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Medical Sample 10


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Medical Sample 10

  2. 2. Pete Toogood Inspra UK Market Senior Marketing Research Update Researcher
  3. 3. Doctor Aims: Move TOWARD AWAY FROM TOWARD • Death/preventable death (short term) • Appropriate medication • 2nd MI, LV damage/negative remodelling, – Symptom relief and patient feels better heart failure – Improve prognosis – EBM/protocols: polypharmacy • Blame/feeling bad because something – IV to oral, titrate to maximum tolerated dose was not done/missed something • Acting early (whilst damage is still reversible) • Uncertainty • Preserving muscle/salvaging myocardium • Breathlessness, oedema • Improvement in condition • Restriction of activity/poor QOL • Additional benefits of added treatments • Side effects/upsetting haemodynamics by • Doing everything possible adding drugs/increasing doses • Mobilised patient who feels better/freedom • Renal failure • Good Doctor/patient relationship • Smoking; Poor diet/obesity • Happy collaborative patient: understands, • Re-admission to hospital compliant, proactive re: lifestyle
  4. 4. “Success” is: Improving mortality, morbidity, prognosis Symptom resolution: breathlessness, swollen ankles, Minimise risk of future chest pain events + readmission Saving difficult patient: especially if close to death, Prescribing optimum doses cardiogenic shock of all drugs on protocol “ticked all the right boxes” Minimising LV damage: able to act whilst damage reversible SUCCESS Improved QOL: getting Established diagnosis and patients mobile, back to cause of HF: nothing missed ‘normal’, optimise capacity Address all Well informed patients who modifiable risk factors are managing their lifestyle because of your education Bring order to chaos: Dx, plan, simplify complex condition
  5. 5. Patient Aims/Fears Need to feel Anxious, scared, Will I die? I don’t want it Chest pain, to happen again? What breathlessness, tired better/less ill frightened are Drs going to do? Need for reassurance Devastated, depressed and hope Best is being done, no further Why did it happen? events, can regain normal life How will it affect mylifestyle/ AIMS/ family/job? How long will I have to stay in hospital? FEARS Need to Denial/angry understand Why so many tablets? What has happened? Why so many tubes/people? To get home, back to normal (work, holidays, sex, driving), Confused be a person again, not a patient
  6. 6. Patients For “Best” Management PATIENT MOTIVATIONS FOR “BEST” TREATMENT CHARACTERISTICS Age - chronological Young: increased benefits to extending life expectancy; potential to be → disabled longer Age - biological Young/fewer comorbidities/more active: more emotive but also → rational re: contraindications and side effects Life Status → Breadwinner: has family so may have more concerns Number of MI events 1ST MI: prevention better than cure so likely to be more aggressive, especially if young → 2+ MIs: worse prognosis; likely to have some LV damage, may already be on max dose of protocol-led drugs; more likely to feel need to be seen to do something else/new Patient Education Level of Education: more likely to understand and appreciate role of → each drug and thereby comply on Tx – doctor may have more empathy toward these patients NB. Best = more ‘aggressive’/earlier tx
  7. 7. Patient Type: Quotes “A young patient with the worst prognosis, they ’re the ones you relate to most... If they are well “There are groups of patients you feel beholden to… if educated, bright, alert, interested, you are bound you are 50 and you have a big infarct the chances are to explain more to them and think more about everything else is working all right, and you have got what you are doing. ” the wife and 2 little kids and the job, and you thought Cardiologist: ACS you had another 30 years of happy life tolook forward to…you really feel you ought to be doing more. ” Cardiologist: ACS “I think patients with severe obesity, they often have multiple health problems… we probably don’t manage these individuals as we ought to as we tend to blame the obesity.” General Physician: CCU “You are more aggressive with some patients – partly to do with age, quality of life and first event, as they are more likely to be in a position where you can do so much more for them.” “By definition the 2nd MI means you’ve not been General Physician: CCU as successful. You need to think about doing something more for the patient.” Cardiologist: ACS
  8. 8. Customer Types • Follow protocols as audited • Spend time explaining to on these patient • Doing right thing/tick • QOL vs life expectancy: all boxes Protocol fewer drugs/lower doses • Less likely to give Inspra Patient as no ‘tick box’ for this? driven driven • Meeting Govt targets (majority) • Minimises risk for doctor if adverse event occurs (“blame culture”) – likely to • Aggressive Rx approach give more drugs up to limits of protocol? Personal • May consider Rx outside challenge protocol • More likely to be more junior/Gen. Phys? Outcome • More likely to Rx Inspra? driven • Aggressive Rx approach • May continue to do all for patient rather than accepting death as outcome (life expectancy vs QOL) • Likely to give more drugs?
  9. 9. Laddering: Outcome Driven Value Death is devastating to relatives, especially if patient was enjoying life had a family to support and an important job Live longer Patient more likely to comply Consequences Better quality of life Attribute Feel better
  10. 10. Laddering: Professional Recognition/ Personal Challenge Value Professional recognition, everybody talking about it Feel powerful, important Feel excited Consequences “Done wonderful job” Patient/family impressed Attribute Survival benefits