Patient Involvement – What’s the Point?
Author: Rachel Lewington, Consultant
Medical device companies have traditionally targeted marketing and research resources at surgeons, doctors and hospitals administration professionals. However, in view of the growth in a consumer based approach to health care, there may be benefits in following the lead shown by the pharmaceutical industry and adopting a marketing approach that reaches patients directly.
‘Patient choice’ and ‘patient participation’ have become buzzwords. Such buzzwords were in evidence at the corporate level when The Center for Business Intelligence held the first forum on Direct to Consumer Strategies for Medical Devices at the end of September this year in Chicago. Companies attending included Guidant, Medtronic, Smith and Nephew, Becton Dickinson and American Medical Systems.
At a political level, governments in Europe are building a patient-centred approach into the provision of public health services. Putting People at the Heart of Services, published by the NHS in the UK in June 2004 sets out a number of targets that give patients a core role in decisions about the health care they receive, as shown in the extract that follows.
“Rapid access is not enough. To meet today’s expectations, patients need to be able to choose from a range of services that best meet their needs and preferences. Between now and 2008, the NHS will be making the changes which enable patients to personalise their care and for those choices to shape the system and the way it is run” (NHS Improvement Plan, June 2004)
Patient profiles – the informed patient versus the uninformed patient
Not all patients wish, or are able to become real partners in determining their care. The extent to which they do so is limited by the type of information available and their ability to access and understand it. In addition, many patients, particularly those who are older, continue to regard themselves as passive recipients of care and are more likely to accept the recommendations of doctors and other health care professionals.
However, a side effect of the growth in consumer society has undoubtedly fostered a belief that patients have a role to play in deciding what course to follow with regard to treatment and care.
The fully involved patient
Highly informed patients are increasingly aware of the treatment options available to them. They are more likely to make the final decision about the treatment path they wish to follow, particularly if they have access to private health care. The following real life example illustrates this,
Patient X is a man in his early 50s diagnosed with prostate cancer. As a senior manager with private health care insurance he was able to visit a number of surgeons before he decided which surgical approach he preferred. His choice fell between an open or laparoscopic procedure. With internet access to trial results and published data he discussed the merits of each approach with his surgeons. Although he found the idea of a laparoscopic procedure appealing, in view of the shortened recovery time, he eventually decided to have an open procedure because he did not feel that surgeons in the UK had sufficient experience in laparoscopic procedures for prostate cancer and he was concerned, from what he had read, that a laparoscopic procedure would not remove enough of the margins around the tumour. The final decision as to which type of surgery was used was made entirely by the patient.
Patients in a position where they are likely to be able to act as a partner in treatment decisions are likely to …
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Have a longstanding or chronic health problemBe in a non-emergency medical situationBe a member of a patient groupBe highly literateBe a professional and/or a graduateHave access to the internet and be adept at using itBe confident about expressing their opinions
Such patients may experience improved outcomes as a result of better patient compliance, a fuller understanding of their medical condition and an appreciation of the long term implications and benefits of different treatment options. As such, informed patients tend to make better decisions about their treatment and in the best scenarios are able to work with health care professionals as a member of a team.
The downside of patients becoming more involved in their treatment is an increase in patient demand for services. Such patients may monopolise doctors’ time and may make excessive demands on health services in terms of the types and qualities of devices and treatments they should have access to.
The uninformed patient
In contrast to the above scenario, the following, again real life example, illustrates how treatment decisions are made by a patient who does not see herself as a partner in choosing her treatment.
Patient Y is a woman in her late 40s suffering from stress urinary incontinence after having three children. With no awareness of the treatment options available for this condition, this lady accepted incontinence as a natural consequence of growing older and continued to manage as best she could using products purchased from supermarkets and pharmacists. Her incontinence affected her confidence and she did not take part in sports and was reluctant to socialise. As such, her treatable condition had a significant impact on her life.
Patients in a position where they are unlikely to be able to act as a partner in treatment decisions are likely to …
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Have a poorer understanding of the way their body worksHave a poorer understanding of medical terminologyBe a non professional or non-graduateBe in an emergency situationBe an older person
Patients who do not have access to information may be unable to make decisions about what would be the best treatment course for them to follow. They may be more unlikely to seek help for conditions that are easily treatable and if they do seek treatment are more likely to accept the first treatment option offered to them without exploring other options fully.
What’s the benefit?
Medical device manufacturers could be excused for asking if there is any concrete benefit in expending additional resources and effort to provide patients with targeted information about medical conditions and products relating to these conditions. There is a wealth of evidence to show that patients benefit when they participate in treatment decisions. The extent to which medical device companies will also benefit is debatable. There are dangers in working with patients to increase their engagement in treatment. The most immediate of these is that doctors can become antagonised and intimidated by patients who appear to be highly informed. Doctors can also resent patients requesting particular devices or treatments on the basis of information they have seen on the internet. In addition, the model of direct marketing to patients which has been used in the US may be less successful in Europe, where patients’ relationships with health care providers and funding providers are different.
Medical device manufacturers can play a prominent role in easing communication between patients and health care professionals. If both the patient and the doctor have access to information presented in a form that they can understand, the patient is able to play a more active role in determining the preferred treatment pathway. The key to successfully implementing a strategy based on patient involvement is to approach the subject from a number of angles. This requires patient education about their condition, about the treatments available and about the benefits and implications of the final treatment pathway chosen.
Not all medical devices are suitable candidates for direct to patient marketing or information. Good candidates include home diagnostic test kits (such as blood glucose monitors) or home care products. Stents, angioplasty catheters and other surgical tools relating to cardiology are also good candidates, since either patients or their relatives referred for such a procedure are more likely to have carried out some research on the internet and can be provided with information that can enable them to express a preference for a particular type of device. This applies to many devices that are implanted in patients. Within surgery, other potential candidates could include anti-adhesion products or hernia meshes, which offer advantages in terms of long term outcome to patients which surgeons may not pick up through patient follow up. Wound care products and surgical treatments for incontinence are also obvious candidates.
However, it is important that such information is always provided in a way that ensures that doctors do not feel disenfranchised by the process and do not feel that medical companies are attempting to drive sales by creating a situation where the relationship between patient and doctor becomes antagonistic.
Providing doctors with tools and materials that benefit patients by making available easy to understand information about their condition can be used to add value to products and also provide an alternative way to reach doctors who often describe themselves as being overwhelmed with traditional marketing media. In public health care systems such as the NHS in the UK there is a growing antipathy towards the provision of incentives to doctors from pharmaceutical and medical device companies. Providing doctors with well produced patient materials helps to foster a positive relationship between companies and health care providers.
Pointers for patient involvement – presenting information and using the best routes
Involving patients themselves in the development of patient materials and information provides a useful way to ensure that information is presented in the most effective format. This is a technique used widely by health care providers as part of their consultation processes. Patients are usually highly willing to offer their opinions and to give input on what information they require. Input from patients is valuable in ensuring that patient materials are pitched appropriately and uses language that patients understand. A useful technique is to ask patients to describe their condition in their own words and to consult small groups of patients about how their condition affects their life, what information sources they find useful and what experiences they have had with treatment.
With regard to presenting information to patients, a number of routes can be used. These range from PR based informative articles in magazines to sponsored events and the internet. The most effective approach need not always be the most expensive or high tech; a less formal approach is often the most effective. Possible approaches include:
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A website dedicated to a particular condition including information on treatment, links to patient support groups, a patient chat room or message board etc.Targeted magazine and newspaper articlesThe development of materials specifically targeted at patient support groupsInvolvement and/or sponsorship of events run by existing patient organisationsLeaflets, CDs and booklets provided to doctor’s clinics
Companies should take note that patients are usually highly willing to offer their opinions and to give input on what information they require. As patient power may shape certain market sectors in the future the approach to patients through readily accessible information material warrants investigation by companies serving the healthcare area.