New Trends In The Hungarian Pharmaceutical Industry

As we pointed out in our previous blog post, 2012 has several changes in store for pharmaceutical companies. The healthcare reform defined by the Semmelweis and Széll Kálmán plans mean comprehensive structural transformation for the entire field.

Changes in the pharmaceutical representative system – the increasing importance of HR

The new decisions effect pharmaceutical representatives most negatively, because the return of investment on the personal meetings with physicians is considerably lower, mainly because of the „additional taxes” that the industry has to face in Hungary. According to the new rulings that came to effect in the middle of 2011 the turnover tax rose from 12% to 20% and pharmaceutical companies have to pay a yearly 10 Million HUF amount after every representative providing product information to physicians and pharmacists. According to the data of GYEMSZI (Institute of Pharmaceutical and Healthcare Quality and Organisation Development) in the beginning of 2011 there were 2 600 pharmaceutical representatives working in Hungary. This number dropped to 2 100 by the end of the year.

In 2012 the HR support of the remaining representatives will be even more important. According to the in-depth interviews carried out by Szinapszis Ltd. among pharmaceutical representatives it has to be a priority in the future to further involve representatives in sales strategies, so they get more comprehensive insights about the entire process. When using personal representative meetings and alternative sales tools simultaneously, the initiation and training of reps are critical, so they don’t look at the new tools as rivals, but as „sales partners” – while supporting the goals of the pharmaceutical management.

The new ePatient appears

The internet plays a key role when people, patients are seeking health-related information. The patient who is constantly searching the web for information appears in the healthcare system as a (more or less) conscious customer, and these new patients or e-patients need their doctors to participate in the communication process as well – creating new challenges for healthcare professionals, since old-fashioned one-way „communication” needs to be replaced by two-sided consultations.

More informed patients have higher expectations of the quality of healthcare, which results of these patients appearing more frequently in the private sector of the healthcare system.

This group of patients create a new target for pharmaceuticals since there is a new opportunity for directed non-expert communication – and not only in the field of OTC treatments.

Improving patient non-adherence – with legislative tools

A so-called patient-compliance program is part of the restricting initiatives proposed for pharmaceuticals in 2012, this program will be introduced first among patients with vascular problems and chronic lung conditions. According to the new initiative patients who want to pay the same amount for their medications they used to need to improve their health parameters with exercise, a healthy diet and lifestyle, and with regularly taking their medications – with losing weight and quitting smoking. Therefore in 2012 the role of patient-compliance programs assumed to become more emphasized.

But when it comes to the improvement of concordance about treatment options physicians are pessimistic: almost 75% of them don’t believe that the before mentioned policies and other initiatives aimed to strengthen the co-operation will result in a better doctor-patient collaboration in the following 2 years.

The more substantial role of pharmacists

Among other things the expansion of generics and the introduction of active ingredient-based prescriptions will further strengthen the role of pharmacists in the future, even more so in sales. Observing the efficiency of pharmacy sales is going to be a crucial, which means measurement of these areas (like mystery shopping) is going to be more significant in 2012.

(Katalin Kiss)

Alarming Level Of Non-Adherence

Recently I came across an alarming data on non-adherence: according to the American Association of Retired Persons (AARP) 25% of people above 50 are not taking their medications as prescribed if they take them at all.

Rather than worrying about the sky-rocketing healthcare costs and revenues we should ask, what makes patients stop a treatment and go against their physician’s advice. Is it only the price of the medication or is it a consequence of miscommunication? And if so, what is pharma doing to find a solution for whatever the problem might be?

  1. First of all the cause of non-complience has to be clear. To be able to act on it one needs to know the real nature of the problem. It might sound obvious, but surprisingly it is often overlooked. To determine the reason for non-adherence pharma and healthcare need feedback from patients. This of course requires communication and listening which to this day seem to be challenging.
  2. Communication: The reason behind stopping a treatment could be the lack of information about certain drugs. A lot of patients end up leaving the doctor’s office not entirely understanding what they have been told. With the constantly decreasing visit times accurate knowledge about a treatment is hard to provide. It has to be a crucial goal to get through to patients and make sure they have all the information they need to successfully complete or maintain a treatment.
  3. Financial solutions: Non-complience can also root from financial difficulties. Healthcare providers, pharma, insurance companies have to be able to work together to find a better system to help patients in need to pay for their medication. To imply that patients come first and not collaborating for a more sufficient way for them to finance their medications is simply misleading.
  4. Marketing tools for adherence: Marketers often focus on the great results and advantages of taking a certain drug. They often forget to emphasize that partial treatment is not a treatment. Through conventional marketing, social media platforms and educational portals pharma has great tools to inform patients and advertise adherence. These tools could be the base of comprehensive compliance campaigns.

(Source: World of DTC Marketing)

Basic Attributes For Collaborative Healthcare

We can agree that more and more patients look for information themselves, or look into what their doctor says during a visit – but that doesn’t mean that trust between physician and patient is not important, that the empowered patient doesn’t need to be convinced that his/her doctor is competent and caring. Just the opposite. A great deal of trust needed in a time when achieving health becomes a shared goal and experience for doctors and patients.

But what is this trust based on? How do patients develop this trust for their physician, what do they take into consideration? According to a recent blog post on Mind The Gap the trust in doctors is based on three attributes:

  • The physician’s clinical skills
  • The physician’s communication skills
  • The patient is the number one concern of the doctor (without any other motives involved)

Because patients are usually not clinically trained (although more and more informed), they rely mostly on the second and third attributes when trusting their doctors. And that’s why it is crucial to spend enough time focusing on the dialogue with the patients, asking and answering questions and discussing any kind of concern they may have.

It is not surprising that communication is key for patients at this point. We are far gone from the idea that patients are not allowed to have an opinion, or any kind of knowledge about their condition or treatment options. Healthcare became more like a collaboration and as such people participating (doctors and patients) have to find a way to talk, communicate and discuss.

This is why it is alarming to see that the amount of time spent on a visit is rapidly decreasing. This is why it is frightening to know that even an important subject like taking a new drug is discussed in 49 short seconds. It is not enough to possess clinical skills and a great amount of information. Physicians also need to know how to pass on that information and earn their patients’ trust to achieve better outcomes and a well-operating collaborative healthcare.

(Source: Mind The Gap)

Poor Communication Equals Non-Compliance

In a recent post on Mind The Gap, a blog dedicated to investigate the quality, or in this case poor quality of communication between physicians and patients, I stumbled upon some alerting data about how much these shortcomings effect compliance. We long knew that being informed and engaged in health increases adherence. But the magnitude of consequences of not providing comprehensive information about new medication was shocking.

Here are some of the sobering facts (also shown on the infographic below):

  • While 50% of the US population takes at least one medication and 85% of seniors have one or more chronic conditions, only 50% of patients are taking their pills as directed.
  • Even more astonishing, that 70% of non-compliance is intentional. The reasons are the following: disbelief in diagnosis and severity of health problem, concerns about side affects – all of which could be discussed during a visit.
  • Doctors spend an average 49 seconds (yes, that’s not even a minute) giving information about a new drug they prescribe.
  • They only tell patients how long to take their pills 34% of the time. In as low as 35% of the cases they spend time mentioning the adverse effects and only 9% of the time they talk about the price of the drug.

 

(Source: Mind The Gap)

Pharma Ads And Online Boundaries

It is interesting to see how different online media companies go about  find setting up rules for pharmaceutical content on their platforms. Some learn from their own experiences, some are careful from the start.

Google for example had to learn the hard way that strict control is needed when it comes to prescription drug ads appearing online. The web giant paid 500 Million dollars in a settlement over AdWords content advertising illegal import of Canadian drugs into the United States. And signs suggest that the company was prepared to handle a situation like this, since the amount was set aside for this purpose. But the hit taken by Google was still enormous: the 500 Million dollars roughly equal the company’s revenue from the Canadian pharmacy ads, plus the pharmacies’ revenue from sales to U.S. customers.

Facebook seems to be trying to avoid a similar fail. Just recently the company updated its already strict Advertising Guidelines. The description of rules has a separate section for pharmaceuticals and supplements that could be very helpful when creating effective Facebook ads.

Pharmaceuticals and Supplements

Ads must not promote the sale of prescription pharmaceuticals. Ads for online pharmacies are prohibited except that ads for certified pharmacies may be permitted with prior approval from Facebook.

Ads that promote dietary and herbal supplements are generally permitted, provided they do not promote products containing anabolic steroids, chitosan, comfrey, dehydroepiandrosterne, ephedra, human growth hormones, melatonin, and any additional products deemed unsafe or questionable by Facebook in its sole discretion.

Depending on your contract with Google you are not entirely in charge what appears among the ads. On Facebook as well several ads appear on your Page that were selected based on only the main focus of your profile. Still I feel more comfortable with Facebook’s solution since the same clear rules apply to all advertisers.

Setting up a Facebook ad is easy, but it also has the crucial step of approval process integrated. From Google’s settlement it seems that they should apply similar restrictions as well.

What do you prefer: Google AdWords or Facebook ads? Let us know in the comments section below!

(Source: Reuters, Facebook)

Medicine In The Digital Era

With new devices constantly appearing on the market at a new speed, it is safe to say that the digital era has arrived. It also consumed the medical field with physicians enjoying the perks of having mobile access to the enormous amount of knowledge required while practicing medicine. While it was long obvious that mobile applications and devices influenced doctors in a major way, a recent infographic about U.S. hospitals and healthcare professionals included surprising numbers to prove just how much they became an integral part of practices.

According to the data below, more than 2 in 5 physicians go online during a patient’s visit mostly for drug references, new publications, disease associations or to look for a support group for patients. The most convincing fact was the high rate of doctors using consulting applications with 94% of them turning to these for information. The infographic also suggests that other mobile based technologies are welcomed as well. For example 86% of physicians are interested in accessing electronic health records, while 83% of them would like to use these devices as prescription tools.

The data also highlights the fact that more and more doctors go on social sites for professional reasons. At the 1188 hospitals observed Facebook seemed the most popular with 1018 pages created. These healthcare facilities shared overall 548 Youtube channels, 788 Twitter accounts and 458 LinkedIn profiles. One thing that stood out was the relatively low number of hospital blogs with only 137 listed for all 1188 hospitals. Despite the fewer blogs in these organizations, the infographic states that blogs are actually favored by doctors compared to private online physician communities.

The numbers once again show the significance of the “mobile movement” among healthcare professionals. Maybe this magnitude is why the FDA, while usually slow in similar cases, felt the urgency to address this phenomenon with its draft guidance for mobile medical applications.

 

(Source: Spinabifidainfo.com)

“Sticky” Patient Comments On Facebook

The conversation about Facebook’s changing commenting policy has been going on for a while now. In a recent, very detailed overview on Pharmaphorum.com, Wendy Blackburn lists the new risks and the possible solutions for the recent  challenges. And finally there are multiple ways of dealing with this issue surface instead of the regular “keep the comments disabled or turn away from Facebook” answer.

The post also highlights certain situations when patient commenting could turn into a problem. People posting off-label use, positive outcomes, their joy over an unfinished clinical trial, their way of using a different dosage of a drug:

“[Drug X] was FDA-approved for asthma but my Dr. prescribed it for COPD and it worked great!”

“Whenever I self-inject [Drug X] I use ice to make the injection feel better and I also take ibuprofen. You should try that.”

“I’ve learned that if I cut my pill in half, I still feel okay, but my prescription will last longer and costs less.”

In the imaginary comments above, you can read about off-label use, unauthorized medical advice and usage not in sync with the recommended dosage. These could all cause problems for a pharma company. But that doesn’t mean that these comments shouldn’t be made possible. They reflect on real situations and sometimes real problems whether they violate regulations or not. Choosing the right platform for this may be challenging, but it is definitely an urgent and crucial task that needs to be faced.

I do understand that unless it is made clear that a pharma company is not responsible for user comments on a Facebook page, allowing these posts are great risk factors. I do agree that this has to be decided. But why wait on the FDA to declare that? Disclaimers work just fine on blogs, Twitter and different social media platforms. Why wouldn’t they be enough for Facebook comments? For content published by others than the company?

There are also different tools for keeping your Facebook wall under control. The post mentions extensive monitoring, moderation, filtering or creating a branded page. So there are solutions for “sticky” patient comments on Facebook. They are time-consuming and result in a large workload, so companies have to decide carefully if it’s worth it or not. The question that still lingers is: what can we do about the issues, like the examples quoted before that have to be hidden on social platforms? Where are those notions going to be addressed?

For more interesting and exciting posts, check out Pharmaphorum.com!

(Source: Pharma on Facebook: past, present and future)

“Connect With Others Who’ve Been There” – Mayo Clinic Launches Online Health Community

Mayo Clinic has always been an innovator in the field of healthcare social media. With clear guidelines set up (and not waiting for the FDA to publish one) the medical mogul built a strong following on Facebook, Twitter and made providing patient-centered health information a top priority. Creating a center for social media acknowledged the importance of these channels. The Mayo Clinic also led by example maintaining a strong online presence even in times of a social media crisis.

Now the organization  is taking the next step ahead to assure its leading position in health related social media. It launched a social network for patients where people with similar symptoms can connect and share their experiences. Here is what the Mayo Clinic posted about the new online patient community:

When you’re facing a health concern, sometimes, what you really need is someone who has already been there. That’s what this community is all about: connecting people who have been through the Mayo Clinic experience with others facing a similar health concern.

So how is the new platform different from previous patient communities or forums? Well for one, it kind of looks like Facebook. A very patient-centered Facebook. Even the expressions are the same. “Mr. X posted on his profile” and “Y commented on X’s post” or “X and Y are now friends.” Sounds familiar, right? Patients can also start discussions on the site or comment on videos. Both features can be found on Facebook.

Aside from not being too creative with the possible user activities on the platform I think Mayo Clinic’s personalized patient social network once again proves that the organization is one step ahead of other healthcare providers when it comes to serve patients with social experience.

What do you think of Mayo Clinic’s online health community? Share your thoughts below!

(Source: Mayo Clinic Center for Social Media)

Ethics And Social Media In Medical School

A new post published on KevinMD.com focuses on how the older generation of physicians are turning their backs on social media and how medical schools avoid the whole subject, like it’s not influencing healthcare today. Which concerned me was the second part of this. We sometimes hear about older doctors using mobile devices and the internet, and every time they appear like superheros. And they are! It’s not easy to adapt to something as you get older. But to take that away from the younger generation has way bigger consequences than we can grasp.

We have a lot of data collected about health online. We keep hearing study results, like “looking for health information is the 3rd most common online activity” or “patients Google their symptoms” or “One in four internet users living with a chronic condition have gone online to find other people with health concerns“. We don’t need to prove anymore that this phenomenon is real and is here to stay. So who can avoid something so obvious?

Apparently medical schools can. According to the article mentioned above, the curriculum has 15 minutes set aside for social media in healthcare which usually means talking about what pictures not to post on Facebook. And while I agree that future physicians need to consider the digital footprint they leave behind (you know what they say, it comes with the job) this topic hardly covers everything there is to talk about when it comes to social media and health. With the online sphere influencing healthcare in almost every aspect, you simply can’t leave medical students without guidance.

Maybe doctors who instantly say no to social media don’t know too much about it. And sure, talking to your students about something you don’t know perfectly could be scary. But if physicians look at this as an opportunity to learn from each other rather than a scary experience to avoid, talking about social media in class could be beneficial for everyone. Every physician learns about ethics. And I’m pretty sure almost every student knows a thing or two about social media. So why can’t the two be combined in a class room. Knowledge of ethics from the professor, knowledge of social media from the students.

Check out Nathan Favini’s blog, the A stranger in this world for more interesting and exciting post.

(Source: KevinMD.com)

e-Patients And Their Health Habits

Social media could be a great staring point for clinical trials. According to a study carried out by Blue Chip Patient Recruitment, e-patients who are active social media users are 60% more likely to have participated in clinical trials.

The data published in the research suggest, that patients using social media are more active in other areas as well when it comes to their health. They are 37% more likely to agree that medication helped imrove their lives, and 21% more likely to be willing to try advanced medication. They are also 29% more likely to visit their doctor for check-ups. They are 39% more likely to state that their condition resulted in a limited lifestyle.

There is one area where patients didn’t seem so active: online communities. When asked about their activities in online communities 80% of the respondents (between the age of 25 and 54) stated that they are reading the posts of others while only a little more than 30% said that they take part in providing content. So sharing posts and comments is definitely less significant compared to looking for information.

(Source: World of DTC Marketing)