The document discusses perceptions of value and relationships among biopharmaceutical stakeholders. It finds that key stakeholders have different definitions of "value" in healthcare, with outcomes being a more important part of biopharma executives' definitions compared to other groups. Physicians are widely perceived as adding the most value to healthcare. While stakeholders generally agree on the benefits of prescription medications, managed care executives are less convinced of patients' spending on medications being worth it. The document also examines stakeholders' perceptions of each other's effectiveness in areas like patient education and understanding needs. Most groups feel patients can do more to improve health behaviors and outcomes.
Pharmaceutical marketing aims to educate consumers and healthcare professionals about new treatments. While some question the value of marketing, it plays an important role in disseminating medical information. Recent changes include voluntary principles for direct-to-consumer ads and a strengthened industry code of ethics. Studies show marketing helps address underdiagnosis and undertreatment by raising disease awareness and prompting patients to see doctors. However, most physicians say clinical knowledge and patient needs strongly influence prescribing over marketing.
Pharmaceutical marketing to healthcare providers provides information on new treatment options, but it is only one of many factors that influence prescribing decisions. Surveys find clinical knowledge, patient factors, and insurance policies have greater impacts. Approximately 67% of US prescriptions are for generic drugs, much higher than other countries. While representatives provide information, prescribing is shaped more by clinical guidelines, peers, formularies, and insurers' prior authorization requirements than representative interactions.
The document discusses perspectives on risk from various healthcare stakeholders. It finds that while stakeholders generally expect longer lifespans, opinions diverge on expectations for curing diseases like cancer. U.S. payers and biopharma executives are less optimistic than others about cost-effective healthcare. Patients want information on medication benefits but are less confident in understanding risks. Both U.S. and U.K. patients want new drugs faster but many also think approval processes don't adequately balance safety. Stakeholders must work together to better understand differing views of risk.
New Health Report 2012 - Media Briefing Deck Quintiles
The document summarizes the key findings of the 2012 New Health Report survey conducted by Quintiles. The survey gathered responses from over 1,350 stakeholders in the biopharmaceutical industry, managed care organizations, investors, and patients in the US and UK. The report found that stakeholders have differing views on risk tolerance and perceptions of healthcare quality. It also found that current tools for assessing risk are limited and better data is needed. Overall, the report aims to foster collaboration between stakeholders to improve innovation in pharmaceutical development and delivery.
The document discusses point-of-care patient recruitment programs that can help pharmaceutical companies address challenges in clinical trial recruitment. It notes that physicians are the most trusted source of healthcare information and that over 50% of clinical trial participants join at their doctor's suggestion. SMI offers programs that create physician endorsement for clinical trials by providing branded materials for exam rooms and waiting areas, which has led to increased patient interest and enrollment in various case studies described.
This document discusses outcomes-based contracts between pharmaceutical companies and payers. It provides background on rising healthcare costs, describes the benefits of outcomes-based contracts for stakeholders, and gives examples of existing contracts linked to outcomes like reduced hospitalizations or reaching clinical targets. The document also outlines challenges, keys to success, and potential future applications in areas like specialty medications.
Consumer health: time for a regulatory re-think? is a report by RB in association with PAGB, written by the Economist Intelligence Unit. It looks at the changing healthcare environment and the role self-care plays and efforts at regulatory harmonisation, the barriers they have encountered, and prospects for the future.
Building Patient-Centeredness in the Real World: The Engaged Patient and the ...EngagingPatients
This paper examines the separate but intertwined ethical, economic and clinical concepts of patientcenteredness and how ACOs provide a structure for turning those concepts into a functioning reality.
Pharmaceutical marketing aims to educate consumers and healthcare professionals about new treatments. While some question the value of marketing, it plays an important role in disseminating medical information. Recent changes include voluntary principles for direct-to-consumer ads and a strengthened industry code of ethics. Studies show marketing helps address underdiagnosis and undertreatment by raising disease awareness and prompting patients to see doctors. However, most physicians say clinical knowledge and patient needs strongly influence prescribing over marketing.
Pharmaceutical marketing to healthcare providers provides information on new treatment options, but it is only one of many factors that influence prescribing decisions. Surveys find clinical knowledge, patient factors, and insurance policies have greater impacts. Approximately 67% of US prescriptions are for generic drugs, much higher than other countries. While representatives provide information, prescribing is shaped more by clinical guidelines, peers, formularies, and insurers' prior authorization requirements than representative interactions.
The document discusses perspectives on risk from various healthcare stakeholders. It finds that while stakeholders generally expect longer lifespans, opinions diverge on expectations for curing diseases like cancer. U.S. payers and biopharma executives are less optimistic than others about cost-effective healthcare. Patients want information on medication benefits but are less confident in understanding risks. Both U.S. and U.K. patients want new drugs faster but many also think approval processes don't adequately balance safety. Stakeholders must work together to better understand differing views of risk.
New Health Report 2012 - Media Briefing Deck Quintiles
The document summarizes the key findings of the 2012 New Health Report survey conducted by Quintiles. The survey gathered responses from over 1,350 stakeholders in the biopharmaceutical industry, managed care organizations, investors, and patients in the US and UK. The report found that stakeholders have differing views on risk tolerance and perceptions of healthcare quality. It also found that current tools for assessing risk are limited and better data is needed. Overall, the report aims to foster collaboration between stakeholders to improve innovation in pharmaceutical development and delivery.
The document discusses point-of-care patient recruitment programs that can help pharmaceutical companies address challenges in clinical trial recruitment. It notes that physicians are the most trusted source of healthcare information and that over 50% of clinical trial participants join at their doctor's suggestion. SMI offers programs that create physician endorsement for clinical trials by providing branded materials for exam rooms and waiting areas, which has led to increased patient interest and enrollment in various case studies described.
This document discusses outcomes-based contracts between pharmaceutical companies and payers. It provides background on rising healthcare costs, describes the benefits of outcomes-based contracts for stakeholders, and gives examples of existing contracts linked to outcomes like reduced hospitalizations or reaching clinical targets. The document also outlines challenges, keys to success, and potential future applications in areas like specialty medications.
Consumer health: time for a regulatory re-think? is a report by RB in association with PAGB, written by the Economist Intelligence Unit. It looks at the changing healthcare environment and the role self-care plays and efforts at regulatory harmonisation, the barriers they have encountered, and prospects for the future.
Building Patient-Centeredness in the Real World: The Engaged Patient and the ...EngagingPatients
This paper examines the separate but intertwined ethical, economic and clinical concepts of patientcenteredness and how ACOs provide a structure for turning those concepts into a functioning reality.
Why Pharmaceutical Prices are Rising and How We Can Fight Against Them?Cedric Dark
Pharmaceutical prices are rising due to minimal government regulation, lack of competition, end of generic drugs wave, supply disruptions and industry consolidation. This leads to increased healthcare costs, formulary changes, nonadherence and rationing of medications. Possible solutions include increasing price transparency, competition, importing drugs from other countries, and legislation prohibiting pay-for-delay deals. Harris Health implemented cost control strategies like a closed formulary, therapeutic substitutions, and patient assistance programs, achieving over $60 million in savings and cost avoidance in fiscal year 2016.
Medication Adherence is a pressing issue in the healthcare setting. New advances in technology using mobile apps and smart devices are now changing the way we approach assessing patients medication adherence. However, this shift also allows a new chance to be engaged with patients regarding their medications and offers the opportunity to be more aware of medication related issues.
This document summarizes information from PORTAL (Program On Regulation, Therapeutics, And Law) about prescription drug prices and value in the US. It notes that prescription drug spending has risen significantly in recent years due largely to high prices of brand name drugs. However, drug prices do not reflect true value, as the FDA approval process does not consider value, payors have limited ability to exclude low-value drugs, and physicians are not required to consider value when prescribing. Potential solutions discussed include value-based contracts, systematic assessment of drug value, and policy changes to promote value-based prescribing.
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
Comparative Effectiveness Research CER: A New Current In Pharmaceutical Bran...JGB1
The document discusses the rise of pharmaceutical comparative effectiveness research (CER) in the United States. CER provides insight into the clinical and cost effectiveness of different drug therapies. It is being driven by growing government and private payer interest in justifying healthcare costs. The federal government is a major funder of CER through agencies like AHRQ and NIH. For pharmaceutical companies, demonstrating strong CER performance can help gain preferred formulary placement and market position, while poor performance may disadvantage a drug. The document outlines considerations for a pharmaceutical brand to conduct its own pilot CER study to evaluate its drug against competitors.
This document summarizes the evolution and current state of emergency medicine clinical pharmacists internationally. It describes how their role has expanded from medication distribution to active clinical roles on multidisciplinary teams. Studies show emergency medicine pharmacists can reduce medication errors, mortality, readmissions, and improve time to appropriate treatments. While initially confined to North America, their benefits are now reported internationally. More evidence is still needed on reducing adverse drug events, but existing data shows emergency medicine pharmacists improve patient outcomes and reduce costs.
This Atrium Health study and pilot program revealed healthcare savings potential resulting from a tailored approach to medication adherence and specialty drug programs.
Patient partnership is increasingly seen as a core strategy for competitive advantage and survival in healthcare. While compliance programs were once sufficient, adherence is now a strategic issue as patients are better informed and have higher expectations. Tactical programs alone are no longer sufficient - companies must plan for long-term strategic dominance through true patient partnerships. The evolution of adherence programs has progressed from presentation-driven to pharmacy-driven, pharmacovigilence-driven, and now to partnership-driven programs that are patient-focused and go beyond just the medical treatment. Organizational change is needed for companies to fully embrace patient-centricity as a leadership priority.
This document discusses regulatory inefficiencies surrounding companion diagnostics and laboratory developed tests (LDTs) in the United States. It uses the case study of Genentech's drug MPDL3280A and its companion diagnostic to show that the FDA thoroughly regulates companion diagnostics but provides no oversight of clinical validity for LDTs. This allows multiple competing diagnostic tests to be used without proof of efficacy. The document also compares healthcare systems and technology assessment processes in the US, UK, and France to illustrate decentralized decision making in the US compared to centralized bodies in other countries.
This document summarizes a presentation on workers' compensation policy issues and solutions related to opioids. It includes discussions from three presenters on topics like the Ohio Bureau of Workers' Compensation pharmacy program, physician dispensing of opioids, and policy reforms. The Ohio BWC program presentation describes the program's formulary changes from 2011-2014 to curb opioid utilization and other drug spending. It also evaluates the program's impact on reducing opioid prescriptions and medical costs. The physician dispensing presentation examines the financial incentives for dispensing and higher claim costs when physicians dispense opioids. It advocates for legislative reforms to curb dispensing to improve outcomes.
Specialty Pharmacy and Oral Chemotherapies – Jorge J. Garcia Pharm D, MS, MHA...flasco_org
The document discusses specialty pharmaceuticals, which treat complex chronic conditions at a high cost. Specialty pharmaceutical spending was $92.2 billion in 2013 and is expected to reach $110 billion by 2014. The top disease states for specialty drugs are oncology, autoimmune disorders, and respiratory conditions. Specialty pharmacies provide services like benefits investigation, prior authorizations, and clinical case management. Health systems can establish specialty pharmacies to better coordinate patient care, reduce costs from ER visits and readmissions, and leverage existing payer contracts and infrastructure. Specialty pharmacies require investments in licensing, technology, staffing and training but can generate over $200 million annually in prescription volume.
- Surgical site infections (SSIs) develop in 2-5% of surgical patients annually in the US, accounting for 14-16% of all hospital-acquired infections and 3% of surgical mortality. They increase costs by $29,000 per patient on average.
- A survey of 103 healthcare professionals found that most facilities have protocols for preoperative skin cleansing, though compliance levels vary. The majority use chlorhexidine gluconate (CHG) products and require two or more applications.
- Improving patient education and compliance was cited as the most significant obstacle to reducing SSIs. Less than 10% of facilities used digital reminders or referred patients to informational websites.
This infographic speaks to the challenges Emergency Departments face in caring and following up with the growing population of patients they see, and demonstrates how some EDs are seeing measurable improvements in care, patient satisfaction and efficiency.
Rebecca M. Shanahan, CEO of Avella Specialty Pharmacy presents on Specialty Pharmacy at Retail Pharmacy at the 2014 Armada Summit. Learn more about Avella and connect with your local rep if you have any questions. http://www.avella.com/
Healthcare is Getting Disrupted... Is Pharmacy Ready?Hillary Blackburn
Change is coming for the healthcare industry, particularly as digital disruption is happening. Within the broader healthcare industry, pharmacy will be impacted and should be ready to help the profession grow and thrive.
United Arab Emirates Pharmacists’ Practices and Views on Adverse Drug Reactio...iosrjce
Adverse drug reactions (ADRs) constitute a huge burden on health systems, and medication errors
(MEs) are the most common preventable cause of adverse drug events. In developed countries pharmacists
contribute to a great extent in ADR monitoring and reporting, improving patient quality of care and safety. This
review aims to explore pharmacists’ practices and views on ADR reporting, extent and causes of MEs and other
health professionals expectations of pharmacists in this regards. An extensive literature search was conducted
using pertinent electronic health databases (ProQuest, PubMed, Embase, and International Pharmaceutical
Abstracts, and the Cumulative Index to Nursing & Allied Health Literature). Hand-searching of the references
retrieved was also performed. Very few studies were found, none report the prevalence or severity of MEs.
Under-reporting of ADRs is common place among community pharmacists in the UAE. Overall physicians
expressed positive views about clinical pharmacists’ role in medication reviews to identify and prevent drug
interactions and improve patients’ clinical outcomes. More research is required to enhance ADR reporting and
reduce MEs in the UAE. Training about the process of ADR monitoring and reporting at undergraduate level
across health science disciplines and continued education and development led by pharmacists is vital to
improve patient safety.
Kristin Gourlay: "What Soaring Drug Prices Mean for Patients," 9.3.15reportingonhealth
Kristin Gourlay's presentation from "What Soaring Drug Prices Mean for Patients," 9.3.15
http://www.reportingonhealth.org/content/what-soaring-drug-prices-mean-patients
This document discusses empowering patients to take a more active role in drug discovery and development. It notes that for many rare diseases, the science is incomplete and drug development is slow. However, patient organizations are already leading many scientific and medical advances. The document advocates for a more collaborative approach where patients work with researchers and companies. It presents examples where patient groups have helped identify new patients, generated data to help trials, and invested in research. It argues that patients need more access to tools and technologies to drive diagnosis and drug development themselves for ultra-rare diseases. An envisioned "23andMe of drug development" could help facilitate this.
This document provides an overview of a 10-session training module for customer service representatives. Session 1 focuses on teaching proper American accent rules, introducing others, using correct verb tenses, and holding conversations. Students practice these skills through roleplays and simulations. The document outlines learning objectives, preparation exercises, and assessment tools to evaluate student progress.
Why Pharmaceutical Prices are Rising and How We Can Fight Against Them?Cedric Dark
Pharmaceutical prices are rising due to minimal government regulation, lack of competition, end of generic drugs wave, supply disruptions and industry consolidation. This leads to increased healthcare costs, formulary changes, nonadherence and rationing of medications. Possible solutions include increasing price transparency, competition, importing drugs from other countries, and legislation prohibiting pay-for-delay deals. Harris Health implemented cost control strategies like a closed formulary, therapeutic substitutions, and patient assistance programs, achieving over $60 million in savings and cost avoidance in fiscal year 2016.
Medication Adherence is a pressing issue in the healthcare setting. New advances in technology using mobile apps and smart devices are now changing the way we approach assessing patients medication adherence. However, this shift also allows a new chance to be engaged with patients regarding their medications and offers the opportunity to be more aware of medication related issues.
This document summarizes information from PORTAL (Program On Regulation, Therapeutics, And Law) about prescription drug prices and value in the US. It notes that prescription drug spending has risen significantly in recent years due largely to high prices of brand name drugs. However, drug prices do not reflect true value, as the FDA approval process does not consider value, payors have limited ability to exclude low-value drugs, and physicians are not required to consider value when prescribing. Potential solutions discussed include value-based contracts, systematic assessment of drug value, and policy changes to promote value-based prescribing.
March 02, 2018
Value-based health care is one of the most pressing topics in health care finance and policy today. Value-based payment structures are widely touted as critical to controlling runaway health care costs, but are often difficult for health care entities to incorporate into their existing infrastructures. Because value-based health care initiatives have bipartisan support, it is likely that these programs will continue to play a major role in both the public and private health insurance systems. As such, there is a pressing need to evaluate the implementation of these initiatives thus far and to discuss the direction that American health care financing will take in the coming years.
To explore this important issue, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School collaborated with Ropes & Gray LLP to host a one-day conference on value-based health care. This event brought together scholars, health law practitioners, and health care entities to evaluate the impact of value-based health care on the American health care system.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/will-value-based-care-save-the-health-care-system
Comparative Effectiveness Research CER: A New Current In Pharmaceutical Bran...JGB1
The document discusses the rise of pharmaceutical comparative effectiveness research (CER) in the United States. CER provides insight into the clinical and cost effectiveness of different drug therapies. It is being driven by growing government and private payer interest in justifying healthcare costs. The federal government is a major funder of CER through agencies like AHRQ and NIH. For pharmaceutical companies, demonstrating strong CER performance can help gain preferred formulary placement and market position, while poor performance may disadvantage a drug. The document outlines considerations for a pharmaceutical brand to conduct its own pilot CER study to evaluate its drug against competitors.
This document summarizes the evolution and current state of emergency medicine clinical pharmacists internationally. It describes how their role has expanded from medication distribution to active clinical roles on multidisciplinary teams. Studies show emergency medicine pharmacists can reduce medication errors, mortality, readmissions, and improve time to appropriate treatments. While initially confined to North America, their benefits are now reported internationally. More evidence is still needed on reducing adverse drug events, but existing data shows emergency medicine pharmacists improve patient outcomes and reduce costs.
This Atrium Health study and pilot program revealed healthcare savings potential resulting from a tailored approach to medication adherence and specialty drug programs.
Patient partnership is increasingly seen as a core strategy for competitive advantage and survival in healthcare. While compliance programs were once sufficient, adherence is now a strategic issue as patients are better informed and have higher expectations. Tactical programs alone are no longer sufficient - companies must plan for long-term strategic dominance through true patient partnerships. The evolution of adherence programs has progressed from presentation-driven to pharmacy-driven, pharmacovigilence-driven, and now to partnership-driven programs that are patient-focused and go beyond just the medical treatment. Organizational change is needed for companies to fully embrace patient-centricity as a leadership priority.
This document discusses regulatory inefficiencies surrounding companion diagnostics and laboratory developed tests (LDTs) in the United States. It uses the case study of Genentech's drug MPDL3280A and its companion diagnostic to show that the FDA thoroughly regulates companion diagnostics but provides no oversight of clinical validity for LDTs. This allows multiple competing diagnostic tests to be used without proof of efficacy. The document also compares healthcare systems and technology assessment processes in the US, UK, and France to illustrate decentralized decision making in the US compared to centralized bodies in other countries.
This document summarizes a presentation on workers' compensation policy issues and solutions related to opioids. It includes discussions from three presenters on topics like the Ohio Bureau of Workers' Compensation pharmacy program, physician dispensing of opioids, and policy reforms. The Ohio BWC program presentation describes the program's formulary changes from 2011-2014 to curb opioid utilization and other drug spending. It also evaluates the program's impact on reducing opioid prescriptions and medical costs. The physician dispensing presentation examines the financial incentives for dispensing and higher claim costs when physicians dispense opioids. It advocates for legislative reforms to curb dispensing to improve outcomes.
Specialty Pharmacy and Oral Chemotherapies – Jorge J. Garcia Pharm D, MS, MHA...flasco_org
The document discusses specialty pharmaceuticals, which treat complex chronic conditions at a high cost. Specialty pharmaceutical spending was $92.2 billion in 2013 and is expected to reach $110 billion by 2014. The top disease states for specialty drugs are oncology, autoimmune disorders, and respiratory conditions. Specialty pharmacies provide services like benefits investigation, prior authorizations, and clinical case management. Health systems can establish specialty pharmacies to better coordinate patient care, reduce costs from ER visits and readmissions, and leverage existing payer contracts and infrastructure. Specialty pharmacies require investments in licensing, technology, staffing and training but can generate over $200 million annually in prescription volume.
- Surgical site infections (SSIs) develop in 2-5% of surgical patients annually in the US, accounting for 14-16% of all hospital-acquired infections and 3% of surgical mortality. They increase costs by $29,000 per patient on average.
- A survey of 103 healthcare professionals found that most facilities have protocols for preoperative skin cleansing, though compliance levels vary. The majority use chlorhexidine gluconate (CHG) products and require two or more applications.
- Improving patient education and compliance was cited as the most significant obstacle to reducing SSIs. Less than 10% of facilities used digital reminders or referred patients to informational websites.
This infographic speaks to the challenges Emergency Departments face in caring and following up with the growing population of patients they see, and demonstrates how some EDs are seeing measurable improvements in care, patient satisfaction and efficiency.
Rebecca M. Shanahan, CEO of Avella Specialty Pharmacy presents on Specialty Pharmacy at Retail Pharmacy at the 2014 Armada Summit. Learn more about Avella and connect with your local rep if you have any questions. http://www.avella.com/
Healthcare is Getting Disrupted... Is Pharmacy Ready?Hillary Blackburn
Change is coming for the healthcare industry, particularly as digital disruption is happening. Within the broader healthcare industry, pharmacy will be impacted and should be ready to help the profession grow and thrive.
United Arab Emirates Pharmacists’ Practices and Views on Adverse Drug Reactio...iosrjce
Adverse drug reactions (ADRs) constitute a huge burden on health systems, and medication errors
(MEs) are the most common preventable cause of adverse drug events. In developed countries pharmacists
contribute to a great extent in ADR monitoring and reporting, improving patient quality of care and safety. This
review aims to explore pharmacists’ practices and views on ADR reporting, extent and causes of MEs and other
health professionals expectations of pharmacists in this regards. An extensive literature search was conducted
using pertinent electronic health databases (ProQuest, PubMed, Embase, and International Pharmaceutical
Abstracts, and the Cumulative Index to Nursing & Allied Health Literature). Hand-searching of the references
retrieved was also performed. Very few studies were found, none report the prevalence or severity of MEs.
Under-reporting of ADRs is common place among community pharmacists in the UAE. Overall physicians
expressed positive views about clinical pharmacists’ role in medication reviews to identify and prevent drug
interactions and improve patients’ clinical outcomes. More research is required to enhance ADR reporting and
reduce MEs in the UAE. Training about the process of ADR monitoring and reporting at undergraduate level
across health science disciplines and continued education and development led by pharmacists is vital to
improve patient safety.
Kristin Gourlay: "What Soaring Drug Prices Mean for Patients," 9.3.15reportingonhealth
Kristin Gourlay's presentation from "What Soaring Drug Prices Mean for Patients," 9.3.15
http://www.reportingonhealth.org/content/what-soaring-drug-prices-mean-patients
This document discusses empowering patients to take a more active role in drug discovery and development. It notes that for many rare diseases, the science is incomplete and drug development is slow. However, patient organizations are already leading many scientific and medical advances. The document advocates for a more collaborative approach where patients work with researchers and companies. It presents examples where patient groups have helped identify new patients, generated data to help trials, and invested in research. It argues that patients need more access to tools and technologies to drive diagnosis and drug development themselves for ultra-rare diseases. An envisioned "23andMe of drug development" could help facilitate this.
This document provides an overview of a 10-session training module for customer service representatives. Session 1 focuses on teaching proper American accent rules, introducing others, using correct verb tenses, and holding conversations. Students practice these skills through roleplays and simulations. The document outlines learning objectives, preparation exercises, and assessment tools to evaluate student progress.
StatPro Revolution brochure - Summer 2012StatPro Group
StatPro Revolution is a cloud-based portfolio analytics service that will transform the way you communicate with your clients. It will reduce your operating costs, enhance your productivity, and fuel a critical understanding of portfolio performance with accurate, up to date performance analytics.
The document discusses several proposed configurations for a third wall component of the GERDA experiment. It summarizes the finite element analysis performed to model the seismic behavior of the primary and secondary containment walls connected by stiffening rings. Concerns are raised about using air between the walls rather than water, due to increased seismic loads. Alternative materials like Lexan polycarbonate are discussed, but it is noted this material has a lower yield strength than metals typically used. The role of stiffening rings in structurally connecting the walls and controlling their motion under seismic loads is also addressed.
State Street Corporation is the world's leading provider of financial services to institutional investors. In 2005, State Street achieved its financial goals including 10-15% growth in operating EPS and 8-12% growth in operating revenue. It delivered value to shareholders, customers, employees and communities. State Street added over 2,000 new investment wins in 2005 and continued to deepen relationships with existing customers around the world.
This document provides an itinerary for a 14 day trip to Italy, including stops in Milan, Venice, Florence, and Rome. Key points of interest are highlighted for each city, along with recommended hotels, tours, and modes of transportation between locations. The conclusion notes that while Italy offers many affordable attractions and activities, city centers can become crowded, especially in Rome during the summer months. Spending less than 3 days in major cities like Rome and Florence is not recommended due to the amount to see and do.
This document provides an alternative to a traditional resume by telling the story of Darryl Heron in 8 sections. It outlines his background and experience living in several cities, his roles as a father and project manager, his experience managing various projects for different companies, his skills in areas like strategic thinking and communication, and his involvement in social media and organizations like Toastmasters. The document aims to give a fuller picture of Darryl beyond just work experience on a single page.
Actitudes ciudadanas ante la utilización de internet como medio de comunicación con el médico
Citizens' attitudes using Internet for communication with physicians
Granada, SADECA. 22 de noviembre de 2013
Linealuce is iGuzzini's high performance linear lighting system for enhancing indoor and outdoor environments. It provides architectural accent lighting and comes in surface-mounted and recessed versions with a variety of optic options. iGuzzini is an international lighting company focused on social innovation through responsible lighting design that improves quality of life. Linealuce uses high-quality LEDs and control systems to create versatile and energy-efficient lighting solutions.
This document summarizes data from over 100,000 workplace effectiveness surveys conducted by Leesman. It finds that workplaces in the top 15 performing locations by Leesman's Index had 43% of employees agreeing the workplace enabled productivity, while the bottom 15 locations had only 23% agreement. Certain activities like planned meetings and collaborating were considered more important and better supported in top locations. The data comes from responses of over 122,500 employees across 1,000 locations in 49 countries, representing a diverse range of industries, genders, ages, and other factors.
Este documento descreve os planos para uma associação portuguesa para paraplégicos, incluindo sua missão de apoiar e acompanhar pessoas com deficiência motora. Ele detalha as atividades planejadas como boccia e rugby em cadeiras de rodas, além de recursos, especialistas e instalações necessários para fornecer cuidados adequados.
O documento discute os custos associados à manutenção de software, destacando que 44% dos custos são gastos em adaptações para atender novas necessidades. Além disso, a densidade de defeitos esperada aumenta exponencialmente com o tamanho do sistema, exigindo maiores investimentos em testes e qualidade. Manter a qualidade em sistemas complexos envolve custos recorrentes significativos.
Este documento presenta el equipamiento disponible para la moto BMW R 1200 RT, incluyendo bolsas, maletas y mochilas para transportar equipaje y proteger la moto. Se describen varias opciones como bolsas interiores, topcases grandes y pequeños, mochilas, bolsas tubo y accesorios para fijar el equipaje de manera segura. El documento proporciona detalles como capacidades, materiales e incluye precios de las diferentes piezas.
Presentation by the BBC's Head of Audience Experience & Usability, Jonathan Hassell and Chris Rourke, MD of User Vision (www.uservision.co.uk) on the benefits of usability and accessibility research for the web, and other media platforms. Presented at Internet World, London, April 2009
This document provides an overview of SpiraPlan, an agile project management software. It discusses the challenges of traditional waterfall project management approaches and how agile methodologies address these issues. SpiraPlan is presented as a complete agile project management solution that integrates requirements management, release planning, iteration planning, task tracking, and bug tracking. The document provides a feature overview and walks through how SpiraPlan supports key agile processes.
British Council - International Career Day 2013 MilanJobadvisor
The document provides information about English language certification exams offered by the British Council in Italy. It discusses the Common European Framework levels of exams like PET and FCE and explains the four skills (reading, writing, listening, speaking) assessed. It provides details on exam formats, tasks, and scoring criteria. Sample writing and speaking tasks are presented to illustrate the requirements. Resources for exam preparation are also listed.
Chief Technology Officer, Matt Stannard, and Digital Account Executive, Lovedeep Jassad, demonstrated the difference between Google analytics and Universal analytics at 4Ps annual conference, Digital EDGE #4PsEDGE.
The document discusses risks and safety factors associated with lithium batteries. It covers common causes of external and internal battery faults, such as external short circuits, too high discharge or charge currents, pole reversal, charging primary batteries incorrectly, and internal short circuits. The document also discusses safety risks specifically for primary lithium batteries and rechargeable lithium-ion batteries. Integrated safety components and protection circuits aim to prevent battery faults from resulting in overheating, fire or explosion.
The document discusses perceptions of value in healthcare among various stakeholders. It finds that stakeholders define value differently, with biopharma being the only group where a majority includes outcomes in their definition. Nearly a third of patients cannot define value. When given choices, stakeholders consistently ranked patient outcomes and safety as most important in determining the value of prescription medications. While most agree medications improve health, managed care executives were least convinced that the money patients spend is worth it.
The New Health Report 2011 - BackgrounderQuintiles
The New Health Report 2011 is a report based on a national survey of biopharmaceutical executives, managed care executives, physicians and patients living with chronic disease conducted by Richard Day Research of Evanston, Ill., on behalf of Quintiles Transnational Corp. Richard Day Research was responsible for all survey design, data analysis and data reporting. Data for this survey were collected between January 5 and February 27, 2011. Included in the sample were 200 biopharmaceutical executives at the director level or above, 153 managed care executives at the director level or above, 400 primary care physicians, 103 board-certified specialists, and 1,000 U.S. adults ages 18+ diagnosed with a chronic health condition who are receiving treatment.
Real-World Evidence: A Better Life Journey for Pharmas, Payers and PatientsCognizant
Driven partly by regulatory pressure, stakeholders in the healthcare ecosystem—including payers and patients—now want real-world evidence (RWE) about wellness to supplement and expand randomized control trial (RCT) input from pharmas about pharmaceuticals' efficacy and effectiveness.
Patient Reported Outcomes (PRO) - Challenge and potential solutions.
Why and how can medical device and pharmaceutical companies, as well as the entire healthcare sector, leverage patient engagement with next-generation ePRO solutions?
Discover our white paper...
Millennial Mindset - Collaborative Clinician [lo res spreads]Amanda Cote Loban
Millennial physicians approach their practice differently than non-millennial physicians. They expect more collaboration with patients, peers, and pharmaceutical companies. They prefer learning about new treatments from their peers rather than independently. While they value the information provided by pharmaceutical companies, most will only consider it as a second opinion after finding information elsewhere first. Millennial physicians want transparency and authenticity from pharmaceutical companies and tools that integrate with their workflow and facilitate peer interaction.
This document discusses insights from a survey of 342 physicians on their perspectives of the pharmaceutical industry. It finds that while recent controversies have eroded public trust in pharma, physicians still see the industry as partners in patient care. However, many physicians feel their decision-making has been constrained by insurers and regulators. The top constraint cited is insurance companies, as their reimbursement policies dictate approved therapies. The FDA is also cited for its narrow drug approvals. Pharma is less blamed, with physicians wanting more open dialogue and information from companies.
The document discusses medication non-adherence and strategies for improving adherence and ensuring safe hospital discharges. It notes that 50% of prescribed medications are not taken correctly and identifies barriers to adherence like cost, side effects, and health literacy. It introduces the Case Management Adherence Guidelines (CMAG) which assess patient knowledge, motivation, and skills to improve adherence using tools like health literacy tests. CMAG provides an algorithm to improve understanding and motivate patients to take medications as prescribed. The document emphasizes the importance of educating patients before discharge to maintain treatment and ensure a safe transition to outpatient care.
This white paper discusses the need for collaboration across stakeholders in oncology care to define value and access to cancer therapies. It notes increasing drug development costs and the need for value-based medicine to provide both enhanced outcomes and lower costs. Real-world evidence from data on patient outcomes is important for evaluating value and informing decisions by regulators, payers and other stakeholders. Accountable care organizations and a shift to more patient-centered, value-based models in the US and globally are changing expectations and incentives around oncology drug development.
Cadth 2015 a5 3 cadth panel pauline mc nulty april 2015 no notesCADTH Symposium
This document discusses the increasing role of patients in drug development and healthcare decision making. It notes that patients want a greater voice in deciding what evidence is required to show drug effectiveness, influencing clinical trial design, and assessing risk/benefit for regulatory approval. PROs (patient-reported outcome measures) are highlighted as a way to systematically capture the patient perspective on symptoms, functioning and quality of life in clinical trials and practice. The example shows how PRO data from rheumatoid arthritis trials demonstrated improvement in daily activities with certain drug treatments.
SHARING VISION – TOWARDS BIOMEDICINE PARTNERSinemet
PharmaCon2007 Congress, Dubrovnik, Croatia "New Technologies and Trends in Pharmacy, Pharmaceutical Industry and Education" http://www.pharmacon2007.com
Abstract is available at http://www.pharmaconnectme.com
- The document discusses a study that assessed the attitudes and behaviors of pharmacy professionals towards patient counseling in Awi Zone, North West Ethiopia.
- The study found that over half of respondents believed counseling is a shared responsibility between pharmacists and physicians. The main reason respondents cited for counseling was improved patient compliance.
- Lack of knowledge and confidence was the primary barrier preventing respondents from counseling patients more. Most respondents felt counseling promotes rational drug use.
Post-Market Research to Create Treatment Guidelines Oriented to Patient Cente...David Selkirk
The document discusses the need for post-market research focused on patient-centered outcomes to develop treatment guidelines. Specifically, it proposes two methodologies: 1) defining treatment algorithms based on symptomatology to determine optimal drug combinations and doses for symptom control, and 2) defining predictors of disease relapse to determine which patients can safely reduce doses. The goal is to provide clinicians and other stakeholders with real-world data on therapies to improve quality of life and inform decision-making.
The document discusses initiatives at Group Health Centre to improve patient care through health information technology innovations. It describes the implementation of an electronic medical record system (EMR XTRA) that allows pharmacists to access patient information, increasing collaboration between pharmacists and physicians. An evaluation found the program improved quality of care by identifying more drug-related problems and increasing medication management recommendations. The document also discusses preparing for electronic prescribing (ePrescribing) to further enhance coordination and safety of patient care.
The document discusses the potential benefits of including clinical pharmacists as active members of medical teams in drug registration clinical trials. It notes that clinical pharmacist involvement in regular medical care has been shown to improve certain clinical outcomes. However, clinical pharmacists are not currently required to have an active role in registration trials, which aim to obtain the best clinical results to ensure drug safety and efficacy. The inclusion of clinical pharmacists in registration trials could help rationalize decision making and potentially improve trial results by reducing issues like undetected toxicity or suboptimal drug selection that cause patients to leave trials early. For these reasons, the document argues that regulatory agencies should require clinical pharmacist participation in new clinical trials.
1) A meta-analysis of survey data from over 21,000 patients with chronic conditions found several key factors that influence patient interest and participation in clinical trials.
2) Health condition, age, gender, treatment satisfaction, awareness of new treatments, and the patient-physician relationship were found to impact a patient's likelihood of interest in clinical trials.
3) In addition to interest, prior clinical trial participation, health condition, treatment satisfaction, and concerns about cost also predicted a patient's actual likelihood of enrolling in future clinical trials if eligible.
The document discusses a report from the NGA that acknowledges pharmacists' scope of practice is restricted by state laws and encourages classifying pharmacists as health care providers to maximize pharmacy services. It summarizes that the report encourages states and private entities to expand what pharmacist services are covered by insurance, state employee health plans, health information exchanges, and Medicaid to allow pharmacists to practice at the full extent of their training.
Real world data is no longer just for those trained in health economics and outcomes research — it can and will touch everyone in the pharma/healthcare space.
CBI asked industry's foremost RWD thought leaders a variety of questions to better understand how bio/pharmaceutical teams can collaborate and capture data in an aggregated form to continue to improve the value of products in development with real world, real-time data.
Real World Data - The New Currency in HealthcareJohn Reites
White paper published in June 2015 by CBI Life Sciences with interview insights from John Reites.
Real World Data (RWD) have become the bio/pharmaceutical industry’s treasure trove for information to inspire stakeholder decision-making. As an industry, professionals have increasingly been looking to RWD to not only assess the bene ts and risks of new medicines in clinical and real world settings, but also as a way to advise healthcare reimbursement decisions worldwide.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Role of Mukta Pishti in the Management of Hyperthyroidism
Quintiles new healthreport_2011
1. Exploring Perceptions of Value and
Collaborative Relationships Among
Biopharmaceutical Stakeholders
2. Exploring Perceptions of Value and
Collaborative Relationships Among
Biopharmaceutical Stakeholders
Overview
Value in Healthcare
Stakeholder Roles and Performance
Future of Healthcare and Medicine
The Patient of Today
Conclusion
About The New Health Report
About Quintiles
Contact Information
3
4
8
14
20
22
23
T a b l e o f Co n t e n t s
3. www.quintiles.com/newhealthreport The New Health Report | 3
Closing perception gaps and multi-stakeholder
collaboration define biopharma’s future
The New Health Report 2011 was commissioned by Quintiles to further explore
sentiment in today’s rapidly changing drug development universe. Within that
universe lies a complex constellation of stakeholders—physicians, payers, patients
and policy-makers—each exercising individual influence within the healthcare
ecosystem that is not necessarily growing, but is certainly shifting. When taken
collectively, however, the unique needs and interconnected responsibilities of these
stakeholders wield an incredible influence on the practice of drug development.
From which therapies are brought to market to the manner in which clinical
research is conducted, this influence presents both a challenge and an opportunity
for the biopharmaceutical industry to involve these stakeholders throughout the
entire development process. To truly foster collaborative relationships, a solid
understanding of the needs and perceptions of all stakeholders provides a starting
point for all groups—particularly biopharma—to ultimately improve patient
outcomes.
The New Health Report 2011 provides further understanding of stakeholder
perceptions toward healthcare and medicine. It is meant to be granular: What do
stakeholders value? What drives these relationships? How and where do they interact?
Last year’s report looked primarily at the relationship between biopharma and payers,
and revealed that a majority of biopharma executives believed that demonstrating
value is their firm’s top priority as the industry changes. This report further examines
the concept of value. It finds that there are vast differences in how key stakeholders
define value in healthcare, as well as additional gaps in how they perceive other
members of the system.
These perception gaps suggest that key stakeholders need to be aligned and working
together to truly improve healthcare—although they have a long way to go. Closing
these gaps is everyone’s job, and the majority of all those surveyed for this report are
optimistic about the future of drug development and healthcare in general. And so
it is this combination of optimism and influence that makes the New Health a rare
opportunity for the biopharmaceutical industry. Under these conditions innovation
can thrive.
I n t r o d u c t i o n
Biopharma
Managed Care
Physicians
Patients
These four icons and four colors
are used throughout to identify
the groups polled in the survey
4. www.quintiles.com/newhealthreport4 | The New Health Report
Value in Healthcare
In today’s New Health environment, market authorization for a new therapeutic is
merely the first gate in a long journey in a biopharmaceutical product’s lifecycle.
Amid the various risk factors contributing to the rapidly changing landscape of
drug development, the growing demands of an increasingly powerful set of market
stakeholders will have long-lasting effects on the future success of the industry.
With physicians demanding further evidence of a new product’s effectiveness,
patients demanding more assurance regarding a drug’s safety, payers demanding
demonstrable proof of a therapy’s value, and policy-makers demanding confirmation
of a product’s real-world risk/benefit profile in large populations, understanding
what information to communicate to each group is a significant challenge for drug
developers. Each stakeholder group has a different evidence requirement, and
appraising these needs and designing trials to address them will go a long way toward
properly aligning development portfolios with marketplace realities.
5. V a l u e i n H e a lt h c a r e
The New Health Report | 5
What is Value? There is no consensus on a definition of value in healthcare.
Stakeholders have internalized the concept of value in very different ways, with
biopharma executives as the only group in which a majority includes outcomes as
part of their definition. For patients and physicians, the process (quality of care)
appears to matter as much as the outcome when it comes to value, although nearly
one-third of patients do not feel they can define value.
In your own words, how would you define “value” in healthcare? Please be specific.
(Unaided responses)
What constitutes value in prescription medications? When given specific choices,
patient outcomes and safety were consistently ranked by executives and physicians as
the most important elements in determining the value of prescription medicines.
When thinking about the value of prescription medications for patients, how
important is each of the following? Please rank each using consecutive numbers
between 1 and 5, where 1 is the most important.
Nearly a third of
patients cannot define
value in healthcare.
Biopharma Managed Care Physicians Patients
Mentions both cost
& outcomes
Mentions cost
Mentions outcomes
Mentions neither
Not sure
38%
30%
23%
10%
Mentions both cost
& outcomes
Mentions cost
Mentions outcomes
Mentions neither
Not sure
23%
43%
13%
20%
Mentions both cost
& outcomes
Mentions cost
Mentions outcomes
Mentions neither
Not sure
19%
40%
10%
28%
Mentions both cost
& outcomes
Mentions cost
Mentions outcomes
Mentions neither
Not sure
2%
30%
4%
33%
31%2%1%0%
46%
32%
16%
6% 10%
<1% 0%
Patient outcomes
Safety
Quality of life
Cost for patients
Ease of use for patients
33%
39%
17%
Most important:
Biopharma Managed Care Physicians
42%
31%
19%
7%
1%
Sums may not add to 100% or be equal to
components due to rounding
6. V a l u e i n H e a lt h c a r e
www.quintiles.com/newhealthreport6 | The New Health Report
Consensus on Value of Pharmacotherapy. There is near universal agreement that
prescription medications improve the health and well-being of patients. Biopharma
and patients, especially, see eye-to-eye when it comes to prescription medication.
Four out of five biopharma executives and patients agree that the money patients
spend on prescription medications is worth it. Physicians mostly agree. Managed
care executives are the least convinced; two out of five disagree that the money
patients spend on prescription medications is worth it.
How valuable are prescription
medications to patients’ health
and well-being?
Patients also place a premium on prescription medications. 85% of patients say
prescription medications are extremely or very valuable to the health and well-being
of patients, and 80% feel as though the money they spend on medications is worth it.
How valuable are prescription medications
to the health and well-being of patients?
Are they:
85% of patients say
prescription medications
are valuable to the health
and well-being of patients.
90%
75%
1%
1%
90%
1%
Extremely /
Very valuable
Not valuable
Extremely /
Very valuable
Not valuable
Extremely /
Very valuable
Not valuable
84%
56%
44%
16%
69%
31%
Agree
Disagree
Agree
Disagree
Agree
Disagree
80% Agree
47% Strongly agree
33% Somewhat agree
20% Disagree
9% Somewhat disagree
11% Strongly disagree
85% Extremely/Very valuable
41% Extremely valuable
44% Very valuable
14% Somewhat valuable
1% Not valuable
1% Not very valuable
1% Not at all valuable
How much do you agree or disagree
with the following statement: All in all,
the money patients spend on prescription
medications is worth it.
Do you agree or disagree that all in all,
the money you spend on prescription
medications is worth it?
7. V a l u e i n H e a lt h c a r e
The New Health Report | 7
When presented with a definition of value that includes outcomes per dollar spent,
most executives and physicians tend to agree with it. About three-quarters of
biopharma, managed care executives and physicians say they mostly agree with this
definition.
Some experts have defined value in healthcare as the outcomes per dollar spent in
providing services. In their definition, outcomes include not only survival but the
extent of recovery or disability, errors, complications, recovery time, recurrences
and other aspects of the patient’s health experience. Do you mostly agree or mostly
disagree with this definition?
Appraising value. Somewhat surprisingly, biopharma executives do not report
readily available outcomes data to demonstrate the value of prescription
medicines. For managed care executives, 85% of those who reported outcomes
data readily available said they used measures developed and tracked by their
own organizations.
Are outcomes data readily available
for your organization to demonstrate
the value of prescription medications?
Less than half of
biopharma executives
say outcomes data are
readily available to
demonstrate the value
of new medications.
Mostly agree
Mostly disagree
Not sure
78%
16%
6%
75%
13%
12%
76%
18%
6%
PhysiciansManaged CareBiopharma
44% Yes, available
38% No, not available
18% Not sure
Measures developed and
tracked by your organization
Collected from
physician practices
Provided by government/
academic agencies
Provided by other
managed care companies
Provided by biopharmaceutical
companies
Purchased from
a third-party
34%
35%
40%
44%
56%
85%
According to Biopharma According to Managed Care
What are the sources of the outcomes
data that you use? (Of those who reported
outcomes readily available)
Sums may not add to 100% or be equal to
components due to rounding
8. www.quintiles.com/newhealthreport8 | The New Health Report
Stakeholder Roles and Performance
The constellation of stakeholders within the healthcare universe is intricately
linked yet often misaligned. Biopharma’s challenge is to demonstrate value to
the other groups within the system. Therefore, understanding the perceptions
of each, with regard to how well the others are performing in specific areas,
offers a favorable vantage point for all groups to reassess the healthcare
landscape and their respective roles in it.
For biopharma, it may warrant an honest rethinking of its role as a developer
and commercializer of medicines—adjacent to, but not truly part of the
system—to a role further emphasizing patient education and health
outcomes. Among all stakeholder groups, ongoing collaboration and increased
communication are paramount to aligning the perception gaps that stymie
innovation and thwart progress.
9. S t a k e ho l d e r Ro l e s a n d P e r f o r m a n c e
The New Health Report | 9
Who adds value? Who does not? Physicians are perceived as adding the most
value to healthcare, with scientists and medical researchers also showing favorable
perceptions. Not surprisingly, health insurance companies and the federal
government were widely seen as adding the least value to healthcare.
In your opinion, how would you rank the following groups in how much value they
add to healthcare? Please rank each using consecutive numbers between 1 and 6, where
1 adds the most value.
Stakeholder perceptions. The illustration below demonstrates approval ratings among
stakeholder groups as to how they perceive the performance of others in improving
health outcomes. Consistent with the data above regarding who adds value to health-
care, this chart illustrates the perception among all other groups that patients them-
selves are not doing enough to improve their own health outcomes.
Overall, do you approve of the job
each of the following are doing to
improve health outcomes in the
United States?
High Approval
Low Approval
% who approve
50%
31%
11%
4%
3%
2%
Doctors healthcare
professionals
Scientists and
medical researchers
Biopharmaceutical
companies
Patients and patient
advocacy groups
Health insurance
companies
Federal government
63%
20%
1%
10%
1%
5%
Adds the most value:
Biopharma Managed Care Physicians Patients
81%
9%
1%
7%
1%
1%
46%
23%
5%
12%
6%
4%
52% 20%
76% 50%
30%
33%44%
65% 45%
73%
Biopharma
(Self-approval = 79%)
Managed Care
(Self-approval = 78%)
Physicians
(Self-approval = 88%)
Patients
(Self-approval = 50%)
13%
74%
Sums may not add to 100% or be equal to
components due to rounding
Physicians are widely seen
as adding the most value
to healthcare.
10. S t a k e ho l d e r Ro l e s a n d P e r f o r m a n c e
www.quintiles.com/newhealthreport10 | The New Health Report
Patient education. Physicians receive high marks for their efforts in educating
patients, particularly among patients themselves, 82% of whom said physicians were
very or moderately effective in educating patients.
How effective is each of the following in educating patients:
Understanding patient needs. Similar sentiment was seen in understanding the needs
of patients, with physicians rated as very or moderately effective by a wide majority
in all groups. Physicians and biopharma both believe managed care falls short in
understanding patient needs, which underscores the disconnect between managed
care and the rest of the system.
How effective is each of the following in understanding the needs of patients:
Collaboration. All groups seem relatively unimpressed with their counterparts’ efforts
to work together to improve patient outcomes. While sentiment toward physicians in
this regard is mostly positive, the pedestrian results toward biopharma and managed
care indicate that there is an opportunity for more collaboration and communication
among all stakeholders.
The only group rating
their own efforts to
educate patients higher
than that of physicians is
managed care executives.
According to According to According to According to
Biopharma Managed Care Physicians Patients
59% 42% 53%
36% 69% 36%
62% 60% 79%
62%
52%
82%
Biopharma
Managed Care
Physicians
Very effective/Moderately effective
According to According to According to According to
Biopharma Managed Care Physicians Patients
Very effective/Moderately effective
79% 54% 65%
26% 77% 21%
75% 83% 92%
55%
45%
83%
Biopharma
Managed Care
Physicians
11. S t a k e ho l d e r Ro l e s a n d P e r f o r m a n c e
The New Health Report | 11
How effective is each of the following in working together with other groups in
healthcare to improve patient outcomes:
Patients need to do more. There is strong sentiment that patients need to do more
to improve their behaviors and lifestyles to reduce health risk. While patients are
acknowledged for effectively seeking out health information—and given surprisingly
high rates of compliance effectiveness by physicians—patients are nonetheless
perceived as not taking a holistic view of their own care. Physicians, specifically,
indicated that patients are not effective in improving their behaviors and lifestyles to
reduce health risks.
How effective do you feel patients are in:
Biopharma is focused on discovery and development. Biopharmaceutical executives
cite translating scientific research into new medications as their most important role
in improving health outcomes.
What is the most important
role that biopharmaceutical
companies play today in
improving health outcomes?
Please rank each using consecutive
numbers between 1 and 5, where 1
is the most important.
According to According to According to According to
Biopharma Managed Care Physicians Patients
Very effective/Moderately effective
Biopharma
Managed Care
Physicians
53% 43% 56%
25% 76% 25%
46% 51% 64%
55%
45%
71%
Very effective/Moderately effective
65%
48%
52%
64%
19% 21% 22%
48%
55%
Seeking out information
about health
Adhering to medication Improving their behaviors
and lifestyles to reduce
health risks
Sums may not add to 100% or be equal to
components due to rounding
Mean rank
Translating scientific research
into new medications 1.8
Bringing new medications
to market 2.2
Identifying unmet
health needs
3.3
Providing value-added
services for patients
4.0
Supporting research
in basic science
3.7
43%
36%
10%
10%
2%
43% of biopharma
executives say translating
scientific research into
new medications is the
industry’s most important
role in improving health
outcomes.
12. S t a k e ho l d e r Ro l e s a n d P e r f o r m a n c e
www.quintiles.com/newhealthreport12 | The New Health Report
Informed patients, better outcomes. Nearly two-thirds of physicians indicate that
patients who actively seek information achieve better health outcomes, yet a third
report an increase in the number of patients who come in with misinformation about
their medical condition.
In your experience, do patients who
more actively seek information about
their medical conditions achieve better
health outcomes than those who are
less active?
Compared to five years ago, do you feel patients come in with misinformation about
their medical conditions more or less often?
Patient sources of information. Patients believe they are well educated about their
condition, with 96% saying that they are very or somewhat informed about the
medical conditions they’ve been diagnosed with. Physicians and websites were cited
as significant sources of information, although surprisingly, both pharma company
websites and social networking sites were rarely mentioned by patients as sources of
information.
Thinking about the medical
conditions you have been
diagnosed with, would you say
you feel:
Nearly three-quarters
of physicians say patient
misunderstanding
of available medical
information contributes
to misinformation about
medical conditions.
36% More often
7% Come with misinformation much more often
29% Come with misinformation somewhat more often
31% Come with misinformation about the same
33% Less often
28% Come with misinformation somewhat less often
5% Come with misinformation much less often
65% Yes
12% No
23% I’m not sure
96% Informed
75% Very informed
21% Somewhat informed
4% Not informed
3% Not very informed
1% Not at all informed
13. S t a k e ho l d e r Ro l e s a n d P e r f o r m a n c e
The New Health Report | 13
Where do you get information about your medical conditions? Unaided responses,
select answers shown (multiple categories allowed).
Biopharma’s changing role. As biopharma adapts to the changing influence of other
stakeholders, and reacts to pressure to more clearly demonstrate the value of its
products, the industry finds itself torn between establishing long-term relationships
at the expense of short-term gains. More than three-quarters of biopharma execs
think the industry should focus on outcomes data, yet overwhelmingly feel as though
a lack of investor support would hinder this fundamental shift.
Do you think biopharmaceutical
companies should invest more in long-
term relationships and long-term
outcomes data at the expense of short-
term gains?
85%
39%
15%
10%
3%
2%
1%
1%
1%
1%
1%
Physicians
Internet (unspecified)
Non-physician healthcare professionals like pharmacists or nurses
News media
Health websites, like WebMD
Product inserts
Online patient forums, discussion boards or chat groups
Talk shows, like Dr. Oz
Advertisements
Social networking sites, like Facebook
Pharmaceutical company websites
78% Yes
14% No
8% I’m not sure
Lack of investor support
Weak financial position
Need greater
commitment internally
Regulatory barriers
No industry consensus
Information or
knowledge gaps
Other
I’m not sure
71%
48%
46%
37%
36%
31%
8%
2%
What barriers do you think
biopharmaceutical companies would
encounter to more investment in long-
term relationships and long-term
outcomes data at the expense of short-
term gains? (Select all that apply)
(n=194)
Sums may not add to 100% or be equal to
components due to rounding
Half of biopharma
executives say
improving health
outcomes should be
the primary focus of
the biopharmaceutical
industry. Only 13%
say maximizing
shareholder value.
14. www.quintiles.com/newhealthreport14 | The New Health Report
Future of Healthcare and Medicine
Today’s healthcare universe has many players—each with its own definition of
value—and demonstrating value to each of them is one of the most important
charges for the biopharmaceutical industry. Only by engaging the entire constellation
of stakeholders toward a common purpose, and incorporating the needs of the value
chain into clinical development, can the biopharmaceutical industry shepherd the
right products to market.
Despite divergent perceptions of value and widely disparate views of other
stakeholder groups, there seems to be a sustained level of optimism for both
the future of healthcare and prescription medications. Most point to advances in
medications and medical technology for their hope and expect personalized medicine
to have a positive effect on patients.
15. F u t u r e o f H e a lt h c a r e a n d M e d i c i n e
The New Health Report | 15
National sentiment toward healthcare and medicines. Most physicians, biopharma
and managed care executives think the country could do more on key healthcare
issues, from affordability of medications to patient education. Broad agreement exists
that the country could do more to make medication affordable. Additionally, three out
of five biopharma executives feel we could do more as a nation to produce innovative
new treatments for chronic conditions and discover effective medications. With
regard to ensuring the safety of medications, most biopharma executives (73%) and
physicians (61%) feel the country does a good job.
Optimism about the future quality of healthcare is stronger among biopharma and
managed care executives than among patients and physicians. Curiously, the majority
of physicians are pessimistic about healthcare quality 10 years from now.
Are you pessimistic or optimistic that the quality of the following will be significantly
improved 10 years from now?
Of the 56% of
physicians who are
pessimistic about the
future of healthcare, 61%
cited reduced access to
healthcare as a reason
for their outlook.
Making medication affordable
Patient education
Helping patients take medication as prescribed
Producing innovative new pharmaceutical
treatments for chronic conditions
Discovering effective medications
Making sure medications are safe
88%
86%
82%
52%
52%
53%
92%
70%
71%
47%
42%
36%
82%
73%
73%
60%
60%
26%
PhysiciansManaged CareBiopharma% Saying “Could Do More”
Healthcare Medications
Optimistic
Pessimistic
Optimistic
Pessimistic
Optimistic
Pessimistic
Optimistic
Pessimistic
64%
36%
63%
37%
44%
56%
54%
46%
Optimistic
Pessimistic
Optimistic
Pessimistic
Optimistic
Pessimistic
Optimistic
Pessimistic
72%
28%
76%
24%
59%
41%
72%
28%
Sums may not add to 100% or be equal to
components due to rounding
16. F u t u r e o f H e a lt h c a r e a n d M e d i c i n e
www.quintiles.com/newhealthreport16 | The New Health Report
Hope in research. Four out of five biopharma executives optimistic about the future
quality of healthcare cite advancements in medication and treatments as a reason
for their positive outlook. A substantial majority of optimistic patients, physicians
and managed care executives concur, although a larger number of managed care
executives cited greater patient involvement as a reason for their optimism.
Why would you say you are
optimistic? (Select all that apply)
Those optimistic that the quality
of healthcare will be significantly
improved 10 years from now
Advances in
medications, treatments
and medical technology
are cited by all groups as
driving their optimism
that the quality of
healthcare will be
improved in 10 years.
Greater patient involvement
in healthcare
Advancements in
medication and treatments
Advancements in
medical technology
Improved access
to healthcare
Improvements in
medical training
Other
74%
62%
62%
60%
23%
10%
Managed Care
Advancements in
medication
and treatments
Advancements in
medical technology
Improved access
to healthcare
Greater patient
involvement
in healthcare
Improvements in
medical training
Other
75%
58%
28%
75%
39%
10%
Advancements in
medication
and treatments
Advancements in
medical technology
Improvements in
medical training
Greater patient
involvement
in healthcare
More people having
access to healthcare
Other
85%
85%
74%
72%
66%
38%
Physicians Patients
17. F u t u r e o f H e a lt h c a r e a n d M e d i c i n e
The New Health Report | 17
Reasons for pessimism vary. Reduced access to care was the most common reason
for pessimism among both physicians and patients.
Why would you say you are pessimistic?
(Select all that apply)
Physicans pessimistic that the quality of
healthcare will be significantly improved
10 years from now (Select responses)
Patients are much more likely to see a better tomorrow for Americans born today.
58% of patients believe it is likely that in lifetimes of Americans born today, the
average life expectancy for Americans will reach 90 years; 29% say this is very likely.
Only two in five biopharma, managed care executives and physicians concur. Yet
despite their optimism regarding improvements in specific health outcomes, slightly
fewer than half of patients feel the nation will become healthier overall in this time.
How likely do you think it is that in the lifetimes of Americans born today: (those
selecting “very or somewhat likely”)
Fewer people having
access to healthcare
Reduced patient
involvement
in healthcare
Declines in research and
development into new
medication and treatments
Lack of improvements
in medical training
Declines in development of
new medical technology
Increased use of untested,
alternative treatments
64%
53%
37%
30%
29%
23%
Reduced access
to healthcare
Declines in research and
development into new
medication and treatments
Declines in development
of new medical technology
Reduced patient
involvement in healthcare
Lack of improvements
in medical training
Increased use of untested,
alternative treatments
61%
50%
28%
27%
24%
15%
Life expectancy for the
average American will
be 90 years
43%
Most cancers will
become curable
29%
A cure for Alzheimer’s
will be found
28%
44%
38%
32%
44%
39%
34%
58%
55%
51%
Biopharma Managed Care Physicians Patients
The nation will become
healthier overall
23% 49%28% 27%
Would you say you are pessimistic
because of:
Patients pessimistic that the quality of
healthcare will be significantly improved
10 years from now (Select responses)
Sums may not add to 100% or be equal to
components due to rounding
55% of patients feel
that most cancers will
become curable in the
lifetimes of Americans
born today.
18. F u t u r e o f H e a lt h c a r e a n d M e d i c i n e
www.quintiles.com/newhealthreport18 | The New Health Report
Personalized medicine. Biopharma and managed care executives are optimistic that
personalized medicine will improve efficacy, safety and public health. More than four-
fifths of biopharma (88%) and managed care (84%) executives believe personalized
medicine will have a positive effect on drug efficacy, and solid majorities of both
groups believe that personalized medicine will have a positive effect on patient safety.
A new technology is developing in healthcare called “personalized medicine,” in which
prescription medications are chosen based on each person’s genetic profile.
Thinking about this trend, do you feel that personalized medicine will have a positive
or negative effect on:
How effective medications are at
getting results
How safe medications are for the
patients taking them
How fast new medications
are discovered
Cost of prescription medications
Job and healthcare discrimination
Patient privacy
Public health in general
3%
4%
3%
28%
55%
38%
43%
4%
13%
14%
30%
15%
40%
38%
5%
5%
7%
9%
8%
14%
14%
88%
78%
76%
33%
22%
8%
5%
No effect I’m not
sure
NegativePositive
According to Biopharma
19%
How effective medications are at
getting results
How safe medications are for the
patients taking them
How fast new medications
are discovered
Patient privacy
Cost of prescription medications
Job and healthcare discrimination
Public health in general
1%
4%
4%
17%
39%
56%
33%
7%
10%
15%
37%
35%
16%
35%
8%
13%
10%
14%
12%
13%
84%
73%
71%
32%
15%
14%
12%
No effect I’m not
sure
NegativePositive
According to Managed Care
56% of managed
care executives feel
that personalized
medicine will have a
negative effect on the
cost of prescription
medications.
19. F u t u r e o f H e a lt h c a r e a n d M e d i c i n e
The New Health Report | 19
Patients are not familiar with personalized medicine. Three out of four patients
have not heard of personalized medicine. Given the perceptions of biopharma and
managed care that personalized medicine will increase the safety and effectiveness of
medications, this presents an opportunity to educate patients on the concept.
A new technology is developing in
healthcare called “personalized
medicine,” in which prescription
medications are chosen based on each
person’s genetic profile.
Have you heard of “personalized
medicine” before today?
Physicians favor personal experience when developing treatment plans for patients.
Physicians rely most on their own experiences when treating their patients, although
they recognize the role of conferences, seminars and peer-reviewed journal articles
in tailoring treatment plans. Physicians do feel constrained by payers, however, with
more than two-thirds of physicians saying that payer formularies dictate all or most of
what they prescribe.
When developing a treatment plan, what do you rely on most?
How much flexibility do you feel you have in prescribing agents to your patients?
Personal experience
Conferences, seminars or continuing medical education
Peer-reviewed journals
Medication labels, package inserts or prescribing information
Information provided by biopharmaceutical companies
Experience of colleagues or peers
Other 3%
38%
29%
18%
5%
4%
3%
68% Payer dictates all/most
11% Payer/provider formulary dictates almost all of what
I prescribe
57% Payer/provider formulary dictates most of what I prescribe
32% Payer dictates small number/none
29% Payer/provider formulary dictates only a small number of
what I prescribe
3% Payer/provider formulary has no bearing on what I prescribe
24% Yes
75% No
1% I’m not sure
Sums may not add to 100% or be equal to
components due to rounding
Three quarters of
patients are not familiar
with the concept of
personalized medicine.
20. Th e P a t i e n t o f To d a y
www.quintiles.com/newhealthreport20 | The New Health Report
Patient Empowerment
By Alexandra Carmichael
Director at The Quantified Self, and co-founder
of CureTogether.com
When patients are diagnosed with a chronic illness, they face a maze of
decisions, questions and options that can be overwhelming. Doctors,
insurance providers, pharmaceutical companies and online communities all
offer important resources to help patients make these decisions and answer
their questions. But patients do not always realize their own power. Patient
voices can be elevated to not only direct their own health and healthcare, but
also to influence the development of new treatments, decide how value is
defined in healthcare and improve the perception of patients as knowledgeable
participants in the conversation about their own health.
As patients are the experts at understanding their own bodies, especially for
chronic conditions (living with a chronic illness every day, trying every possible
treatment, knowing what works and what doesn’t, connecting with other
patients), there is a wealth of knowledge and expertise in these bodies and
minds that is untapped. Patients can influence which treatments are developed
for which conditions, by speaking up loudly enough for themselves, and which
ones are discontinued because of, say, too many adverse effects. By the same
token, pharmaceutical companies, insurance companies and doctors will
increasingly need to realize the decision-making power of patients, and take the
time to understand patient needs, demonstrate the value of new treatments to
them and involve patients in the healthcare conversation. Patients are willing to
do more, but need to be trusted and enabled to do so.
How can patients impact drug development? There is a definite trend towards
patients increasingly taking active control of their health, sharing information
about treatments with each other and seeing the healthcare system as a partner
in making decisions. Patient-reported comparative effectiveness studies and the
power of patient activism will play increasingly significant roles in the success or
failure of new therapies.
What can players in the rest of the healthcare space do to intersect with and
make the most of this increasing trend? Some ideas to consider are to start
by going where empowered patients gather—in online patient communities,
social media and patient advocacy groups. Tap into how patients experience
their conditions and how they feel about the treatments they try—what are their
emotional, social, financial, lifestyle and health needs? A focus on understanding
and empowering patients will help all health stakeholders to better meet the
needs of their customers, maintain a positive reputation going forward, and
improve quality of care. Everybody wins when patients are empowered instead
of overwhelmed.
When prescribed a
new medication, 76%
of patients usually
ask their doctor or
pharmacist if a generic
version is available.
21. The New Health Report | 21
Th e P a t i e n t o f To d a y
Patients are more willing to share private health information than to participate in
clinical trials for the development of new medications. 53% of patients are willing to
consider clinical trial participation, compared with 62% who would consider sharing
their genetic profiles for the discovery of new medications.
To help discover new medications, would you consider:
Patients feel they don’t have influence in developing prescription medications.
Despite recognition by other stakeholders that patients’ influence is growing, most
patients don’t feel as though they’re very influential in the drug development process.
Thinking of how much
people like you influence
what new prescription
medications are available,
would you say people like
you are:
Patients overwhelmingly suggested that they are successful in complying with
prescribed treatment regimens, and controlling other factors that contribute to
positive health outcomes. Physicians give their patients credit for medication
adherence, but suggested their patients could do more to follow their
recommendations for improving lifestyle behaviors.
How successful do you feel
you are at:
Allowing experience with prescription medications and
health data to be included in a global research database
Allowing genetic profile to be included in a global
research database
Allowing medical files to be included in a global
research database
Participating in a clinical trial
69%
62%
55%
53%
19% Very/Extremely influential
7% Extremely influential
12% Very influential
35% Somewhat influential
46% Not influential
25% Not very influential
21% Not at all influential
Sums may not add to 100% or be equal to
components due to rounding
Taking your medication as prescribed
Eating a healthy diet
Exercising regularly
11%
48%
43%
2%
13%
29%
87%
40%
28%
Not at all
successful/ Not
very successful
Somewhat
successful
Extremely
successful/ Very
successful
53% of patients
feel that health
insurance companies
don’t understand
their needs.
22. www.quintiles.com/newhealthreport22 | The New Health Report
Conclusion
This report suggests considerable misalignment among healthcare stakeholders
on various aspects of the healthcare universe. Physicians seem well respected, but
indicate frustration in working with managed care companies and feel that patients
must improve their own lifestyle choices. Indeed, patients are viewed by all groups
as not doing enough to improve their own healthcare. Payers seem to be caught in
the middle. With new regulations and increasing enforcement of existing regulations,
coupled with the need to control costs while providing more services to their
members, payers appear to be squeezed by policy-makers, patients and physicians to
better understand their individual needs. They also appear to be more cost-focused
than other groups, yet possess significant leverage with biopharma in demanding
evidence of a product’s value before placement on formulary. And despite their desire
to focus more on patient outcomes, biopharma perceives significant pressure from
investors to maximize shareholder value.
Amid all of this, clinical research must continue. And in the New Health, the pressure
to conduct this research quickly, at less cost and with less risk to patients has never
been greater. To do so, biopharmaceutical companies work with innovators to
develop a better understanding of disease biology; work with payers to incorporate
market access considerations into clinical development; work with specialty providers
and partners to create and optimize predictive tools; and work with physicians on
educating their patients on their medical conditions. But this interconnectedness
must be embraced as an opportunity, as open dialog and ongoing collaboration will
foster an environment from which innovative therapies will be developed.
23. www.quintiles.com/newhealthreport The New Health Report | 23
About The New Health Report
The New Health Report is a report based on a national survey of biopharmaceutical
executives, managed care executives, physicians and patients living with chronic
disease conducted by Richard Day Research of Evanston, Ill., on behalf of Quintiles
Transnational Corp. Richard Day Research was responsible for all survey design, data
analysis and data reporting.
Data for this survey were collected between January 5 and February 27, 2011. Included
in the sample were 200 biopharmaceutical executives at the director level or above, 153
managed care executives at the director level or above, 400 primary care physicians,
103 board-certified specialists, and 1,000 U.S. adults ages 18+ diagnosed with a chronic
health condition who are receiving treatment.
Professionals were recruited via postal mail, telephone, fax and e-mail and completed
the survey in a self-administered online questionnaire. Patient interviews were
conducted via landline and cellular telephone.
With pure probability samples of these sizes, one could say with 95 percent probability
that the results have a sampling error of +/- 7 percentage points for biopharmaceutical
executives, +/- 8 percentage points for managed care executives, +/- 4 percentage points
for physicians and +/- 3 percentage points for patients.
About Quintiles
Quintiles is the only fully integrated biopharmaceutical services company offering
clinical, commercial, consulting and capital solutions worldwide. The Quintiles
network of 20,000 engaged professionals in more than 60 countries around the globe
works with an unwavering commitment to patients, safety and ethics. Quintiles helps
biopharmaceutical companies navigate risk and seize opportunities in an environment
where change is constant. For more information, please visit www.quintiles.com.
Contact Info
Mari Mansfield, Media Relations
(mari.mansfield@quintiles.com)
+1 919 998 2639
For non-media inquiries,
Adam Istas, Corporate Communication
(adam.istas@quintiles.com)
+1 708 948 7070