Engaging Health Care Practitioners to Recommend Evidencebased Community Programs

1
EngagingHealth Care Practitioners to Recommend
Evidence-based Community Programs

• Teresa J. Brady, PhD
• Arthritis Program CDC
• Terry Savage, MA
• Westat

2
Background

• Audience research suggests
• Dr. referral/recommendation powerful influence on
  PWA
• PWA expect Dr.s to tell them about self
  management education programs
• Few patients are referred to community-based
  programs by their Primary Care Provider (PCP)
• Attempts to elicit referrals have had limited
  success

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Increasing Recommendationsfrom Primary Care
Practices

• Purpose Develop strategies to entice primary
  care providers (and their staff) to refer
  patients to SME and PA programs
• Process
• Literature Review
• Formative Research
• Strategy and Materials Development
• Pilot Test of strategies and materials

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Formative Research

• Primary Care Practices
• Interviews with PCPs (MDs, NPs, PAs)
• Interviews with office managers
• Online survey of all of the above
• Potential Implementers
• Interviews with Arthritis/AID Project
  Coordinators

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Collaborative Project

• Directors of Health Promotion and Education --Pam
  Eidson
• CDC --Terry Brady
• Westat
• Simani Price
• Colleen Ryan
• Terry Savage
• Jennifer Berktold

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Presentation Overview

• Summarize
• Interviews with Arthritis/AID project
  coordinators
• Formative research with primary care practices
• Describe
• Research-based outreach strategy
• Proposed marketing toolkit
• Gain your feedback

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Interviews with Potential Implementers

• 17 AID Project or State Arthritis Coordinators
  invited to participate
• In-depth interviews completed with 15 states
• 14 included at least 1 SHD staff
• 5 included multiple people
• 3 partner organizations participated
• Systematic analysis of interview transcripts to
  identify themes

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Arthritis/AID Project Coordinator Interviews

• Interview Content
• Current recruiting activities and materials
• Thoughts on outreach to physician practices
• Needs for conducting PCP outreach

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Coordinator Interview Findings

• Current Recruiting Activities and Materials
• Outreach to PCPs limited
• Publicity and program stability are challenges
• Positive word-of-mouth important
• Social support and connections, brand
  recognition, class format, results help
  recruiting efforts

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Coordinator Interview Findings

• Common Recruiting Strategies
• Word of mouth
• Establishing classes where people are
• Flyers and posters
• Press releases, newsletter or community calendar
  inserts
• Presentations in community locations
• Presentations at health care conferences

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Coordinator Interview Findings

• Outreach to Physician Practices
• Direct outreach to PCPs not emphasized
• Current approaches
• Conference/meeting presentations
• Working with health plans/MD associations
• Distributing prescription pads
• Marketing considerations
• PCPs are busy appreciate evidence base
• Value of practice champions
• Single interaction not enough

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Coordinator Interview Findings

• Concerns about Physician Practice Outreach
• Dr. to busy to see them
• Too many PCPs to reach
• Entre difficult without relationships
• Not a systems approach
• Seen as pharmaceutical rep
• PCPs need education about arthritis self
  management

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Coordinator Interview Findings

• Who could/would do the Outreach?
• HD staff (30)
• Local staff (30)
• Partner Mgmt staff (13)
• Not sure (13)
• How ready to do physician practice outreach?
• Ready! (40)
• Somewhat, Not, I dont know

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Coordinator Interview Findings

• Marketing materials should include
• Brochures, postcards, and posters
• PCP referral forms
• A brief presentation for PCPs
• Materials should
• Be brief and customizable
• Mention the programs evidence base
• Be written so patients at all literacy levels
  can understand

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Presentation Overview

• Summarize
• Interviews with Arthritis/AID project
  coordinators
• Formative research with primary care practices
• Describe
• Research-based outreach strategy
• Proposed marketing toolkit
• Gain your feedback

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Increasing Referralsfrom Primary Care Practices

• Literature Review Results
• Only 5 of PCP visits result in any type of
  referral (all patients)
• 45 Surgical
• 31 Sub-specialist
• 12 Non-physician clinicians
• PCPs have limited awareness of exercise
  guidelines and community resources

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Increasing Referralsfrom Primary Care Practices

• Literature Review Results (cont)
• PCPs lack confidence that their recommendations
  will result in behavior change
• Non-physician staff play crucial role in getting
  word of community programs out

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ACHES Survey Results (N 2238 Adults with
Arthritis)
SME recommended 10 (3.7 million)
SME recommended attended 5 (1.8 million)
SME attended 10 (3.7 million)
Patients who receive recommendation 18 times more
likely to go than those who dont get
recommendation. --Murphy 08
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Increasing from Primary Care Practices
Recommendations
Referrals

• In-depth Interview Results
• See recommendations to community resources as
  part of their job
• PCPs likely making referrals to PT,
  recommendations to weight loss programs and
  exercise facilities (YMCA)
• Unaware of community based-arthritis programs,
  but idea very warmly received.

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Formative Research Primary Care Practices

• In-depth Interview Results (cont)
• Key questions
• Cost
• Convenience
• Credibility
• 11 visits from program leaders most useful to
  make practitioners aware of program
• Want leave behind materials for provider and
  patient handouts

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Formative Research Online Survey of Primary
Care Practices

• N 404
• 51 MDs
• 25 PA/NP
• 25 Practice/Office Managers
• 54 family practice
• 47 small offices (less than 5 pro.staff)
• 52 suburban settings
• 22 at least half minority pt. population

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On-line Survey Content Areas

• Awareness/use of community programs
• Essential information to provide
• Influential program characteristics
• Programmatic questions
• Strategies to introduce program to PCP practices

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On-Line Survey Results Awareness/Use of Local
Programs

• 80 recommend community programs at least several
  times per month
• 60 several times per week
• 56 reported being aware of programs for
  arthritis
• YMCA, medical facilities, senior centers
• PA/NP more aware (71) than MD (51) and Office
  managers (50)
• 20 aware of E-B programs described

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On-Line Survey ResultsFactors Influencing
Decision to Recommend

• Low cost (average rating 4.64)
• Convenient location (4.63)
• Led by trained instructors (4.49)
• Convenient times (4.49)
• Evidence-base/effective (4.43)
• Small recommendation influential (4.15)
• Not for profit/not sell anything (4.14)

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On-Line Survey Results Which features
influence most?

• Low cost 47
• Benefits to patients 24
• Program qualities -- 21
• Location/access -- 14
• Evidence-base -- 12
• Trained instructors 12

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On-Line Survey Results What questions do you
have?

• 28 Logistics
• class time, location, transportation
• 17 Cost
• 14 Instructor training/credentials
• 6 Program effectiveness

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On-Line Survey Results Low Cost

• 25.00 would be affordable to
• Majority of our patients 65
• About half of our patients 21
• Less than half of our patients 15

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On-line Survey ResultsHow to Introduce the
Program to the Practice

• Bring materials to the office (average rating
  4.17)
• 80 very/somewhat effective
• Conferences (3.21)
• 41 very/somewhat effective
• Newsletters/e-mail/journals (3.15)
• 39 very/somewhat effective
• Send materials by mail (3.7)
• 36 very/somewhat effective

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On-Line Survey Results When bringing materials
to office

• 61 make appointment in advance
• 21 drop in without appointment ask to speak to
  someone
• 18 drop off materials to be given to staff
• Note 6 mentioned bring food

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On-Line Survey Results Who to contact at the
Practice

• 42 Office/Practice Manager
• 31 Physician
• 16 PA/NP
• 8 Front Desk/Referral Desk
• 5 Medical assistant

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Marketing Materials/Strategies would greatly
influence

• 37 Brief in person meeting
• 31 Program fact sheet
• 26 Fact sheet on evidence
• 26 Website for providers
• 21 Visit a session
• 19 Scientific articles
• 18 Online or DVD video of session
• 14 Contact info of participants

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On-Line Survey Results Value of Clinician
Reminders

• 51 thought would be helpful
• 60 Periodic mailing
• 48 Posters
• 40 Chart stickers
• 38 Reminders in electronic medical
• record

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On-Line Survey Results Value of Patient Handouts

• 82 Thought would be helpful
• 78 Brochures
• 76 Flyers/tearoff pads
• 64 Prescription pads
• 49 Postcards
• 48 Posters for patients
• 42 Patient website
• 21 Info for provider website

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On-Line Survey Results Value of Endorsements

• Patient word of mouth (average rating 4.22
  greatly influence 47)
• Arthritis Foundation (4.06 40)
• Local rheumatologists (3.99 37)
• Local PCPs (3.93 30)
• Am. Coll. of Rheumatology (3.90 34)
• AAFP (3.78 28)
• CDC (3.53 21)
• AMA (3.50 21)

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Summary of Research with Primary Care Practices

• Limited awareness of community based programs
• Prefer personal visit to introduce the program
• Pitch needs to address cost, credibility and
  convenience
• Patient handouts more useful than clinician
  reminders
• Repeated contact helpful

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Presentation Overview

• Summarize
• Interviews with Arthritis/AID project
  coordinators
• Formative research with primary care practices
• Describe
• Research-based outreach strategy
• Proposed marketing toolkit
• Gain your feedback

37
Recommended Outreach Strategy for Increasing PCP
Recommendations to Community-based Programs
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Recommendations

• In-person practice visits more likely to elicit
  recommendations to community programs
• Formative research demonstrates providers prefer
  educational outreach approach
• Literature shows practice visits more effective
  than other methods of marketing health
  interventions to providers
• Traditional marketing methods efficient but not
  effective

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Goal of Outreach Strategy

• Raise awareness of community programs among
  primary care providers and their practices

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Approach

• Provide strategies, step-by-step guidance, and
  practical tools for marketing programs
• Prepare state health departments and partners to
  effectively market programs

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Keys to Marketing Success

• Identify the most promising PCPs
• Develop new or take advantage of existing
  relationships with providers and practice
  gatekeepers
• Combine in-person practice visits with regular
  follow up

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Proposed Marketing Toolkit

• Grounded in research and responsive to program
  needs
• Offers step-by-step practical guidance on
• Overcoming barriers and motivating
  recommendations
• Identifying and establishing relationships with
  primary care practices
• Knowing what providers value about programs
• Conducting a practice visit
• Reinforcing and extending marketing efforts

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Toolkit Contents

• Prepares program and partner staff for visits
• Includes messages that highlight program benefits
  and guidance on leveraging existing materials and
  resources
• Research briefing
• Information on evidence base for and
  effectiveness of programs
• Marketing tip sheet
• Guidance on identifying PCPs to target
• Visit planning checklist

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Toolkit Contents

• Training video
• Practice visit demonstration
• Role-playing exercises
• Scripts for initial calls and in-person visits
• Guidance on contacts and visits
• FAQs
• Answers to provider questions

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Toolkit Contents

• Supply of customizable leave-behind marketing
  materials
• Fact sheet for providers emphasizing program
  cost, convenience, and credibility
• Handout to make it easy for providers to
  recommend your program
• Brochure for patients

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Toolkit Contents

• Website
• Training video
• Toolkit contents for download and printing
• Evaluation
• Guidance on evaluating and fine-tuning marketing
  efforts

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Pilot Test

• Develop prototype
• Pilot in 5 states
• Revise toolkit based on feedback from pilot sites

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Dissemination

• 21 state health departments
• Partner organizations
• Arthritis Foundation
• State aging programs and partners
• YMCA/YWCA
• Senior centers
• Other organizations delivering program

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Next Steps

• Fall/Winter 20092010 Develop marketing
  strategies and materials for engaging PCPs
• Spring 2010 Test strategies and toolkit
  materials
• Summer 2010 Revise toolkit materials as
  necessary
• Fall 2010 Roll out toolkit to programs nationwide

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Questions / Comments?
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Contact Information

• Teresa J. Brady, PhD
• Senior Behavioral Scientist
• Arthritis Program
• Centers for Disease Control and Prevention
• 4770 Buford Hwy MS K-51
• Atlanta, GA 30341
• 770-488-5856
• tob9_at_cdc.gov

• Terry Savage, MA
• Senior Project Director
• Westat
• 1600 Research Blvd.
• Rockville, MD 20850
• 301-610-8731
• terrysavage_at_westat.com