# Presentation: 285233

## Physician-Patient Relationships, Patient Empowerment and the Role of Information

***Physician-Patient Relationships, Patient Empowerment ******and the Role of Information***

- Mike Magee, MD
- Vice President, Medical Relations and Science Policy
- Pfizer Inc.

- Presented at the FDA DTC Public Hearing
- September 23, 2003

## Evolution of the Patient-Physician Relationship

***Evolution of the Patient-Physician Relationship***

***Paternalistic***

**Study conducted on patient and physician attitudes**
**3,500 interviews in the United States, United Kingdom, Canada, Germany, South Africa and Japan**

***Participatory***

***Today’s Patients, More of a Partner Than Ever ***

## Evolution of the Patient-Physician Relationship

***Paternalistic***

- Patients and physicians committed to joint decision-making
- Patients research own health conditions
- Patients today expect physicians to be team leaders and to provide clinical and educational support
- Physicians are the lead source of information, the most trusted source, and the source most likely to catalyze positive behavior change

***Participatory***

***Second only to family relationships***

***Source: Magee, Relationship-Based Health Care in the US, UK, Canada, Germany, S. Africa, and Japan, 2003***

## Patients Want to Be Involved and Empowered

***Patients Want to Be Involved and Empowered***

***Patients in All Countries Are More Engaged Than 10 Years Ago but Particularly in the U.S...***

- Ask more questions – 91% agree
- Make more choices and actively evaluate benefit and risk – 87% agree
- Take better care of own health – 90%
- Relationship with their physician is extremely, very important – 78% (second to family relationships)

- What Does It Mean to Be Empowered?

***Source: Magee, Relationship-Based Health Care in the US, UK, Canada, Germany, S. Africa, and Japan, 2003***

## Information is Key to Patient Empowerment

- 80% of adults feel they need to be more active in managing their own healthcare1
- 50% actively seek information from sources other than their physicians2
- 55% of all adults say they, or their family need more information about at least one health condition3
- 96.7 million consumers are going on line, and 65% seek health information4

- Sources: 1.Yankelovitch Monitor, 2002; 2. Harris, Interactive, 2002; 3. Pfizer, data on file, 2002; 4. Manhattan Research, 2002

## DTC Advertising is a Major 

***DTC Advertising is a Major ***
***Source of Valuable Information***

***Source: Harvard Harris, 2002***

***Doctors***

***Ads***

***Pamphlets***

***Newspapers and Magazines***

***Television and Radio***

***Family and Friends***

***Pharmacist***

***Internet***

***Sources of health care information adults use "often"****** ***

## DTC Advertising Has Positive Effects in a Number of Ways

- Helps create a new language of medicine
- Provides a new understanding of disease and causality
- Motivates patients to see their physician
- Primes patients to ask better more informed questions
- Aids physicians in individualizing care
- Educates and empowers not only the patient, but family and community simultaneously

## DTC Advertising Is Helping Create a New Language of Medicine 

- Disseminates important public health messages1
- Helps millions of Americans comprehend medical language2
- Provides simple, directive messages that help patients understand health disorders and their causes3
- Brings public health messages to ***new*** audiences by overcoming barriers of low literacy and cultural differences to raise health awareness4

- 1Sources:  Prevention annual surveys, FDA Patient surveys, FDA Physician survey, Market Measures/Cozint DTC Monitor, NMA, Physician survey, etc.
- 2Sources:  Prevention annual surveys, FDA Patient surveys , Harvard/Harris, GAO “meta-analysis” of available research, NCL
- 3Sources: Prevention annual surveys, FDA Patient surveys, Harris/Harvard survey, Market Measures/Cozint DTC Monitor
- 4Sources:  Commonwealth Fund, March 2002, NMA Physician study, 2002

## DTC Advertising Provides a New Understanding of Disease and Causality

- Encourages patients to discuss sensitive medical issues1
- Helps de-stigmatize disease2
- Encourages compliance with physician prescribed treatment regimens3

- 1Sources:  Harvard/Harris 2003, Curkendall Eur Urol 2000,
- 2Source:  Kessler, *JAMA*, June 2003
- 3Sources: RxRemedy 2001, IPSOS Pharma Trends, *Industry Insights, *2002

## DTC Advertising Motivates Patients to See Their Physician

***DTC Advertising Motivates ******Patients to See Their Physician***

- Numerous studies from different stakeholders, FDA, Prevention, Harvard/Harris, NCL, etc. 1
- Visits result in more things than prescriptions2,3

***Rx asked for***

***Behavior/lifestyle change***

***Not the Rx asked for***

***OTC reco***

*** ******Reco different med***

***Other***

***No med***

- Sources:  GAO “meta-analysis” of available research, Prevention annual surveys, FDA Patient surveys, Harris/Harvard survey, National Consumers League 2003, Market Measures/Cozint DTC Monitor
- FDA , DTC Patient Study, 2002
- See also Harvard/Harris Interactive, 2003 for physician visit outcomes resulting from a patient request for a brand seen/heard in an ad

## Under-diagnosis and Under-treatment Are Enormous Problems Facing the Country

***Under-diagnosis and Under-treatment ******Are Enormous Problems Facing the Country***

- Source: Centers for Disease Control, National Health and Nutrition Survey III

- Treated to Target

- Untreated

**% of Population**

- Treated, but Not to Target

- Undiagnosed

***Diagnosis and Treatment Status of Over-18 US Population***

## Speaking With Physicians Often Leads to New Diagnoses1/Co-morbidities

**43% of Diagnoses Were “High Priority” Conditions According to AHRQ/IQM Criteria:**

- No Diagnosis

**46%**

**25%**

**20%**

- New Diagnosis

- Conversation Was About Existing Condition

- Missing/Unknown = 9%

**9%**

- 1 Source: Harvard/Harris Interactive Study, 2002
- 2. Curkendall Eur Urol 2000

- Diabetes
- High Cholesterol
- Hypertension
- Depression
- Asthma
- Arthritis
- Anxiety

***Diagnoses****

***History, Physical Exam, Blood Work******2***

## DTC Advertising Prepares Patients to Be More Informed

- Advertisements include details on major risks and provide ways for consumers to gather more information1
- Patients are more informed and confident to ask better questions of their physician2
- Aids physicians in individualizing care3

- 1Sources:  Prevention annual surveys, FDA Patient surveys, Market Measures/Cozint DTC Monitor
- 2Sources:  FDA Patient surveys, FDA Physician survey, Market Measures/Cozint DTC Monitor
- 3Sources:  Magee, Chapter 6, *Connecting with the New Healthcare Consumer* McGraw-Hill, 2000, Stoeckle *Encounters Between Patients and Doctors: An Anthology, *Lipkin *Patient Education Counseling* 1996, Lipkin *Ann Internal Medicine* 1984

## DTC has Broader Societal Benefits

- Educates and empowers not only the patient, but family and community simultaneously1

- 1Sources:  Magee, *Relationship Based Health Care in the United States, United Kingdom, Canada, Germany, South Africa and Japan, Sept. 2003*

## In Summary, DTC Strengthens the Physician-Patient Relationship by...

- Helping patients proactively engage their physician
- Ensuring patients are informed, empowered and working in true partnership with their physician
- Keeping patients engaged with their physician over time
- Expanding communication and individualization of care