharma company that's aware of this reality and capitalizes on it.

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How Long Should a Survey Be?

In crafting a survey, one must consider the tolerance of the patient for survey length. Patients won't stay engaged forever, and the time it takes to finish a survey will have an enormous impact on the number of surveys completed as well as the reliability of the data captured.

Determining the optimal length of a survey may be more art than science, however over the years, we've found a number of factors to hold true:

1. The more serious and impactful the disease, the greater the tolerance for length. A patient with mild allergies, for example, will generally be less willing to stay on the phone for a given amount of time than would a patient with diabetes. The less "important" the condition in their own minds, the less time they're willing to offer.
2. The more symptomatic the disease, the greater the tolerance for length. Patients with chronic back pain, for example, tend to have a greater length tolerance than those with heart disease, even though the latter is a potentially life threatening condition. Symptoms seem to keep the disease more top of mind, and as a result, patients are more willing to engage. (Keep in mind however, that at some point, acute symptoms — such as severe pain — reduce tolerance, because the patient is physically unable to stay on the phone very long.)
3. If multiple surveys will be required, survey length must be shorter. With a single survey, you can go significantly longer, since most people who begin a survey will stay with it to completion. If there's a need for a follow-up however, and the initial session was too long, many will think, "I'm not doing this again," and never come back. As a result, even if the patient would be willing to go considerably longer in a given session, we'll often shorten it, so that they come back next time.
4. Encouragement points are essential. We build in points along the way where we inform people of their survey-taking progress: "We're just past halfway," "Three more questions to go," etc. This removes the mystery and helps people remain on track.

Overall, it's important to remember the human element in any survey. The data gathered is only as good as the information provided, and survey length is an important consideration in keeping people engaged and attentive.

Last month, InfoMedics presented a poster at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) annual meeting. The ISPOR poster is titled, "New Audience for Patient- Reported Outcomes (PRO) Data," by DL Kerney, PhD, P LeVine, MPH.

And this month, we will present a poster at The Academy Health Research Poster entitled: "Feasibility of a Feedback Initiative for Facilitating Patient Engagement and Physician-Patient Communications," by DL Kerney, PhD, P LeVine, MPH.

"The patients can spend as long as they need on the phone talking to someone who can answer all of their questions in these programs. I don't have that kind of time to spend with them."

— Doctor of Internal Medicine, regarding the benefits of InfoMedics' programs

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InfoMedics creates an interactive, real-time means for helping patients and physicians better communicate about a diagnosed condition or prescribed treatment.

This results in improved health outcomes and consistent increases in prescribing levels for new prescriptions and refills.

April 2007

March 2007

January 2007