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Teresa J. Brady, PhD Senior Behavioral Scientist Arthritis Program

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

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Teresa J. Brady, PhD Senior Behavioral Scientist Arthritis Program

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  1. 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

  2. Agenda • How we did the audience research • Five key findings (and a bonus) • Recommendations based on the research • Turning the research into action

  3. 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

  4. The Importance of Provider Recommendation N= 2500 SME recommended 10% (3.7 million) SME recommended & attended 5% (1.8 million) SME attended 10% (3.7 million) • Patients who receive recommendation 18 times more likely to go than those who don’t get recommendation. --Murphy 08

  5. 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)

  6. Increasing Referrals from Provider Offices Literature 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

  7. QualitativeMethods: 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. PCP Audience Research Key Learning # Don’t call it a referral.

  13. PCP Audience Research • Insurance company rules govern referrals “if program low cost rather than covered by insurance…free to recommend it unfettered”

  14. PCP Audience Research Key Learning # PCPs welcome information about community programs.

  15. 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”.

  16. 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

  17. 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

  18. PCP Audience Research Key Learning # Providers top concerns about community-based programs: • Cost • Convenience • Credibility

  19. 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)

  20. On-Line Survey Results:Which features influence most? • Low cost – 47% • Benefits to patients – 24% • Program qualities -- 21% • Location/access -- 14% • Evidence-base -- 12% • Trained instructors – 12%

  21. 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

  22. PCP Audience Research Key Learning # Preferred method to learn about community programs: • 1:1 visits from people knowledgeable about program (academic detailing)

  23. 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

  24. 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

  25. 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

  26. 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

  27. PCP Audience Research Key Learning # Need to foster facilitators and reduce barriers to recommendation.

  28. In-depth Interview Results:Recommendation Facilitators and Barriers Facilitators • 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

  29. 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%)

  30. Key Learnings from PCP Audience Research • Ask for recommendation, not referral • PCPs welcome info • Emphasize cost, convenience, and credibility in your pitch • Make personal visits to provider offices • Use strategy and materials to address facilitators and barriers

  31. 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

  32. Recommendations: Materials Practitioner Oriented • Program fact sheet • Cost, Convenience, Credibility • What happens in program • Benefits (evidence) Patient Oriented • Brochures/Flyers/Tearoff sheets

  33. 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

  34. Bonus Learning: (…from the pilot test) Key Learning # PCPs prefer interventions that address multiple chronic diseases

  35. Provider Outreach Guide Marketing Chronic Disease Interventions to PCPs…

  36. 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 tob9@cdc.gov Questions:

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