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Parallel Session 4

Keys for advancing patient

empowerment in future

Simon Barnes, Boehringer Ingelheim

and

Ketki Gupte, Verilogue Inc

EphMRA 2013 Pharmaceutical Market Research Conference

Relatively Speaking - Keys for

Advancing Patient

Empowerment in the Future

Background: Boehringer Ingelheim

Pradaxa

•Launched in the UK Q3 2011

•Direct competitor to warfarin

•First of Novel Anticoagulants to be

launched – high media interest

•Strong Payor reaction to Pradaxa

•Patient requests denied by physician

Three primary tenets of Patient

Empowerment

Knowledge

Understanding

Action

Real World Physician-Patient Dialogue

Analysis

•Linguistic and traditional market

research methods used for analysis

• Results based on the physician-

patient dynamic

• Identifying best practices and

obstacles to patient empowerment

•Analysis draws on Atrial Fibrillation

dialogues from UK, France, Japan,

US and Canada

Current Situation

IN: …what role do your patients have in the

treatment decision making process…?

RE: The vast, the vast majority of

patients will concur with our decision

that they should be anticoagulated with

Warfarin. (MD TDI 83240 - CARD)

A clear acknowledgement of the patients’ limited role and lack of

empowerment

PT Audio

MD Audio

Rare medication-requests by patients

CG: There's no alternative with

warfarin?

DR: There are alternatives… if I see he

don't tolerate the warfarin, if your INR is

going up and down… and you're not

reaching the therapeutic target, then…

that could be a consideration only if you

don't tolerate warfarin (80483 – CARD)

Physician response: a denial to respond to the question

Qualitative research shows even irritation, at times, on the

physicians’ part when confronted with such requests

Audio

Proprietary and Confidential © Verilogue, Inc. All rights reserved.

8

The Exam Room: Who Does The

Talking?

Average Length

of Interaction

36% Patient

1% Caregiver

62% Physician

75

Interactions Hours Total

Duration

The Issue: In-office Physician-Patient Dynamic

9.23

mins.

11.16

•Physicians are authority in this

speech situation

•Operate by the goals and

purpose of objectivity,

information-exchange and

problem-solving

•High control over topics

•Communication dynamic

skewed

Sample bullet Bullet 2

Bullet 3

Proprietary and Confidential © Verilogue, Inc. All rights reserved.

A visual representation of the skewed

power dynamic and topic control

DR: you come to our warfarin clinic

here?

PT: That's right.

DR: is that suiting you okay? PT: It is. DR: That is better than going up to the

hospital?

PT: Much better

DR: And you find the levels have been

quite stable with that, haven’t you?

PT: That’s right, yeah

What do the Patients Remember?

When asked, patients do not remember all the

details of the stroke risk discussion from

diagnosis, what is recalled is the link between

the risk of stroke and the need for treatment (TDI

PTs have had AF from 4 mos. - 20 yrs.)

Physicians confirmed that they review the risk of

stroke heavily at diagnosis but little afterwards

In describing the risk, physicians state that

they will not cite specific statistics, realizing

that this is highly individualized (per

CHADS2 scoring)

Physicians are receptive when patients

express effects on quality of life

DR: Do you find the Warfarin is

quite restricted for you or do you

feel quite confident with it?

PT: Oh! I find it restrictive. Yes.

It worries me a lot. Yes I do. If I

have to take some antibiotics and

then after three days it will shoot

up and then I'll have to keep

coming in to have it readjusted.

So obviously I just try my

hardest not to have more

antibiotics. (80146 - GP)

DR: But it nearly interacts with

everything.

PT: Well yeah. I mean every time

you buy at a [INAUDIBLE] or a

normal ailment you know, it always

says not if you're on warfarin.

And I think, I mean I can't take

the anti-inflammatory tablets.

And that was all my aches and

pains, that annoys me. I can't

take ibuprofen because of the

same reason.

(79378 - GP)

Audio

What does the physician see?

During these assessments, physicians use closed-

ended questions which often limit patients’ ability to

openly discuss their treatment experiences

On the whole, PT do not want to ‘disappoint’ their MD

, as a result, potential issues are often minimized or

forgotten

The limited input from patients about their actual

experience with warfarin leads to a disconnect with

physicians who then see no reason to switch the

patient to other available treatments

Conclusion: Better communication key

to Patient Empowerment

•Action: Demonstrate Quality of Life

as an impetus for patients to act

•Knowledge: Arm patients with

more/better information

•Understanding: Highlight to MDs that

increased communication leads to

greater adherence and improved

outcomes

Take-away: Quality of Life discussion

is important

•Dialogue research shows when

Quality of Life is evoked,

physicians are more receptive to

patient requirements and needs

•Highlight to patients, convenience

of Pradaxa—no daily monitoring,

no restrictions on food and

medications and thus no lifestyle

changes

DR: Sure. You mentioned

golf, how many holes do

you normally play?

PT: Eighteen.

DR: And are you still able to

do it?

PT: Yes, yeah, yeah.

DR: Okay.

PT: But, uh, the, I, I'm finding

for the last, uh, few months

I'm finding I'm, I'm getting

tired after, uh, maybe 13, 14

holes. (79346 - GP)

Takeaways: various stakeholders to be

involved in treatment management

•Highlight role played by

Caregivers in overall treatment

management and increase

involvement therein

•For Physicians: encourage

improved communication,

highlight gold-standard

examples

What did we do next?

•Using more emotive communication techniques

with the customers

•Campaign Materials

•Language

•Implement Patient Support Programmes

•Use Patient Friendly Language