HealthEd and Amylin EXL Digital Pharma West 2011

Return on Education™—Leveraging Patient Education to Improve Treatment Outcomes
Susan LaRue, RD,CDE, Clinical Education Specialist, Medical Relations and Information, Amylin Pharmaceuticals, Inc
Susan Eno Collins, RD, CHES, SVP, Health Education, HealthEd; Community Leader, SurroundHealth.net

Give us the next 30 minutes and we will…
Give you an introduction to Return on Education™—a framework you can use to develop effective programs
Show you a case study where we incorporated the framework
Share the positive results we got
Hopefully, answer your questions
6/21/2011
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Return on EducationTM: Starts with a behavior-based approach for developing programs
3
Program
Development and
Refinement
Post (After Program Launch)
Pre (In Planning)
During (In Development)
Uncover Insights
Choose Behavior Model
Develop Objectives
Capture and Analyze Results
Launch

Education Impact
Desired Action
And includes a Return on EducationTMframeworkfor evaluating the outcomes of the program
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Program/Business Impact
Customized based on program objectives
Examples include
Screening/diagnosis
Talking with HCP
Fill initial Rx
Take Rx as prescribed
Conversion
Use of device
Persuasion
(“This is important to me”)
+
Clarity
(“I understand and can apply what I am learning”)
+
Insight-driven content
(“This relates to me and my life”)
+
Reaction to tactic/program
(“This has been worth it. I have learned something new.”)
Program
Engagement
Reach
Frequency
Business
Length on therapy
Increased sales
Rep access
Health Outcomes
Symptom alleviation
HEDIS measurement
Function
Clinical measures

Case study: Effects of Patient Education Support Program on Pramlintide Adherence

Acknowledgement
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6
This case study is based on the following publication:
Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.
We wish to thank the lead author, Gayle Lorenzi, RN, CDE, University of California at San Diego, for her expertise and contributions

Pramlintide is taken as an adjunct to mealtime insulin
Analog of the hormone amylin
Hormone cosecreted with insulin by the beta cells in the pancreas
Deficient in people with type 2 and type 1 diabetes
Adjunct treatment for people with type 2 or type 1 diabetes who take mealtime insulin
Injectable
Taken prior to major meals
A major meal is >30 grams of carbohydrate or > 250 calories
Offers improved blood glucose control
Fewer blood sugar swings throughout the day
Added benefit of potential weight loss
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The numbers shed light on the product’s challenges
3
Patients taking pramlintide at meal times may already be taking 4 shots of insulin a day
Pramlintide becomes 3 additional shots to integrate into a daily routine
50%1
Adherence to medicines across multiple chronic conditions, including diabetes
50% in 2 months2
About 50% of patients starting pramlintide discontinued therapy within 2 months
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Sources:
1. World Health Organization: Adherence to long-term therapies: evidence for action. Geneva, World Health Organization, 2003.
2. Data on file. San Diego, CA., Amylin Pharmaceuticals, Inc.

Why did patients stop treatment? Their answers revealed a need
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Lack of effectiveness (volunteered)
Dosing regimen too complicated
Did not lose weight
Too expensive
Side effects (volunteered)
Additional injections required
Potentially 57% of reasons for discontinuation can be addressed with
additional education/realistic expectations
Source:
Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.

To develop our program, we started with the Return on EducationTMapproach
10
Program
Development and
Refinement
Pre (In Planning)
Uncover Insights
Develop Objectives
Launch

Program objectives were based on behavior-change principles
Set realistic expectations at the beginning of treatment
Build problem-solving and communication skills
Increase sense of self-efficacy (“I can do this”)
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Trying to take a walk in patients’ shoes (uncovering insights)
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Starting Pramlintide Therapy
Maintaining Pramlintide Therapy
Healthcare provider knowledge
Realistic expectations
Hope for improvement
Adjustment period/need for flexibility
Insulin/appetite changes
Weight loss
Improved glucose levels, fewer fluctuations
Improved AIC
Perceived benefits of therapy
Increased sense of control of diabetes
Weight loss
Less insulin
Motivators
Motivators
Additional injections
Side effects
Therapy disappointment
Impact of changes on family dynamics
Suboptimal dosing; fewer benefits realized
Life demands
Lack of healthcare provider support and education
Frustration: different routine and considerations
Unanticipated hyperglycemia
Injection burden and treatment complexity
Unexpected side effects
Barriers
Barriers

Behavior models provide a blueprint for program design
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Program designed using Social Cognitive Theory

Designed for clarity by integrating health literacy principles
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“I have challenges accessing, understanding, and using health information “
“One out of 3 Americans have basic or below basic health literacy skills”
Source:
National Center for Education Statistics. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. (NCES 2006-483). http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483.

Applying the Return on EducationTMapproach to develop the program
15
Program
Development and
Refinement
Pre (In Planning)
Uncover Insights
Develop Objectives
Launch

Weight loss
Improved glucose levels, fewer fluctuations
Improved AIC
Perceived benefits of therapy
Increased sense of control of diabetes
Weight loss
Less insulin
In-officestarter kit with demo video
Welcome kit with goal setting and wellness map
Newsletter with expert
and patient interviews
Motivators
Motivators
Share Your Story
Newsletters
Feedback survey
Co-pay card
Co-pay card
Outbound/inbound calls with nurses
24/7 Information and education
Outbound/Inbound calls with nurses
Program design was mapped to insights…
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Additional injections
Side effects
Therapy disappointment
Impact of changes on family dynamics
Suboptimal dosing; fewer benefits realized
Life demands
Lack of health care provider support and education
Barriers
Barriers

To create a holistic, integrated experience
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In-officestarter kit with demo video
Welcome kit with goal setting and wellness map
Newsletter with expert
and patient interviews
Share Your Story
Newsletters
Feedback survey
Co-pay card
Co-pay card
Outbound/inbound calls with nurses
Outbound/Inbound calls with nurses

Outcomes of a Behaviorally Based Program

Did the Return on EducationTMapproach work?
19
Program
Development and
Refinement
Pre (In Planning)
Uncover Insights
Develop Objectives
Launch

Education Impact
Return on EducationTMframework guided the evaluation plan
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Desired Action
Persuasion
Behavior Change Model Metrics
Change in Knowledge
Change in Attitudes
Change in Skills
+
Clarity
Clear by Design
+
Tone
Relevance
Accuracy of Information
+
Satisfaction
Appeal
Usefulness
Needs Met
Impact
Intended/Actual use of materials
Examples include
Screening/diagnosis
Talking with HCP
Fill initial Rx
Conversion
Use of device
Program
Engagement
Reach
Frequency
Enrollment
Channel preference
Site visits
Business
Length on therapy
Increased sales
Rep access
Market expansion
Health Outcomes
Symptom alleviation
HEDIS measurement
Function
Clinical measures

Program was relevant
75%: same or more vs. 11% less
Q: Would you like to have more, less or about the same: Information about organizing my medicines
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75% of respondents want the same or more level of information about organizing their medicines
Source:
Data on file. San Diego, CA., Amylin Pharmaceuticals, Inc.

Program had high appeal
71% of respondents want the same or more tools for talking with their HCP
71%: same or more vs. 13% less
Q: Would you like to have more, less or about the same: Tools for talking with my HCP
Source:
Data on file. San Diego, CA, Amylin Pharmaceuticals, Inc.

Program was useful
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Percentage of Patients
The same/longer duration of calls
The same/more frequent diabetes information
The same/more frequent contact
The same/more frequentnewsletters
Patients Wanted:
Source:

Prompted patients to talk with their HCPs
Most respondents agree that the program helps them talk with their HCPs
Q: The Support Program has helped me talk with my HCP about my pramlintide treatment
Source:
Data on file. San Diego, CA, Amylin Pharmaceuticals, Inc.
24

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Percentage of Patients
Patients Reported:
High self-reported compliance and persistency
On and continuing therapy the first 3 months
Administration of maintenance dose
Dosing 2 or 3 times daily
Source:

Improvements were demonstrated
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Patients in program were on pramlintide 50% longer relative to those not in program
Source:

Program refinement based on analysis

Using the Return on EducationTMapproach to refine
©2011 HealthEd Group, Inc.
28
Program
Development and
Refinement
Pre (In Planning)
Uncover Insights
Develop Objectives
Launch

Teachable moments shouldn’t be missed
Web enrollments make up 50% of enrollees and often occur outside of business hours of call center.
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Video-based FAQs feature call center nurse
Video on BRAND.com creates continuity and familiarity

Educational game developed to address confusion about Major Meals
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Brand
Brand
Brand.

One barrier and motivator still had to be addressed
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Weight loss
Motivators
Lack of healthcare provider support and education
Barriers

A challenge and opportunity for you

You can use the Return on EducationTMapproach to createa solution that promotes action and change
33
Program
Development and
Refinement
Pre (In Planning)
Uncover Insights
Develop Objectives
Launch

Education Impact
Desired Action
And evaluate your Return on EducationTM
6/21/2011
34
Examples include
Screening/diagnosis
Talking with HCP
Fill initial Rx
Conversion
Use of device
Persuasion
+
Clarity
+
+
Program
Engagement
Reach
Frequency
Business
Length on therapy
Increased sales
Rep access
Health Outcomes
Symptom alleviation
HEDIS measurement
Function
Clinical measures

This is a complicated recipe
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What patients have to manage day to day can also be complicated
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“My Day”

Retention ratesof different learning styles1
Hands On
90%
Within just a few minutes of leaving the doctor’s office, patients may remember less than 50% of the critical information the doctor shared.2
Discussion
60%-70%
Audiovisual
40%-50%
Seeing
HearRead
Digital solutions can help make learning more effective
37
10%-20%
5%-15%
HCP Office Visit
1. Adapted from Edgar Dale’s “Cone of Experience.
2. Davis TC, Williams MV, Marin E, Parker RM, Glass J. Health literacy and cancer communication. CA Cancer J Clin. 2002;52:134-149.

Which can lead to positive health outcomes
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“My Health”

Thank you!
Time for your questions
6/21/2011

To contact us
Susan LaRue Susan.LaRue@amylin.com
Susan Eno Collins s.collins@healthed.com
To obtain a copy of this presentation, go to www.healthed.com
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HealthEd and Amylin EXL Digital Pharma West 2011

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HealthEd and Amylin EXL Digital Pharma West 2011 — Presentation Transcript