Case Studies on
Point-of-Care
Dynamics Revealed
Through Integrated
Physician/Patient Research

By Geoff Penney, Vice President
& Louise Gillis, Associate Vice President, GfK Market Measures

Each year GfK Market Measures conducts research in more than 30 therapy areas, exploring the physician, patient, managed care organization decision maker and long-term care provider perspectives. From this we have the ability to take an across-stakeholder perspective on a given therapy area, which can afford us with the unique opportunity to explore the point-of-care dynamics between the physician and patient. The contrast of the physician’s time-pressured clinical assessments against the detailed, nuanced elements of the disease or condition experienced by the patient is where there are expectations of divergence or convergence – a richness of information that neither physician nor patient market research alone can provide.

Recently, GfK Market Measures embarked on an initiative to compare data from eight therapeutic class studies for which we had physician and patient data perspectives allowing us to identify points of comparison (similarities and disconnects) in physician and patient-reported symptoms, attributes of importance, measures of brand satisfaction, comparisons of unmet needs and specific data on patient reported perceptions and experiences with their physician discussions.

For this article we identify several brief examples of the point-of-care dynamic that were revealed in this exercise. These examples, together with others, were shared in more comprehensive detail in an educational teleconference on this same topic last month
(Click here to view the archived
webinar presentation. Please note: you must enter your e-mail address to access the presentation).


Revealing Disconnects
in Reported Symptoms

One of several illustrations of these insights is taken from our multiple sclerosis physician and patient research, where we saw a disconnect between the prevalence of symptoms reported by neurologists and symptoms reported by MS patients (see figure below).

Fatigue is most commonly reported by both neurologists and patients. But there is gap: While 86 percent of MS patients report suffering fatigue, neurologists estimate 62 percent. In addition, spasticity, cognitive difficulties, bladder dysfunction and vision problems are all reported more by patients than neurologists.

We suspect neurologists may be prioritizing symptoms, and therefore are less likely to fully estimate the spectrum of symptoms experienced by their MS patients. Some of these symptoms may be related to the treatment itself, and neurologists may not be making the distinction.

A better understanding of these disconnects may reveal an opportunity for a strategic partnership with a brand able to relieve these ancillary but important symptoms. Or it may reveal the need for speaking points provided to sales reps that would emphasize the importance of these symptoms to patients contrasted with physicians’ possible under-appreciation.

Another example, taken from our COPD physician and patient research, shows shortness of breath upon exertion, wheezing and lung tightness, mucus or sputum production, difficulty walking and chronic cough are symptoms or aspects of the condition that are reported far more by patients than physicians (see figure below).

The implication of this gap in COPD symptom reporting is that physicians may assume their patients are better managed than they are. If the physician-patient dialogue is not adequately aligning the importance of symptoms for both the physician and patient, an opportunity exists for marketers to close this gap, or enter into a dialogue about compliance or manage patients’ expectations about the disease. The bottom line is that by not having this dialogue at the point of care, patient satisfaction with a brand may suffer, and switching may be the result.

Uncovering Unmet Needs

From another point-of-care perspective, we examined product attribute importance and satisfaction with brands across our physician and patient therapeutic class studies.

Identifying unmet needs among physicians is an important piece of research that should be considered early on in product development. As brand marketers struggle to find differentiators in the marketplace, understanding the patient perspective as early as Phase II will help uncover new clinical trial endpoints that otherwise may be overlooked at such a critical point in product development.

Let’s look at one example from the depression market’s critical unmet needs reported by physicians and patients, specifically, primary care physicians and psychiatrists’ understanding of unmet needs compared with Lexapro and Effexor XR users (see figure below).

What we found was that the attributes of low incidence of sexual dysfunction and low weight gain are critical unmet needs for psychiatrists, who are prescribing higher doses for their more difficult-to-treat patients, and as a result deal more with these side effects as they increase dose levels. The patient perspective reveals efficacy-related unmet needs. Lexapro users report improvements with onset of action and focus and concentration as unmet needs. EffexorXR users, who tend to suffer greater depression severity than Lexapro users, report improvements in focus and concentration, greater symptom relief and less sexual dysfunction as unmet needs.

Now, if initially we only conducted research among physicians, we may not necessarily see improving focus and concentration as an opportunity, but by conducting parallel research with patients, we see focus and concentration – as well as faster onset – as opportunities in this market.

Application in the Context of Patient Segments

One question the reader may ask is how some of these illustrations apply in the context of a patient segmentation model that often reveals three or four target patient segments. Patient segments bring their own expectations to the point-of-care dynamic that need to be acknowledged. We were able to identify one important segment of the population defined by disease or condition severity. Disease severity presents an important a priori segment (an often easily identified patient subgroup determined by age or gender or brand use, for example). As one example we looked to the rheumatoid arthritis marketplace (see figure below).

In this case, we realized in our analysis that patients on biologics and a traditional DMARD therapy provided descriptions of their condition that clearly made them the more severe sufferer relative to the traditional DMARD-only user. Brand attributes such as “prevents future bone/joint damage” and “improves mobility/range of motion” represent important efficacy dimensions, and in both cases the biologic+DMARD users rate those attributes with greater importance. In contrast and of nearly equal importance among the DMARD users, few side effects is more important in their decision to use a medication.

What does this mean for the marketer? First, the value of future preventative bone and joint damage must be raised for the DMARD-only user since in the case of a degenerative disease the benefits to the patient may not be immediate. At the same time, these patients are more conscious of and potentially more influenced by potential side effects. Messages that support a clear discussion of potential side effects balanced against improved efficacy (and future benefits in slowing disease progression) will more likely move this patient to the appropriate biologic medication trial – the ultimate goal in this rheumatoid arthritis marketplace.

Implications for Pharmaceutical Marketers

These are some illustrations of the value of thinking about and incorporating into your market research plans the point-of-care perspective – how comparing and contrasting physician and patient perceptions and reported experiences can reveal important, new points of differentiation (whether for use in Phase II or Phase IV clinical design endpoints or in marketing messages for pre-launch or launched brands). Finally, the point-of-care perspective facilitates an across-stakeholder dialogue and strategy. Analogous to our physician-patient discussion and the need for shared expectations and perspectives, the point-of-care dialogue can represent a common meeting place, where market researchers responsible for professional and patient market research can meet and find benefits and opportunities for each others’ business goals. As a natural consequence of this dialogue, the point-of-care perspective helps to enhance an integrated or umbrella strategy for your brand.

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