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1 Doctor - Patient Global Communication Performance Insights from the Worldwide Independent Network (WIN) of Market Research Fall, 2011 Slide 2 2 Contents 1. Background & Research 3 2. Context and Methodology 4 3. Key Findings 6 4. Communication Assessment Tool 7 5. Medication Usage 10 Slide 3 3 Background WIN, the Worldwide Independent Network of Market Research, the largest independent organization of Market Research firms with members in 64 countries, prepared this landmark review of physician-patient communication. Research Physician-Patient communication critically influences the effectiveness of medical education initiatives, treatment decisions and patient compliance to recommended treatments. WIN conducted this ground-breaking study on physician-Patient communication throughout the world to provide the healthcare stakeholders with a better understanding on how patients perceive communication skills of their doctor, how patients engage their physician, how treatment choices are influenced, the frequency and preferred modes of interaction and sources of influential information. 1. Background & Research Slide 4 4 2. Context and Methodology Methodology and Geographical distribution: In total, the study was carried out in 39 countries. In each country, the most appropriate interviewing methodology was used given local conditions. Fieldwork dates: Fieldwork was conducted between July 19 th 2011 and October 3 rd 2011. Sample: The total size of the sample is 31 577 cases representative of 1 938 990 516 people. Sample in each country is probabilistic and was designed to represent the general adult population. General coverage of the sample is as follows: 75% national 25% urban Weighting: The data was weighted in two steps to obtain representation by country and worldwide. The data was first weighted to generate data representative of the general population for each country. A second weight, according to the size of the population surveyed, was then applied to obtain global and regional totals. The margin of error per country is between +/- 2.34% and 5.66%, 19 times out of 20. The table on the next page presents a summary of the methodology used in each country to conduct this survey. Each sample is representative of its countrys population in terms of socio-demographic variables. Sample sizes ensure accurate generalizations to the total population and allow a very precise interpretation of the results. Slide 5 5 2. Context and Methodology CountryFirmMethodSampleTotal PopulationSampling Method Sample representation Population represented by sample AgeWeighting variablesFieldwork dates Margin of error +/- Armenia MPG LLC (Marketing Professional Group) CATI10037 953 438Quota SamplingNational3 356 00018+Gender, AgeAug. 12-253.09% AustraliaColmar BruntonOnline91020 000 000StratifiedNational18 200 00018+Gender, Age, RegionAug. 4-103.25% AustriaGallup AustriaFace to Face5328 400 000Random quota samplingNational7 300 00014+ Gender, Age, Region,Employment, Income Jun. 20 - Aug. 34.25% BosniaMareco Index BosniaCATI7503 850 000Multistage random sampleNational2 950 00015+NoJul. 19 - Aug. 53.58% BrazilIbope InteligenciaFace to Face1410190 000 000ProbabilisticNational141 248 57616+Gender Age, EmploymentAug. 11-152.61% BulgariaBBSSFace to Face6337 300 000RandomNational6 500 00018+ Gender, Age, Region, Type of settlement Jul. 28-Aug,043.90% CanadaLeger MarketingOnline100433 739 900RandomNational24 750 00018+ Gender, Age, Region, language Aug. 8-153.09% ChileIBOPE Inteligencia ChileCATI47315 116 435RandomUrban5 408 15018-60Gender, Age, LocationAug. 19- Sep. 54.51% ChinaWisdomAsiaOnline4001 300 000 000 Random Sampling with online Panel (Shanghai, Beijing and Guangzhou) Urban51 520 00015+NoAug. 11-174.90% ColombiaCNC (Centro Nacional de Consultoria)CATI61244 000 000Two-stage design applied simple random samplingUrban13 826 63018-65NoAug. 23-293.96% Czech Republic Mareco Ltd.Face to Face100010 224 626Random route samplingNational8 392 53018+ Gender, Age, Region, Size of Community Aug. 4-153.10% DenmarkDMA ResearchOnline5105 600 000RandomNational4 200 00018+NoAug. 12-154.34% FinlandTaloustutkimus OyOnline5225 385 000RandomNationl4 577 25015+Gender, Age, RegionAug. 12-19 4.29% FranceBVAOnline99965 000 000Quota MethodNational50 700 00018+ Gender, Age, Region, Occupation Aug. 1-43.10% GermanyProdukt+MarktOnline100681 800 000RandomNational56 500 00018-70Gender, Age, RegionJul. 25-Aug. 23.09% GreeceCentrum S.ACATI30010,961,758StatifiedUrban6,351,50618-74RegionJul. 18-Aug. 35.66% Hong KongConsumer SearchCATI8007 100 000Random quota samplingNational6 130 30015+Gender, AgeJul. 30-Aug. 193.46% IcelandCapacentOnline717320 000Random from our Web-panelNational247 43716+Gender, Age, RegionAug. 10-183.66% IndiaDataPromptCATI8031 210 193 422RandomUrban963 600 00018+NoJul. 23-Aug. 193.46% IrelandRed C ResearchCATI8394 580 000 Random digital dial including both landline and mobile numbers National3 203 81418+ Gender, Age, Social class and Regio. Aug. 8-103.38% ItalyDoxaCATI88260 300 000RandomNational50 000 00018+ Gender, Age, Region, Size of Community, Occupation Jul. 21-243.30% JapanNRC (Nippon Research Center )Online1000126,475,664RandomNational99,604,61018-79NoAug. 11-153.10% KenyaInfinite InsightFace to Face100338 610 097RandomNational26 254 86518+NoJul. 30-Aug. 83.09% LebanonReachCATI10003 759 136RandomNational2 781 76018+NoAug. 1-304.38% LuthuaniaUAB RAITFace to Face7033 200 000Random Probilty RoutineNational2 625 40015-74Gender, Age, EducationAug. 1-183.10% MacedoniaBRIMAFace to Face8202 052 722Multi stage stratified random probabilityNational1 689 26515+ Gender, Age, Region size, Nationality Sept. 1-73.42% PakistanGallup PakistanFace to Face1752187 342 721 Stratified Probability SamplingNational88 000 00018+ Gender, Age, Region, Type of settlement Aug. 7-133.70% PalestinePCPOFace to Face9924 170 000RandomNational1 876 50018+NoJul. 20-Aug. 152.34% PeruDatumFace to Face91827 412 157probabilistic, multistage stratified allocationUrban16 085 38518-69Gender, RegionAug. 5-83.11% PolandMarecoFace to Face30538 200 000Stratified randomUrban5 100 00015-65NoJul. 28-Aug. 23.23% RomaniaTNS CSOPFace to Face75021 431 298Stratified Probability SamplingNational18 190 00318+Gender, Age, RegionJul. 24-Aug. 15.61% RussiaRomirOnline1180143 000 000RandomUrban69 000 00018-44Gender, Age, RegionAug. 5-93.58% Saudi ArabiaPARCCATI115527 000 000RandomUrban13 000 00015+NoJul. 19 - Aug. 242.85% South AfricaTRS (Topline Research Solutions)Face to Face40049 320 000 Random (Johannesburg, Durban, Capetown ) Urban33 819 80018+Gender, Age, RegionJul. 29-Aug. 102.88% KoreaGallup KoreaOnline50049 773 145Random Soft QuotaNational40 359 21118+Gender, AgeAug. 9-184.90% SwedenCMA ResearchOnline10499 446 812StatifiedNational7 250 00015-75NoAug. 9-133.03% SwizterlandIsopublicFace to Face3437 870 134Random-quotaNational6 050 31415-74Gender, Age, RegionSept. 21-Oct. 35.29% TunisiaEMRHODCATI6009 910 872Stratified (governorates are strata)National732 32618+NoAug. 22-274.00% USATRiGOnline1002313 232 044RandomNational234 265 00018+Gender, Age, Region, RaceAug. 8-12 3.10% Slide 6 6 3. KEY FINDINGS Doctor-Patient Relationship Around the World 1.Communication effectiveness between doctors and patients is related to being compliant to taking prescribed medication exactly as the doctor directed. 2.Communication Assessment Tool (CAT) showed the communication between doctor and patients is poor with a very low score of 22%. 3.Asian markets are amongst the lowest on communication effectiveness. 4.Directionally, comparing results from prior years, communication effectiveness between doctors and patients on a global level trended downward. Slide 7 7 5. Doctor Communication Assessment Tool Q. Thinking of your most recent visit, please rate the doctors communication with you. Compared to last year, fewer citizens rated their doctor as excellent this year in all of the 15 communication assessment categories asked in the survey. Only a quarter or less rate their doctor as excellent in all of the categories. Only 18% of respondents felt their doctor encouraged them to ask question. With only 25%, talk in terms I could understand this is the attribute that received the rating of excellent most frequently. 7 *Global totals represent the averages of the top boxes scores in every surveyed country **In 2010, 23 countries participated in the survey. IN 2011, 39 countries participated in the survey of which only 15 were recurrences from 2010. CAT (Comunnication Assessment Tool) Attributes 2011 % 2010 % Talked in terms I could understand 25 32 How would you rate the care provided by your doctor 24 30 Paid attention to me (looked at me, listened carefully) 24 32 Treated me with respect 24 34 Greeted me in a way that made me feel comfortable 23 29 Showed care and concern23 30 Understood my main health concerns 23 30 Discussed next steps, including any follow-up plans 22 29 Gave me as much information as I wanted 22 30 Let me talk without interruptions22 31 Showed interest in my ideas about my health 22 29 Spent the right amount of time with me 22 30 Checked to be sure I understood everything 21 27 Involved me in decisions as much as I wanted 19 25 Encouraged me to ask questions18 23 Total22 29 Key Finding: A quarter or less of citizens rate their doctor as excellent in all of the categories. Slide 8 8 5. CAT (Communication Assessment Tool) Overall, the CAT score in the 39 surveyed countries is at a low of 22. The country with the highest CAT score is Ireland with a score of 66. On the other hand, Pakistan continues to record a low CAT score with the lowest this year at 5 (Pakistan scored a 7 in 2010). Of the countries that participated in the survey for the past two years, Austrias CAT score most decreased (-19) while Italy (+10), Lebanon (+8), Korea (+7), China (+7) most increased. 8 Key Finding: On average, citizens throughout the world give their doctor a low CAT score. Communication Assessment Tool (CAT) Country 2011 % 2010 % Ireland66NA Armenia66 NA Chile59NA Macedonia56 NA Bosnia51NA Australia49 NA USA48 52 Lebanon48 40 Saudi Arabia45 51 Canada43 47 Sweden37 NA Germany36 NA France35 39 Switzerland33NA Greece32 NA Colombia28 NA Iceland27 30 South Africa25NA Bulgaria24 -25 Brazil23 30 Lithuania23NA Russia23 -22 Tunisia22 NA Korea22 15 Austria21 40 Denmark21 NA Italy21 11 Czech Rep.20NA Romania20 NA Finland19 NA India16 -17 Kenya15 NA Palestine14 NA Hong Kong13NA Poland11 NA China11 4 Japan10 -11 Peru6 NA Pakistan5 7 Total22 29 Communication Assessment Tool (CAT) The Communication Assessment Tool (CAT), developed by Makoul et al, assesses patient perceptions of physicians interpersonal and communication skills. The CAT is a 15-item survey that is easily administered in a paper-and-pencil format, via the phone or Internet. The CAT asks respondents to rate different dimensions of the communication and interpersonal skills of the physician using a 5-point rating scale (1=poor, 2=fair, 3=good, 4=very good, 5=excellent). Makoul et al found that scoring the CAT based on the proportion of items rated as excellent was more meaningful than summarizing the scores using means. Their psychometric analysis of response scales indicated that a rating of excellent was akin to yes, while even very good was closer to no than yes. Data for the present study were analyzed using the sum of the items scored as excellent divided by the number of items answered.* *Source: http://www.stfm.org/fmhub/fm2010/September/ Linda567.pdf (2010) Q. Thinking of your most recent visit, please rate the doctors communication with you. **In 2010, 23 countries participated in the survey. IN 2011, 39 countries participated in the survey of which only 15 were recurrences from 2010. Slide 9 9 High CAT scores Citizens in Armenia, Australia, Bosnia, Canada, Chile, Columbia, France, Germany, Greece, Ireland, Lebanon, Macedonia, Saudi Arabia, Sweden, Switzerland, and the USA are very satisfied with their communication with their doctors with CAT scores above average. Low CAT scores Citizens in China, Hong Kong, India Japan, Kenya, Pakistan, Palestine, Peru, Poland and are the least satisfies with their doctor with below average CAT scores. Average CAT scores Respondents in Austria, Brazil, Bulgaria, Czech republic, Denmark, Finland, Iceland, Italy, Korea, Lithuania, Romania, Russia, South Africa and Tunisia have average CAT scores. 5. Global Communication Assessment Tool (CAT) Summary Summer 2010 Doctor-Patient Relationship around the world *The data for this graph is based on questions presented on slides 12. For the definitions of CAT (communication Assessment Tool) please refer to slide 12. Key Finding: Slide 10 10 39% of individuals currently have a medication that was prescribed by a doctor. Just over half (57%) of respondents take the medication exactly according to the doctors directions and another 31% take the medication according to the doctors direction most of the time. While Bulgarians are most likely to take prescription medication exactly according to direction (91%), citizens of Peru and Czech Republic are the least likely to do so with 29% who answered that they only some of the time or rarely take the medication according to direction. Key Finding: Just over half (57%) of citizens on prescribed medication take it exactly according to the doctors directions. 10 6. Medication Usage Q. Do you currently have a medication that was prescribed by the doctor with whom you most recently met? Q. How often would you say you have taken this prescription medication exactly according to the doctors direction? Yes % All the time % Most of the time % Only some of the time/Rarely % China 80 43553 Korea 68 365410 USA 63 70218 Australia 62 67303 Palestine 58 342838 Canada 57 72235 Austria 57 68321 South Africa 55 582517 Bosnia 53 8479 France 5373233 Bulgaria 52 9163 Colombia 52 701514 Romania 50 75187 Denmark 50 79183 Germany 50 64323 Sweden 49 75186 Czech Rep. 48 442629 Japan 48 55423 Italy 48 76203 Poland 47 77192 Ireland 4778139 Macedonia 47 85104 Lithuania 46 72198 Hong Kong 44414314 Brazil 43 78148 Tunisia 41 502723 Switzerland 40 68238 Iceland 39 61346 Armenia 39 431838 Pakistan 38 414711 Lebanon 38 741610 Saudi Arabia 37 5820 Finland 37 73243 Greece 35 68725 Chile 35 652113 Russia 32 50427 Peru 31 531829 India 26 443422 Kenya 24 601920 Total 39 573112 Of those on prescribed medicaton, taken medication according to doctor's direction