report of svs integrated brand communications study 5-2-07 ) · svs integrated brand communications...

L.C. Williams & Associates Research Group April 2007

Society for Vascular Surgery

Integrated Brand Communications Study Report

April 2007

L.C. Williams & Associates Research Group April 2007


INTEGRATED BRAND COMMUNICATIONS STUDY

REPORT

Contents

Executive summary 1

Project purpose and methodology 4

Detailed findings

Demographics 5

PCP and patient experience with vascular surgeons 7

Words that come to mind when PCPs think of vascular surgery 7

Referrals to vascular surgeons and other specialists 10

The PCP perspective on vascular surgeons 10

Perceptions of invasiveness and complexity 11

Factors PCPs consider very important when they refer patients 13

Factors that have no effect on the referral decision 13

Factors that might lead PCPs away from vascular surgeons 15

Familiarity with SVS 17

Preferred information sources 17

Sources that influence patient requests for referrals 18

Patients’ understanding of vascular surgeons 19

What vascular surgeons or SVS could do to increase referrals 20

Predictors of likelihood of referring to a vascular surgeon 24

Appendix A – Overall data table

Appendix B – Responses to “Other, specify” and open-ended questions

Appendix C – Cross-tabulation table summaries

Appendix D – Qualitative interviews report

Appendix E – Survey questions

SVS Integrated Brand Communications Study Report

L.C. Williams & Associates Research Group 1 April 2007


INTEGRATED BRAND COMMUNICATIONS STUDY REPORT

EXECUTIVE SUMMARY

This study was conducted by the L.C. Williams & Associates (LCWA) Research Group to develop a factual foundation for testing and refining an integrated branding campaign and messaging that had been prepared by SVS and to better understand the factors that are important when physicians refer their patients to vascular surgeons. The two-phased project included qualitative in-depth interviews with 13 primary care physicians (PCPs) in January 2007, and, based on the insights gained from the interviews, a quantitative Web-based survey of 250 PCPs (physicians in internal medicine, general practice and family practice) in March 2007. This summary focuses on the Web-based survey results. Details of the qualitative in-depth interviews can be found as an appendix of the report. Survey participants included PCPs in 44 U.S. states. A composite respondent to this survey is a male, general/family practice or internal medicine physician working in group private practice. On average, he has practiced 17 years and works in a community with a population greater than 100,000. Predictors of likelihood of referring to a vascular surgeon Researchers conducted advanced analyses to identify factors that, if increased, would predict an increase in the likelihood that PCPs would refer patients to vascular surgeons. The purpose of these techniques is not to identify the largest numeric results or correlations but, rather, to discover cause-and-effect factors that will result in more referrals. No “silver bullet” was identified, although the value of attracting more PCPs to VascularWeb is certain. The overall predictive finding is:

� PCPs who visit VascularWeb.com more frequently will refer a larger percentage of their patients to vascular surgeons. This is true across all demographics in the data and underscores the value of VascularWeb to SVS and its members.

Also, several predictors were identified that may be practical to incorporate into data-driven strategies and tactics for targeted audiences and are included in the full report.

Summary of survey findings PCP and patient experience with vascular surgeons. PCPs were asked to rate their personal and patients’ experiences with vascular surgeons. Most PCPs say their experiences have been very positive (47%) or positive (37%). They also believe their



patients have had similar positive experiences with vascular surgeons: 35% very positive and 45% positive. Words that come to mind when PCPs think of vascular surgery. When asked “What three words or phrases come to mind when you think of vascular surgery?” responses were categorized into four approximately equivalent groups:

� Descriptors of vascular surgery (“invasive” was the most frequently cited descriptor)

� Named disorders or procedures (“abdominal aortic aneurysm,” “peripheral vascular disease,” “bypass surgery” and “claudication” were the most frequent responses)

� General purview (responses included general conditions, body areas and unspecified procedures)

� Descriptors of vascular surgeons (“skilled,” “expert,” “specialized” and “experienced” were the most frequently cited descriptors).

Referrals to vascular surgeons and other specialists. Despite the positive experiences with vascular surgeons, the many positive words when describing vascular surgery and the high percentages who agree with positive statements in general about vascular surgeons, PCPs are nearly twice as likely to refer patients to cardiologists (19%) than to either vascular surgeons (8%) or to interventional radiologists (7%). Moreover, more than a quarter of PCPs disagree with the assertion that vascular surgeons perform angioplasty and stent procedures better than other specialists and close to 20% of PCPs disagree with the statement that vascular surgeons are trained and experienced in medically managing patients with less severe peripheral vascular disease. PCPs may have the perception that vascular surgeons typically provide services and procedures that are more invasive and more complex than other specialties. Of the PCPs surveyed, 85% and 83% rated the services and procedures as more invasive and more complex, respectively, compared to interventional radiologists or cardiologists. Factors that might lead PCPs away from vascular surgeons. PCPs responded to a series of questions to identify factors that might lead them to refer patients to a cardiologist or an interventional radiologist rather than a vascular surgeon, even though the patient’s specific need would seem to suggest referral to a vascular surgeon. The questions were in three groups, seeking information about factors that come into play during the decision-making process:

� The referring PCP (64% of PCPs indicated the preference for alternative procedures/treatments as a factor)



� The patient (58% of PCPs indicated the severity of symptoms/conditions or symptoms/conditions overall as factors)

� The cardiologist or IR (68% of PCPs selected the specialist’s skill/expertise and 67% selected the specialist’s ability to perform specific procedures as factors)

Factors PCPs consider very important and factors that have no effect when they refer

patients. Out of 13 factors that PCPs were asked to consider when deciding whether to refer a patient to a vascular surgeon, 90% indicated the vascular surgeon’s skill/expertise, 86% indicated the vascular surgeon’s quality of patient care and 78% indicated the vascular surgeon’s ability to treat as very important. However, some PCPs think that factors like the ability to perform minimally invasive procedures and open vascular procedures (16%), the ability to perform specific procedures compared to other specialists (10%) and reputation (10%) have no effect when they consider referring patients to vascular surgeons. Familiarity with SVS. More than half (51%) of the PCPs surveyed are unfamiliar with the Society for Vascular Surgery, and barely one in 10 is very familiar (2%) or somewhat familiar (10%). Given the low level of familiarity with SVS, it is not surprising that a very large percentage (89%) say they have never visited VascularWeb. Preferred information sources and sources that influence patient requests for referrals. More than two-thirds (69%) of PCPs would like information about referring patients in personal contacts from local vascular surgeons, and personal correspondence from area vascular surgeons (67%). Regarding patient requests for referrals, family and friends (72%) are the most frequently mentioned source for information as well as other physicians (53%). The Web is the third most-frequently mentioned source. What vascular surgeons or SVS could do to increase referrals. When PCPs were asked what SVS could do more effectively to increase referrals, more than 80% of responses fell into three categories:

� Provide more information (45%)

� Improve surgeon visibility (23%)

� Improve surgeon communication (14%) Details are included in the full report and its appendices.



PROJECT PURPOSE AND METHODOLOGY This project was completed for the Society for Vascular Surgery (SVS) by the L.C. Williams & Associates (LCWA) Research Group. The study was undertaken to develop a factual foundation for testing and refining an integrated branding campaign and messaging that had been prepared by SVS and to better understand the factors that are important when physicians refer their patients to vascular surgeons. The research was conducted in two primary phases: qualitative in-depth interviews with 13 primary care physicians (PCPs) and a quantitative, Web-based survey of 250 PCPs (physicians in internal medicine, general practice and family practice). Honoraria were paid to each qualitative ($150) and quantitative ($40) participant. In-depth telephone interviews were conducted January 15 – February 2, 2007. A report of those interviews is included here as Appendix D. Based on insights gained from the interviews, a questionnaire was prepared and approved by SVS. The online survey was conducted March 7-13, 2007, by sending an e-mail invitation to U.S. PCPs who had opted-in to participate in such studies. This sample size provides overall data with a margin of error of +/- 6 and a 95% confidence level for the population represented in the online physician panel. In the data analysis phase, frequencies and means were conducted. Cross-tabulations were produced to help identify important demographic differences, and differences were tested for statistical significance using procedures appropriate for the data. Correlations were produced for several items, and regression analyses were conducted. Tables for the overall data are included as Appendix A; cross-tabulation summaries are included as Appendix C. The report focuses on the overall results and includes a report of regression analyses. In addition, selected free responses from “other, specify” and open-ended items are included in the report. All free responses are included as Appendix B.



DETAILED FINDINGS Demographics

Location of respondents. Survey participants are located in 44 U.S. states. Not represented in the data are physicians in Alaska, Arkansas, Montana, South Dakota, Vermont and Wyoming.

Respondent location

Alabama 4 Alaska 0 Arizona 4 Arkansas 0 California 21 Colorado 7 Connecticut 4 Delaware 2 Florida 18 Georgia 8 Hawaii 2 Idaho 2 Illinois 13

Indiana 3 Iowa 2 Kansas 1 Kentucky 1 Louisiana 1 Maine 2 Maryland 9 Mass. 8 Michigan 14 Minnesota 2 Mississippi 1 Missouri 3 Montana 0

Nebraska 2 Nevada 1 New Hampshire 1 New Jersey 14 New Mexico 1 New York 21 North Carolina 5 North Dakota 2 Ohio 14 Oklahoma 5 Oregon 4 Pennsylvania 19 Rhode Island 2

South Carolina 3 South Dakota 0 Tennessee 2 Texas 10 Utah 1 Vermont 0 Virginia 4 Washington 4 West Virginia 1 Wisconsin 2 Wyoming 0

Years in practice. The average PCP responding to this survey has practiced 16.8 years. Two-thirds of the respondents have practiced 8-25 years. Area of practice. Half of the respondents (50%) term their practices area “general practice” or “family practice,” with nearly as many (46%) selecting “internal medicine.”

Area of practice

50% 46%

2% 2%

0%

20%

40%

60%

80%

General/Family

Practice

Internal Medicine Primary Care Other

Practice type. The majority work in a group (64%) or solo (26%) private practice. A few who termed their practice type “academic” (5%) or “hospital staff” (3%) also responded. “HMO” was mentioned by three PCPs.



Practice type

64%

26%

5% 3% 2%

0%

20%

40%

60%

80%

Group Private Solo Private Academic Hospital Staff Other

Practice site population. Most PCP’s surveyed (54%) practice in communities with populations greater than 100,000. Just 10% practice in communities with populations smaller than 25,000.

Practice site population

54%

20%15%

10%

0%

20%

40%

60%

80%

More than 100,000 50,001-100,000 25,000-50,000 Less than 25,000

Gender. Most physicians responding to the survey are male (58%). This is comparable to the 60%-40% male-female ratio reported by the Women Physicians Congress for general and family practice physicians.*

Gender

58%

42%

0%

20%

40%

60%

80%

Male Female

* Source: Physician Characteristics and Distribution in the U.S., 2006 Edition



Topic-specific findings

PCP and patient experience with vascular surgeons. Most PCPs say their experiences with vascular surgeons have been very positive (47%) or positive (37%). They also believe their patients have had similar positive experiences with vascular surgeons: 35% very positive and 45% positive. Very small percentages of physicians report negative experiences either for themselves or their patients.

PCP personal and patient experience with vascular surgeons

35%

45%

17%

4%0%

47%

37%

12%

2% 1%

0%

20%

40%

60%

5 - Very positive 4 3 2 1 - Very negative

Patients' experience Personal experience

Words that come to mind when PCPs think of vascular surgery. When asked “What three words or phrases come to mind when you think of vascular surgery, respondents supplied more than 600 words or phrases pertaining to vascular surgery and surgeons. Responses were categorized into four approximately equivalent groups:

� Descriptors of vascular surgery – 27%

� Named disorders or procedures – 26%

� General purview – 26%

� Descriptors of vascular surgeons – 20% Descriptors of vascular surgery

Descriptors of vascular surgery were divided into three categories: those with a positive (9%), negative (54%) or neutral (37%) connotation. By far, “invasive” was the most frequently cited descriptor of vascular surgery, accounting for 27% of this category and half of the negative comments. A breakdown of positive, negative and neutral descriptors, along with their frequency of occurrence, is noted in the following table. Words were subjectively categorized based on their context in responses.



Table 1 Descriptors of Vascular Surgery

Positive # Negative # Neutral #

Life-Saving 7 Invasive 43 Complex 19 Comprehensive 2 Complicated 11 Surgeons 16 Safe 2 Risky 8 Carotid 6 Beneficial 1 Expensive 4 Vascular 4 Effective 1 Serious 4 Arterial 3 Extensive 1 Difficult 3 Technical 3 Options 1 Scarring 3 Delicate 2

Critical 2 Femoral 2 Life-Threatening 2 Venous 2 Urgent 2 Intricate 1 Complications 1 Popliteal 1 Disaster 1 Ineffective 1 Time-Consuming 1

Total 15 Total 86 Total 59

Named disorders or procedures

Respondents primarily cited one of four disorders or procedures they considered related to vascular surgery:

� abdominal aortic aneurysm (“AAA”, “triple A”) – 20%

� peripheral vascular disease (“PVD”) – 19%

� bypass surgery – 16%

� claudication – 13%

AAA, PVD, bypass surgery and claudication account for nearly 70% of this category, suggesting these are the primary disorders and procedures that come to mind when considering vascular surgery. Respondents also suggested a number of other diseases and procedures they associated with vascular surgery. These are listed in the tables on page 9, along with frequency of appearance. Procedures and diseases are reported verbatim from free response data; synonymous entries may appear.



General purview of vascular surgeons

A number of responses were far more general than those categorized in the three other sections comprising this item yet still fell within the scope of a vascular surgeon’s duties. Entries include conditions (e.g. ulcers, blockages), specific areas or functions of the body (e.g. veins, leg), and unspecified procedures (e.g. grafting, surgery). Respondents most frequently listed “vascular disease” (16%), “procedures” (14%) or “surgery” (10%) in this category. A complete listing of conditions, areas or functions and unspecified procedures is listed in Table 4 below. Entries are reported verbatim from free response data; synonymous entries may appear.

Table 4 General Conditions, Body Areas, and Unspecified Procedures

Afflictions

#

Areas/Functions #

Unspecified Procedures

#

Blockage 3 Blood 2 Amputation 4 Clots 1 Blood Vessels 3 Central Intervention 1 End Stage Disease 2 Circulation 2 Grafting 5 Pain 2 Leg 1 Open Blockages 6 Severe Disease 2 Peripheral 1 Open Heart 2 Stenosis 7 Veins 8 Operate 1 Ulcers 2 Peripheral Pulse 1 Varicose 6 Plastic Tubes 1 Vascular Disease 25 Procedures 22 Vascular Disorder 1 Repairs 7 Vascular Obstruction 1 Salvage 2 Spare a limb 2 Stents 11 Surgery 15 Vascular Intervention 2 Vascular Procedure 1 Wound Care 1

Total 52 Total 17 Total 84

Table 2 Other Named Disorders

Angina 1 Atherosclerosis 3 Cardiovascular Disease 2 Carotid Vascular Disease 2 Coronary Artery Disease 3 Hyperlipidemia 1 Ischemia 2 Peripheral Artery Disease 4 Vascular Lesions 1

Table 3 Other Named Procedures

Angioplasty 1 Ankle/brachial Index 1 Aortic Aneurysm Surgery 1 Aortofemoral Bypass Surgery 1 Cardiovascular Surgery 1 Coronary Artery Bypass Grafting 1 Carotid Artery Surgery 1 Embolectomy 2 Endarterectomy 11 Femoropopliteal Surgery 3 Inpatient surgery 1 Open Heart Surgery 1 Revascularization 3 Varicose Vein Surgery 1 Vascular Surgery 1



Descriptors of Vascular Surgeons

Respondents listed more than 120 positive and negative descriptors of vascular surgeons who were most frequently described as “skilled” (18%), “expert” (12%), “specialized” (10%) and “experienced” (9%). A considerable number of other positive descriptors were assigned to vascular surgeons and are listed in Table 5.

Table 5 Positive Descriptors for Vascular Surgeons

# # # Skilled 22 Communicates 2 Heroic 1 Expert 15 Dedication 2 Innovative 1 Specialized 12 Intelligent 2 Meticulous 1 Experienced 11 Patient 2 Nice 1 Competent 8 Calm 1 Perfectionist 1 Care/Caring 5 Constancy 1 Quality 1 Professional 4 Detail-Oriented 1 Reputable 1 Well-Trained 3 Hardworking 1 Surety 1

Those participants who negatively described vascular surgeons used words like “arrogant,” “impersonal,” “scarce,” “unavailable,” “rude,” “distant,” “volatile,” “defensive” and “poor communicator.” However, negative remarks accounted for less than 18% of this category. Respondents generally tended to hold positive opinions of vascular surgeons. Referrals to vascular surgeons and other specialists. Despite the positive experiences PCPs and their patients have had with vascular surgeons and the many positive words used by PCPs when describing vascular surgeons, PCPs are nearly twice as likely to refer patients to cardiologists (19%) than to either vascular surgeons (8%) or to interventional radiologists (7%).

Percentage of patients referred to specialists

during a typical month of practice

19%

8% 7%

0%

5%

10%

15%

20%

25%

Cardiologists Vascular surgeons Interventional radiologists

The PCP perspective on vascular surgeons. PCPs responded to a series of questions to capture their broad feelings about vascular surgeons and vascular surgery. As the chart on page 11 illustrates, PCPs have some positive thoughts about vascular surgeons, but also some possible misconceptions.



How PCPs see vascular surgeons in general

27%

19%

5%

13%

9%

34%

23%

36%

25%

17%

39%

58%

59%

61%

74%

0% 20% 40% 60% 80%

Perform angioplasty and stent procedures

better than other specialists

Are trained and experienced in medically

managing patients with less severe peripheral

vascular disease

Provide the best care for my patients

Are best qualified to diagnose and treat

patients at all levels of treatment

Are the first specialists considered when

patients need treat. for vascular disease

Disagree Neutral Agree

Vascular surgeons...

Perceptions of invasiveness and complexity. This preference for referring to cardiologists instead of vascular surgeons may be partially caused by the perception of many PCPs that vascular surgeons typically provide services and procedures that are more invasive than other specialties. More than half (55%) of the PCPs surveyed use the “more invasive” label, and when the next level is taken into account – ratings of 4 on a 5-point scale – the more-invasive total grows to 85%.

Invasiveness: Compared to interventional radiologists or

cardiologists, vascular surgeons typically provide

services and procedures that are...

0%3%12%

30%

55%

0%

20%

40%

60%

80%

100%

5 - More invasive 4 3 2 1 - Less invasive

More invasive 85%

Less invasive 3%



Similarly, 51% of PCPs see the services and procedures provided by vascular surgeons as more complex, and that swells to 83% when the next level of ratings is included.

Complexity: Compared to interventional radiologists or

cardiologists, vascular surgeons typically provide

services and procedures that are...

0%2%

15%

32%

51%

0%

20%

40%

60%

80%

100%

5 - More complex 4 3 2 1 - Less complex

If invasiveness and complexity are viewed by PCPs as potential negatives when they are referring a patient, their perceptions may depress the percentage of referrals they make to vascular surgeons.

More complex 83%

Less complex 2%



Factors PCPs consider very important when they refer patients. To provide a sense of the importance of various factors that PCPs consider when deciding whether to refer a patient to a vascular surgeon, the physicians were asked to rate 13 factors using a scale from 1 (not at all important) to 5 (very important). To focus on the relative importance of the factors, the following chart reports only the “very important” ratings. All results are included in Appendix A.

Percentage of PCPs who see factors as "very important" when

deciding whether to refer to a patient to a vascular surgeon

58%

16%

49%

51%

54%

56%

60%

61%

65%

65%

72%

78%

86%

90%

0% 20% 40% 60% 80% 100%

Other

Office or practice location

Reputation

Availability

Communication with patient

Follow-up with the patient

Communication with doctor

Experience

Ability to diagnose

Follow-up with doctor

Ability to perform specific procedures

Ability to treat

Quality of patient care

Skill/Expertise

The vascular surgeon's...

Nearly two dozen PCPs cite other factors that would be important when deciding to refer or not refer a patient to a vascular surgeon. Factors most often mentioned are personality and interpersonal skills, insurance issues, skills or qualifications, availability and whether they know the surgeon personally.

Factors that have no effect on the referral decision. Another survey question asks whether a series of factors have a positive or negative effect or have no effect when considering referrals to vascular surgeons. All factors are seen as having a strong



positive effect. The chart below reveals the percentage of PCPs who say each factor has no effect on their referral decision.

Percentage of PCPs who say a particular factor has "no effect"

when they consider referring patients to vascular surgeons

13%

2%

2%

3%

5%

6%

7%

7%

7%

8%

8%

9%

10%

10%

10%

16%

0% 5% 10% 15% 20%

Other

Ability to treat

SkillExpertise


Effect on patient health outcomes

Ability to diagnose

Communication with the patient

Communication with you

Ability to treat patient only if indicated clinically

Availability

Experience


Follow-up with you, as the referring physician

Reputation

Ability to perform specific proced. comp. to

other specialists

Ability to perform minimally invasive procedures

and open vascular procedures

The vascular surgeon's...



Factors that might lead referring PCPs away from vascular surgeons. PCPs responded to a series of questions to identify factors that might lead them to refer patients to a cardiologist or an interventional radiologist rather than a vascular surgeon, even though the patient’s specific need would seem to suggest referral to a vascular surgeon. The questions were in three groups, seeking information about factors that come into play during the decision-making process and have to do with:

� The referring PCP

� The patient

� The cardiologist or IR The questions and three charts summarizing the PCPs’ responses follow:

In general, what factors might lead you to refer to another specialist like a cardiologist or an interventional radiologist (IR) instead of a vascular surgeon when the patient has a specific disease such as peripheral claudication, carotid artery disease or abdominal aneurysm?

The patient's...

5%

37%

47%

50%

56%

58%

0% 20% 40% 60% 80%

Other

Initiation of referral

Expected health outcomes

Location of symptoms/conditions

Symptoms/conditions

Severity of symptoms/conditions

Several listed other factors related to the patient that might lead to a referral to a cardiologist or IR, including patient’s preference, insurance, availability and patient co-morbidities.



Your...

4%

57%

64%

0% 10% 20% 30% 40% 50% 60% 70%

Other

Need for a second opinion

Preference for alternative

procedures/treatments

Three physicians also cite other factors that might lead them to refer to a cardiologist or IR rather than a vascular surgeon: a patient with an established relationship with another physician, and the opinion of one respondent that it is his “understanding that in my area vascular surgeons do not do minimally invasive procedures.”

5%

24%

33%

37%

39%

44%

46%

51%

52%

53%

55%

56%

58%

67%

68%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Other

Office or practice location


Ability to diagnose

Communication with the patient

Reputation

Follow-up with you, as the referring physician

Communication with you


Availability

Experience

Ability to treat

Ability to perform minimally invasive procedures

Ability to perform specific procedures

Skill/Expertise

The specialist's (e.g. cardiologist's / IR's)...

Insurance requirement is cited as an “other” factor that might lead the PCP to refer patients to a cardiologist or IR. Also mentioned are: which specialties perform a given



procedure in an area, if a cardiologist or IR is already treating the patient, co-morbidities, patient’s preference and location in hospital. Familiarity with SVS. More than half (51%) of the PCPs surveyed are not at all familiar with the Society for Vascular Surgery, and barely one in 10 is very familiar (2%) or somewhat familiar (10%).

Familiarity with Society for Vascular Surgery

2%10%

15%23%

51%

0%

20%

40%

60%

5 - Very

familiar

4 3 2 1 - Not at all

familiar

Use of VascularWeb. Given the low level of familiarity with SVS, it is not surprising that very few PCPs say they have visited VascularWeb. A very large percentage say they have never visited the SVS website (89%).

Have visited www.VascularWeb.org

0% 5% 2% 4%

89%

0%

20%

40%

60%

80%

100%

5 - Very

frequently

4 3 2 1 - Not at all

Preferred information sources. PCPs want information about referring patients from vascular surgeons to come from the vascular surgeons themselves. More than two-thirds (69%) would like to get the information in personal contacts from local vascular surgeons, and personal correspondence from area vascular surgeons is nearly as popular (67%).



PCP's preferred sources for receiving information

about referring patients to vascular surgeons

96%

96%

75%

71%

66%

33%

31%

4%

4%

25%

29%

34%

67%

69%

0% 20% 40% 60% 80% 100% 120%

Newspaper articles

Magazine articles

The Web

Brochures

Medical journal articles

Correspondence from

area vascular surgeons

Personal contacts with

area vascular surgeons

Not a preferred source Preferred source

Several respondents cite other sources would be most useful: insurance network and CME meetings. Sources that influence patient requests for referrals. Family and friends (72%) are the most frequently mentioned source for information that influences patients to ask for a referral to a specialist, PCPs say. Other physicians (53%) are also seen as strong influences on patients. The Web is the third most-frequently mentioned source, followed by consumer print media, brochures, and radio and television.



Sources of information most frequently mentioned by patients

as influencing them to ask for a referral to a specialist

1%

1%

4%

14%

14%

17%

19%

24%

53%

72%

0% 20% 40% 60% 80%

Other

Don’t know

None of my patients have initiated a referral

Radio or television showsadvertisements

Brochures

Newspaper articles

Magazines or other publications

Information on the Web

Other physicians

Family members or friends

Patients’ understanding of vascular surgeons. Only 12% of PCPs strongly agreed that their patients understand vascular surgeons perform the same minimally invasive angioplasty and stent procedures for peripheral vascular disease as interventional radiologists and cardiologists while 41% strongly disagreed or disagreed with that statement.

Extent to which PCPs believe patients know that

vascular surgeons perform minimally invasive procedures too

11%

30%32%

16%

12%

0%

10%

20%

30%

40%

1 - Strongly

disagree

2345 - Strongly

agree



What could vascular surgeons or the Society for Vascular Surgery

do more effectively to increase referrals from physicians like you?

More than 80% of responses to the above open-ended question fell into three categories:

� Provide more information (45%)

� Improve surgeon visibility (23%)

� Improve surgeon communication (14%) Clearly, respondents would like more information with the type ranging from contact information to outcome data to, most importantly, specific procedures offered by each surgeon. Respondent comments suggest that with accurate and current contact and procedure information readily available, PCPs may be more likely – or at least, better able – to consider referring a patient to a vascular surgeon. Provide more information

Respondents would primarily like to receive information detailing the procedures (and related diagnostic criteria for each) offered by area vascular surgeons. More than 50 requests (a significant number in a pool of 250) were made for this type of data. Examples include:

“Need specific information from the surgeon in OUR OWN community about

what procedures are available and the indications for referral.”

“Educate physicians regarding procedures available.”

“Send information detailing what procedures they offer in their practices.”

“Brochures on the procedures they do.”

Primary care physicians would also like to receive information on other topics, including the availability of less or non-invasive procedures, new products or technology, comparisons to other-invasive specialties, guidelines for referral and treatment, outcome data and access information like phone numbers, credentials and accepted insurance programs.

� Availability of less or non-invasive procedures

“Emphasize the availability of less invasive options. Some patients may not be

candidates or refuse surgery for non-life threatening conditions.”

“Increase awareness on ability to do minimally invasive procedures.”

“Educate about minimally invasive procedures..”

� New products or technology

“Provide information on new and standard procedures.”



“Inform us [on] newer techniques.”

“Marketing for new techniques that vascular surgeons can offer.”

“Knowing what treatments are available especially newer technology would be

most beneficial. Too often we may not realize there is treatment for specific

problems and the pros and cons of the treatment. If we don’t know it’s there,

we can’t utilize it. In the ‘old days’ we had time to attend hospital based CME

when various specialties could update us. That is no longer an option.”

� Comparisons to other specialties

“Expound on when to use surgeon vs. interventionalists.”

“Let FP’s know why they think we should refer to them instead of other

specialties.”

“Help me understand benefit or risk reduction for my patients if vascular vs. IR

cares for them, help me understand which cases are best attempted by vascular

surgery vs. cards vs. IR.”

� Guidelines for referral and treatment

“Provide evidence-based guidelines for appropriate testing, referral and

treatment (e.g. of asymptomatic carotid bruits, claudication).”

“Provide me with up-to-date information on current diagnostic and treatment

methods, appropriate screening tools and referral indications.”

“Educate Primary Care Physicians when to refer.”

� Outcome data

“Provide outcomes data comparing specialties’ performance of common

procedures.”

“Provide data supporting their superiority over other specialties for specific

conditions.”

“More CME dinner programs giving us truthful outcome data.”

� Access information

“Provide access information, phone numbers, websites.”

“Provide a list of available surgeons in the area and insurance they accept.”

“Detail all primary care physicians on their indications, criteria, options and

local contacts.”

“Provide us with accurate contact information to make our referral process as

easy as possible.”

To a much lesser extent, PCPs would also like information on the following topics:



� surgeon reputations

� explanation of procedures

� usefulness of a vascular intervention

� quality of care Improve surgeon visibility

PCP’s would like vascular surgeons to be more visible and maintain a higher profile through lectures and seminars, visiting local societies, being active in the community and by directly interacting with general practitioners, internists and other primary care physicians. Respondents indicated they would like to see local surgeons introduce themselves to primary care physicians, visit their offices and directly correspond with them to maintain contact.

� Improve visibility by giving lectures or seminars, being active in the

community and attending local society conferences

“Have the surgeons lecture and demonstrate their availability.”

“Give dinner talks.”

“More interaction through seminars, conferences, create a clearer distinction as

to what a vascular surgeon can offer over a cardiologist over the long term

patient care for specific diagnoses.”

“More exposure.”

“Visit my Internal Medicine journal review club and review an interesting

article with us.”

“Take an active role in the community, and I don’t mean appearing on the

society page.”

� Directly correspond with PCP’s via email, telephone, correspondence or

personal visits

“More MD contact and face-to-fact interaction.”

“Emails.”

“Direct contact via email and mailings.”

“Have individual physicians contact us in the office.”

“More personal contact.”

“Direct personal contact.”

“Contact primary care physicians and outline their services and how they can

assist our patients. Reach out to the primary care physicians and engage their

interest.”



� Introduce yourself and visit local medical offices and clinics to establish a

relationship

“Stop by and introduce themselves.”

“Get the surgeons out to the PCPs.”

“Personal appearance to our clinic.”

“Making personal visits to the office, perhaps as a luncheon.”

“Meet doctors on site at their practice or dinner program.”

“Get the local vascular surgeons to do ‘Grand Rounds’ at the local hospitals

and have staffers call/visit family practitioner offices.”

Improve surgeon communication

Respondents would like to see better communication and follow-up from vascular surgeons. Specifically, they would like vascular surgeons to make themselves more available to PCPs, be more timely in updating the primary physician and in general, be more receptive to keeping the lines of communication open between referring physicians and their offices.

“Improve communication with our office (chart notes and operative notes),

better availability for appointments, better communication of what procedures

they can and want to perform.”

“More communication.”

“Communicate with us.”

“Communication with the primary care physician after the consultation

performed either via email, dictation, letters or phone conversation in follow-

up.”

“Better communication, more interactive with the patients, thorough follow-up

until problem stabilized.”

“Improve communication between the surgeons and referring physicians; be

more accessible.”

“Communicate more effectively, timely.”

“Keep lines of communication open.”



PREDICTORS OF LIKELIHOOD OF REFERRING

TO A VASCULAR SURGEON

Regression description and findings

Researchers conducted advanced analyses – initially correlation testing and then, based on correlations, regression testing – to identify factors that, if increased, would predict an increase in the likelihood that PCPs would refer patients to vascular surgeons. These advanced analyses go beyond simply tabulating results and often reveal patterns in the data that may not readily apparent; the purpose of these techniques is not to identify the largest numeric results or correlations but, rather, to discover cause-and-effect factors that will result in more referrals. No “silver bullet” was identified, although the value of attracting more PCPs to VascularWeb is certain. Also, several predictors were identified that may be practical to incorporate into data-driven strategies and tactics for targeted audiences. Some may have little practical value to integrated brand communications, but they are not the result of coincidence or chance. Overall predictive finding

� PCPs who visit VascularWeb.com more frequently will refer a larger

percentage of their patients to vascular surgeons. This is true across all demographics in the data and underscores the value of VascularWeb to SVS and its members.

By gender

� Female PCPs who perceive “quality of patient care” as a positive factor in their decision to refer patients to vascular surgeons will refer a larger percentage of their patients to them. This suggests that in the decision-making process “quality of patient care” may be of greater importance to female PCPs.

By area of practice

� General/family practitioners who perceive “quality of patient care” as a positive factor relating to vascular surgeons will refer a larger percentage of their patients to them. This suggests that in the decision-making process “quality of patient care” may be of greater importance to general/family practitioners than to internists.



By years in practice

A number of drivers of referrals to vascular surgeons were identified for various PCPs grouped by the number of years they have been in practice. The predictors are statistically sound, though some perhaps are not easily explained.

� For PCPs who have been in practice 16-20 years, knowledge that vascular surgeons can perform minimally invasive procedures will increase their referrals to vascular surgeons. This suggests a knowledge gap that, when filled, will benefit vascular surgeons.

� PCPs who have been practicing 6-10 years and 16-20 years and who perceive “quality of patient care” as a positive factor relating to vascular surgeons will refer a larger percentage of their patients to them. This suggests that in the decision-making process mid-career PCPs place a higher value on the “quality of care” factor.

� For PCPs who have been practicing 11-15 years the vascular surgeon’s office or practice location is the best predictor of whether patients will be referred to an interventional radiologist. This may suggest that for this group, referral to an interventional radiologist was largely driven by the comparative location of area vascular surgeons.

� For PCPs who have been in practice 6-10 years, visiting VascularWeb increases the likelihood that they will refer to an interventional radiologist. This is an exception to the overall predictive finding noted previously. It is a very strong predictor for this group and may indicate that they may not be finding the information on VascularWeb that will convince them to refer to a vascular surgeon rather than an interventional radiologist.

report of svs integrated brand communications study 5-2-07 ) · svs integrated brand communications...

Documents