Developing a Message Strategy for Safer Oral Anticoagulant Use Summary Presentation

1. Developing a Message Strategyfor Safer Oral Anticoagulant UseSummary Presentation September 21, 2005

2. Key Research Questions • What is the optimum target audience to get the most behavior change? • What is the specific action that a key audience should take to improve safe use of oral anticoagulants? • When is the target audience open to receiving the message? • What image comes to mind in the target audience when they hear the names of key organizations working in this area? • What rewards will our audience receive if they improve safety? • What evidence supports any behavior change?

3. Research Activities • Interviews with Anticoagulation Experts • Pharmacists, physicians • Representatives of large health delivery systems • Focus Groups – Consumers • Seniors who self-report that they follow many of the monitoring guidelines (Doers) • Seniors whose self-report indicates that they are not compliant with monitoring guidelines (Non-doers). • Focus Groups – Health Care Providers • Physicians - (GP, Internists, and Geriatric specialty) • Pharmacists - (Chain and Independent pharmacy)

4. Expert Interviews Consumer- related issues: • Importance of understanding the disease process and drug action and the need for monitoring • Importance of communicating fully and often with all health care providers • Negative effects of age on treatment • Importance of recognizing lifestyle effects on treatment • Need for immediate and on-going education

5. Consumer Focus Groups “Doer” Focus Group: • View compliance with an oral anticoagulant regimen as a “way of life” and provides “peace of mind” • Self-monitor and seek out information about taking blood thinners • Knowledgeable about proper oral anticoagulant regimen protocols • Manage logistics, access to care, and results • Significant (?) and dramatic life event

6. Consumer Focus Groups “Non-doer” Focus Group: • Express anxiety, fear, and suspicion related to their oral anticoagulant; it’s a “rat poison” • Limited knowledge of treatment regimen and lack details of compliance • Express presence of unwanted side effects – due to oral anticoagulant • Indicate doctor had not told them about important details • Unaware of numeric values associated with lab results and lacked sensitivity to relationship between lifestyle and test results

7. Pharmacist Focus Groups • Believe that they should or do play an active and important role in patient education • See reimbursement for educational efforts • Recognize physicians as key source of information • Believe pharmacists can be effective partners in physician educational efforts • Time constraint is a big obstacle to patient education • Compliance is personality driven • Positive rewards hard to discern, prefer fear • Patient education should be personal counseling rather that written materials.

8. Physician Focus Groups • Frustration! • Abundance of misinformation and clarifying information is time consuming • Problems arise from plethora of interactions, including drugs prescribed by other physicians. • Lament inability to get lab results in timely manner • Poor outcomes due to patient’s inability to understand regimen guidelines and failure to communicate change with physicians

9. Physician Focus Groups • Stressed the following optimal behaviors: • Taking medication as prescribed • Returning to physician for monitoring • Reporting complications in timely manner • Problems in regulating INR can result in variations in generic drug manufacturers • They are the appropriate source for information • No clear rewards for following guidelines, they stress the avoidance of bad outcomes.

10. Physician Focus Groups • Characterized a ‘good’ physician as one who promptly notifies patients of lab results and makes sure they return for follow up. They manage the reporting well, but concede that follow-up visits are hard to ensure • Negative response to pharmacists playing a role in patient education

11. Conclusion • Results provide coalition with varying consumer perspectives and valuable input from providers and pharmacists • The limited scope of the project may raise as many questions as it answers, but it provides useful insight into the general audience • The “Doer” and “Non-doer” segmentation was useful and may have uncovered several important differences between these two groups that can be explored in future research

12. Strategic Questions - Answers • Target Audience – because of the two consumer styles (doer and non-doers) will need to refine the target audience and direct the design of campaign messages. • Call to action - If a target audience is further refined, a clear call to action should be designed to focus on simple behaviors that are consistent with the research findings. • Opening - One opening that each consumer style shares is the need to obtain results from their lab testing. While the message for each audience type may be different the opening to deliver this message is the same. *Based on a limited number of groups.

13. Strategic Questions-Answers • Image - It is unclear how any of the images of organizations associated with the campaign could be leveraged to help the campaign. For the most part organizations were unknown. • Rewards - Unfortunately, the rewards promoted by doctors and pharmacists tended to skew negative and future driven. May want to consider other ways to position oral anticoagulants to be in the present and positive. For example, the Doer participants experience daily ‘peace of mind’ when taking an oral anticoagulant. • Evidence to support behavior change - Perhaps it could be the positive feedback associated with a good score, although this factor may need additional testing to more fully understand its relevance. *Based on a limited number of groups.