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Patient Adherence Survey
                                         Q1 2011



Wool.labs 2010 (Confidential)                              1
Introduction

• The Healthcare Crowdsourcing Project was launched to
  illuminate themes surrounding patient adherence and some
  of varying opinions based on the role a person plays in the
  adherence lifecycle
• Insights from our WebDigTM database were added - as were
  authentic verbatims that illustrate particular points
• By merging both datasets, we were able to highlight some
  insights that will be useful in all of our adherence work




Wool.labs 2010 (Confidential)                                   2
Executive Summary

• Patient adherence is of concern to everyone in healthcare
• The reasons are complex, but our experience shows us that improvements
  can be made by listening more to patients and sharing information across
  everyone touching the adherence lifecycle
• We see adherence as an ongoing and evolving topic much like disease
  treatment itself
       – Too many times, we see industry get frustrated with the reach of their results
         and just quit. The up and down cycle probably makes the problem worse
• There are disconnects between patients and other groups that hinder
  progress in patient adherence
       – Too much emphasis may be being placed on patient forgetfulness
       – Patients, more often than not, actively choose whether to take their
         medication but also may not fully understand the implications of their actions

Wool.labs 2010 (Confidential)                                                             3
Patient Themes That Impact Adherence
                            Data from the Survey and WebDigTM studies




Wool.labs 2010 (Confidential)                                           4
Patient Themes That Impact Adherence


Definitions
• Strong theme – a dominant theme recurring in the majority of patient-
  oriented studies
• Common theme – a persistent theme recurring in at least 50% of all
  patient-oriented studies
• Less Common theme – a recurring but perhaps not persistent theme
  occurring in less than 50% of all patient-oriented studies
• Emerging theme – a theme that has been occurring in more recent
  timeframes but is becoming persistent in at least 50% of all studies and
  increasing consistently.




Wool.labs 2010 (Confidential)                                                5
Patient Themes That Impact Adherence


Strong Themes
• Patients use social media as a means to connect with others to share
  experiences, set expectations for themselves, and offer/seek advice

• Patients are looking for real world experiences and will shun other opinions
       Please don't think I am being rude, but I need answers from people who have actually been through this, the not
       eating/drinking/total fatigue or their caregivers. I have tried everything, offered him everything and anything he
       wanted to eat and he takes one bite and says he can't eat. I'm desperate!!
       http://answers.yahoo.com/question/index?qid=20090207103618AAPTFBK . 2008.


• Patients “choose” treatments and speak in an extremely empowered tones
       We have made the choice to stay on chemo for now–16 rounds of carbo/taxol/avastin were the first line and this
       week my brother will have his 16 round of alimta/avastin.
       http://cancergrace.org/lung/2008/11/07/saturn-positive/ November 2008


• While identified as a need, expectation setting is still not universal,
  thorough, or effectively done by medical professionals
Wool.labs 2010 (Confidential)                                                                                               6
Patient Insights

There are significant differences & similarities between what patients think
and what others think (such as marketing & advertising professionals)

•Patients are quicker and more decisive about following the advice of fellow
patients than others seem to expect
•Patients are more influenced by marketing & advertising than professionals
think
•Patients forget less to take their medication than others think
       – They question their diagnosis more than expected by others – this is a top
         reason for poor adherence in the eyes of patients
•Patients are more positive about solutions to adherence than professionals
•Patients feel that a family member or close friend is most influential on their
adherence
       – Other groups feel that patients, themselves, are the most influential


Wool.labs 2010 (Confidential)                                                         7
Through the Lens of WebDig Data


Patients believe
• Physicians do not set expectations about how their treatment will affect
  different aspects of their life and body
• Not addressing the body holistically feeds a lack of trust
We have seen
• Lack of trust degrades relationships - which degrades adherence
       Something happened yesterday which has prompted today’s blog topic – patient empowerment – a recurring theme on this
       blog. Now I know there are plenty of good doctors out there, who carefully listen to their patients and are fully engaged with
       them, and I don’t wish to come across as a medic-basher, but once again, I found myself in a disturbing doctor/patient
       situation which has raised my hackles.

       I have mentioned before my anger and frustration that my oncologist never discussed with me at the outset of treatment,
       the fertility complications which can be a result of treatment for breast cancer. I felt at the time that my concerns were not
       listened to and it left me with a lingering distrust of the medical profession – I stress this is my own personal issue, I am
       happy to know that many of you have a wonderful relationship with your medical carers. I know it is also unfair to tar every
       doctor with the same brush of mistrust, but yesterday my faith was shaken yet again.

       http://beyondbreastcancer.wordpress.com/2010/06/17/empowering-the-patient/ June 2010

Wool.labs 2010 (Confidential)                                                                                                       8
Survey Results



Wool.labs 2010 (Confidential)                    9
Survey Questions
Wool.labs recently fielded a Patient Adherence survey within social media
forums – the results are covered on the following slides
      • In addition to the results in total, we also have broken out select results by
        patients and marketing professionals, the two largest respondent groups
      • We then also looked at the difference and similarities between groups

Survey questions:
1.   Based on your usage or study of social media do      6.   Do you think patients have influence over what
     you see patients seeking the opinions of fellow           their physicians prescribe to them?
     patients online in user forums and blogs?
                                                          7.   Who do you think has the most influence over
2.   What do you think of the concept of patients              whether a patient stays on treatment or not?
     seeking advice of other patients?
                                                          8.   Why do you think patients don’t take their
3.   Do you think patients’ use of social media impacts        medication or treatment as prescribed?
     their adherence to their prescribed treatment?
                                                          9.   What argument or reason do you think is the most
4.   Do you think patients would stop their treatments         powerful in keeping a patient on their prescribed
     based on the advice of others in social media?            treatment?

5.   What do you think the pharmaceutical and/medical     10. Do you believe that the problem of patient
     device industry have an impact on patient                adherence is solvable?
     adherence?
Wool.labs 2010 (Confidential)                                                                                   10
Survey Methodology

• Wool Labs conducted the Patient Adherence survey as part of
  its Healthcare Crowdsourcing Project in January 2011
       – Patients, health care professionals and health care marketers were
         invited to participate through active, relevant conversations in social
         media
       – Ten multiple choice questions focused on Patient Adherence and the
         influence of social media
• Wool Labs used our WebDig Survey system to deploy and
  analyze the survey and results
• Quotes and some insights presented in the deck are from our
  WebDig database and the hundreds of studies we have
  conducted on patient behavior

Wool.labs 2010 (Confidential)                                                      11
1.    Based on your usage or study of social media do you see
      patients seeking the opinions of fellow patients online in user
      forums and blogs?

     60%               57%

     50%


     40%


     30%
                                         22%
     20%

                                                                                                              9%
     10%                                                    6%                               6%
                                                                             0%
       0%
                   Yes, and I          Yes, but not    No, not really.    No, and I      I’m not really      Other
                strongly agree.        widespread                         strongly           sure.
                                     and/or not that                      disagree.
                                          often

                                                                  “Other” fill-in examples:
                                                                  “Yes and that concerns me.”
     Respondents:
                                                                  “Yes, would have selected option1, but not sure what 'strongly
     Entire Audience                                              agreeing’ with. It is widespread and the wisdom of the masses
     Wool.labs 2010 (Confidential)                                is sought & leveraged.”                                12
8.      Why do you think patients don’t take their
        medication or treatment as prescribed?

                                                                    Other                                                       27%
         The medication or treatment makes them feel worse than the
                                                                                     2%
                                 condition it treats.
      Taking medication or using their treatments is not making them
                                                                                     2%
            feel any better so it seems a waste of time and money.
       It’s too hard to keep taking or using their treatments every day
                                                                                          4%
                             and they can’t keep up.
     They really don’t feel sick so it’s doesn’t seem to make that big a
                                                                                               6%
                           difference to miss some.
     They personally decide whether they need this treatment or not,
                                                                                0%
                                   no one else.
            They feel better so they think that they no longer need it.                                          18%

           They can’t afford their treatment so they need to ration it.              2%
          They don’t trust that their physician has truly diagnosed the
                                                                                     2%
                                  problem right.
         They don’t really understand why they are taking or using it.                                     14%

                           They forget to take it or use it as they should.                                            22%

                                                                              0%          5%        10%   15%    20%     25%      30%



       Respondents:                                                           “Other” fill-in examples:
       Entire Audience                                                        They don't have all the information -- most don't understand
      Wool.labs 2010 (Confidential)
                                                                              the how, when, where beyond the basics.”               13
2.    What do you think of the concept of patients
      seeking advice of other patients?


         It is helpful for patients as they can compare and                         Patients
           see what others experience so they can better
             understand what to expect as their situation                             45%
                               progresses.

         It is helpful for patients as they can compare and               Marketing & Advertising Professionals
           see what others experience so they can better
             understand what to expect as their situation                                  58%
                               progresses.

         It is helpful for patients as they can compare and                               All
           see what others experience so they can better
             understand what to expect as their situation                                53%
                               progresses.


                                                                     0%      10%    20%         30%   40%   50%     60%     70%


                                     Next Popular Answer:
                                     All - It is really important for patients to find others for support and camaraderie. 18%
     Respondents:                    Marketing & Advertising Professionals - It is really important for patients to find others for
     Entire Audience                 support and camaraderie. 19%
                                     Patients - Patients need to find those they trust to turn to for advice. Fellow patients know the most
     Wool.labs 2010 (Confidential)
                                     about how a disease really progresses and/or how medication works in the real world. 18%     14
3.      Do you think patients’ use of social media impacts
        their adherence to their prescribed treatment?


                                                                      Other           3%


                                            No, I don't see this happening            3%

      Yes, I think that patients will take the advice of other patients they
      trust even if it means questioning their physicians and even if their                                                          32%
                          disease or condition is serious.

          Yes, I think other patients have a certain level of influence on a
                 patient but not as much as healthcare professionals.
                                                                                                      13%

     Sometimes, I think it varies based on the patient and perhaps only if
      the disease, condition, and/or treatment were not life threatening                                             23%
                                   or serious.
       No, patients may talk with others and share experiences but know
        better than to take extreme medical advice without talking to a               3%
                                   professional.

     Maybe, but patients listen to other patients as well as professionals
                    and then make up their own minds.
                                                                                                                     23%

                                                                               0%      5%     10%     15%     20%     25%      30%     35%



 Respondents:
 Marketing and advertising professionals                                       “Other” fill-in examples:
                                                                               “I think in some cases it will impact them. I also believe a
       Wool.labs 2010 (Confidential)
                                                                               patient's social circle and family can have an impact. 15
8.    Why do you think patients don’t take their
      medication or treatment as prescribed?


                                                                     Other                      10%
           The medication or treatment makes them feel worse than the
                                  condition it treats.
                                                                                                10%
              Taking medication or using their treatments is not making
            them feel any better so it seems a waste of time and money.
                                                                                    0%
         It’s too hard to keep taking or using their treatments every day
                              and they can’t keep up.
                                                                                    0%
         They really don’t feel sick so it’s doesn’t seem to make that big
                             a difference to miss some.
                                                                                                10%
             They personally decide whether they need this treatment or
                                    not, no one else.
                                                                                    0%

               They feel better so they think that they no longer need it.                                                          40%

              They can’t afford their treatment so they need to ration it.          0%
            They don’t trust that their physician has truly diagnosed the
                                    problem right.
                                                                                                            20%

            They don’t really understand why they are taking or using it.           0%

                            They forget to take it or use it as they should.                    10%

                                                                               0%        5%   10%   15%   20%   25%   30%   35%   40%   45%



     Respondents:
     Patients
                                                                               “Other” fill-in example:
     Wool.labs 2010 (Confidential)                                             “All of the above”                                             16
TM
  About WebDig


• WebDig uses the entire Internet to find conversations on any subject –
  industries, companies, brands and/or specific topics. The combined use
  of our advanced website screening, natural language processor,
  sentiment algorithms, extensive data processing capabilities, and
  targeted human intervention eliminates all off-topic comments and
  spam to isolate the most meaningful conversations about a subject. And
  since we scour the entire Internet, we retrieve everything regardless of
  where and when it was posted—even in places that go undetected by
  the major search engines and other commercial tools.
• As a pioneer and leader in social cognition systems, we have conducted
  hundreds of studies. We have been advancing our systems since 2007
  and have applied our software across the Internet as well as within TV
  and radio.


Wool.labs 2010 (Confidential)                                                17
TM
About WebDig Survey


• WebDig Survey is the lead component in our Crowdsourcing tool set and
  is a robust question builder, deployment and analytics system that
  supports over 25 different question types along with branching and
  conditional logic . Security is also robust and flexible.
• Surveys are quick and easy to create and can be deploy via email,
  standalone webpages or embedded into websites. Survey branding is
  easily customized.
• Results can be viewed in real time through an executive dashboard.
• We have deployed hundreds of surveys to thousands of participants
  throughout the US and the world.




Wool.labs 2010 (Confidential)                                             18
Steve Chiles
CONTACT


                    Schiles@woollabs.com
                    (610)331-5865
                    Follow: @woollabs




 Wool.labs 2010 (Confidential)             19

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Wool labs healthcare crowdsourcing patient adherence

  • 1. Patient Adherence Survey Q1 2011 Wool.labs 2010 (Confidential) 1
  • 2. Introduction • The Healthcare Crowdsourcing Project was launched to illuminate themes surrounding patient adherence and some of varying opinions based on the role a person plays in the adherence lifecycle • Insights from our WebDigTM database were added - as were authentic verbatims that illustrate particular points • By merging both datasets, we were able to highlight some insights that will be useful in all of our adherence work Wool.labs 2010 (Confidential) 2
  • 3. Executive Summary • Patient adherence is of concern to everyone in healthcare • The reasons are complex, but our experience shows us that improvements can be made by listening more to patients and sharing information across everyone touching the adherence lifecycle • We see adherence as an ongoing and evolving topic much like disease treatment itself – Too many times, we see industry get frustrated with the reach of their results and just quit. The up and down cycle probably makes the problem worse • There are disconnects between patients and other groups that hinder progress in patient adherence – Too much emphasis may be being placed on patient forgetfulness – Patients, more often than not, actively choose whether to take their medication but also may not fully understand the implications of their actions Wool.labs 2010 (Confidential) 3
  • 4. Patient Themes That Impact Adherence Data from the Survey and WebDigTM studies Wool.labs 2010 (Confidential) 4
  • 5. Patient Themes That Impact Adherence Definitions • Strong theme – a dominant theme recurring in the majority of patient- oriented studies • Common theme – a persistent theme recurring in at least 50% of all patient-oriented studies • Less Common theme – a recurring but perhaps not persistent theme occurring in less than 50% of all patient-oriented studies • Emerging theme – a theme that has been occurring in more recent timeframes but is becoming persistent in at least 50% of all studies and increasing consistently. Wool.labs 2010 (Confidential) 5
  • 6. Patient Themes That Impact Adherence Strong Themes • Patients use social media as a means to connect with others to share experiences, set expectations for themselves, and offer/seek advice • Patients are looking for real world experiences and will shun other opinions Please don't think I am being rude, but I need answers from people who have actually been through this, the not eating/drinking/total fatigue or their caregivers. I have tried everything, offered him everything and anything he wanted to eat and he takes one bite and says he can't eat. I'm desperate!! http://answers.yahoo.com/question/index?qid=20090207103618AAPTFBK . 2008. • Patients “choose” treatments and speak in an extremely empowered tones We have made the choice to stay on chemo for now–16 rounds of carbo/taxol/avastin were the first line and this week my brother will have his 16 round of alimta/avastin. http://cancergrace.org/lung/2008/11/07/saturn-positive/ November 2008 • While identified as a need, expectation setting is still not universal, thorough, or effectively done by medical professionals Wool.labs 2010 (Confidential) 6
  • 7. Patient Insights There are significant differences & similarities between what patients think and what others think (such as marketing & advertising professionals) •Patients are quicker and more decisive about following the advice of fellow patients than others seem to expect •Patients are more influenced by marketing & advertising than professionals think •Patients forget less to take their medication than others think – They question their diagnosis more than expected by others – this is a top reason for poor adherence in the eyes of patients •Patients are more positive about solutions to adherence than professionals •Patients feel that a family member or close friend is most influential on their adherence – Other groups feel that patients, themselves, are the most influential Wool.labs 2010 (Confidential) 7
  • 8. Through the Lens of WebDig Data Patients believe • Physicians do not set expectations about how their treatment will affect different aspects of their life and body • Not addressing the body holistically feeds a lack of trust We have seen • Lack of trust degrades relationships - which degrades adherence Something happened yesterday which has prompted today’s blog topic – patient empowerment – a recurring theme on this blog. Now I know there are plenty of good doctors out there, who carefully listen to their patients and are fully engaged with them, and I don’t wish to come across as a medic-basher, but once again, I found myself in a disturbing doctor/patient situation which has raised my hackles. I have mentioned before my anger and frustration that my oncologist never discussed with me at the outset of treatment, the fertility complications which can be a result of treatment for breast cancer. I felt at the time that my concerns were not listened to and it left me with a lingering distrust of the medical profession – I stress this is my own personal issue, I am happy to know that many of you have a wonderful relationship with your medical carers. I know it is also unfair to tar every doctor with the same brush of mistrust, but yesterday my faith was shaken yet again. http://beyondbreastcancer.wordpress.com/2010/06/17/empowering-the-patient/ June 2010 Wool.labs 2010 (Confidential) 8
  • 9. Survey Results Wool.labs 2010 (Confidential) 9
  • 10. Survey Questions Wool.labs recently fielded a Patient Adherence survey within social media forums – the results are covered on the following slides • In addition to the results in total, we also have broken out select results by patients and marketing professionals, the two largest respondent groups • We then also looked at the difference and similarities between groups Survey questions: 1. Based on your usage or study of social media do 6. Do you think patients have influence over what you see patients seeking the opinions of fellow their physicians prescribe to them? patients online in user forums and blogs? 7. Who do you think has the most influence over 2. What do you think of the concept of patients whether a patient stays on treatment or not? seeking advice of other patients? 8. Why do you think patients don’t take their 3. Do you think patients’ use of social media impacts medication or treatment as prescribed? their adherence to their prescribed treatment? 9. What argument or reason do you think is the most 4. Do you think patients would stop their treatments powerful in keeping a patient on their prescribed based on the advice of others in social media? treatment? 5. What do you think the pharmaceutical and/medical 10. Do you believe that the problem of patient device industry have an impact on patient adherence is solvable? adherence? Wool.labs 2010 (Confidential) 10
  • 11. Survey Methodology • Wool Labs conducted the Patient Adherence survey as part of its Healthcare Crowdsourcing Project in January 2011 – Patients, health care professionals and health care marketers were invited to participate through active, relevant conversations in social media – Ten multiple choice questions focused on Patient Adherence and the influence of social media • Wool Labs used our WebDig Survey system to deploy and analyze the survey and results • Quotes and some insights presented in the deck are from our WebDig database and the hundreds of studies we have conducted on patient behavior Wool.labs 2010 (Confidential) 11
  • 12. 1. Based on your usage or study of social media do you see patients seeking the opinions of fellow patients online in user forums and blogs? 60% 57% 50% 40% 30% 22% 20% 9% 10% 6% 6% 0% 0% Yes, and I Yes, but not No, not really. No, and I I’m not really Other strongly agree. widespread strongly sure. and/or not that disagree. often “Other” fill-in examples: “Yes and that concerns me.” Respondents: “Yes, would have selected option1, but not sure what 'strongly Entire Audience agreeing’ with. It is widespread and the wisdom of the masses Wool.labs 2010 (Confidential) is sought & leveraged.” 12
  • 13. 8. Why do you think patients don’t take their medication or treatment as prescribed? Other 27% The medication or treatment makes them feel worse than the 2% condition it treats. Taking medication or using their treatments is not making them 2% feel any better so it seems a waste of time and money. It’s too hard to keep taking or using their treatments every day 4% and they can’t keep up. They really don’t feel sick so it’s doesn’t seem to make that big a 6% difference to miss some. They personally decide whether they need this treatment or not, 0% no one else. They feel better so they think that they no longer need it. 18% They can’t afford their treatment so they need to ration it. 2% They don’t trust that their physician has truly diagnosed the 2% problem right. They don’t really understand why they are taking or using it. 14% They forget to take it or use it as they should. 22% 0% 5% 10% 15% 20% 25% 30% Respondents: “Other” fill-in examples: Entire Audience They don't have all the information -- most don't understand Wool.labs 2010 (Confidential) the how, when, where beyond the basics.” 13
  • 14. 2. What do you think of the concept of patients seeking advice of other patients? It is helpful for patients as they can compare and Patients see what others experience so they can better understand what to expect as their situation 45% progresses. It is helpful for patients as they can compare and Marketing & Advertising Professionals see what others experience so they can better understand what to expect as their situation 58% progresses. It is helpful for patients as they can compare and All see what others experience so they can better understand what to expect as their situation 53% progresses. 0% 10% 20% 30% 40% 50% 60% 70% Next Popular Answer: All - It is really important for patients to find others for support and camaraderie. 18% Respondents: Marketing & Advertising Professionals - It is really important for patients to find others for Entire Audience support and camaraderie. 19% Patients - Patients need to find those they trust to turn to for advice. Fellow patients know the most Wool.labs 2010 (Confidential) about how a disease really progresses and/or how medication works in the real world. 18% 14
  • 15. 3. Do you think patients’ use of social media impacts their adherence to their prescribed treatment? Other 3% No, I don't see this happening 3% Yes, I think that patients will take the advice of other patients they trust even if it means questioning their physicians and even if their 32% disease or condition is serious. Yes, I think other patients have a certain level of influence on a patient but not as much as healthcare professionals. 13% Sometimes, I think it varies based on the patient and perhaps only if the disease, condition, and/or treatment were not life threatening 23% or serious. No, patients may talk with others and share experiences but know better than to take extreme medical advice without talking to a 3% professional. Maybe, but patients listen to other patients as well as professionals and then make up their own minds. 23% 0% 5% 10% 15% 20% 25% 30% 35% Respondents: Marketing and advertising professionals “Other” fill-in examples: “I think in some cases it will impact them. I also believe a Wool.labs 2010 (Confidential) patient's social circle and family can have an impact. 15
  • 16. 8. Why do you think patients don’t take their medication or treatment as prescribed? Other 10% The medication or treatment makes them feel worse than the condition it treats. 10% Taking medication or using their treatments is not making them feel any better so it seems a waste of time and money. 0% It’s too hard to keep taking or using their treatments every day and they can’t keep up. 0% They really don’t feel sick so it’s doesn’t seem to make that big a difference to miss some. 10% They personally decide whether they need this treatment or not, no one else. 0% They feel better so they think that they no longer need it. 40% They can’t afford their treatment so they need to ration it. 0% They don’t trust that their physician has truly diagnosed the problem right. 20% They don’t really understand why they are taking or using it. 0% They forget to take it or use it as they should. 10% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Respondents: Patients “Other” fill-in example: Wool.labs 2010 (Confidential) “All of the above” 16
  • 17. TM About WebDig • WebDig uses the entire Internet to find conversations on any subject – industries, companies, brands and/or specific topics. The combined use of our advanced website screening, natural language processor, sentiment algorithms, extensive data processing capabilities, and targeted human intervention eliminates all off-topic comments and spam to isolate the most meaningful conversations about a subject. And since we scour the entire Internet, we retrieve everything regardless of where and when it was posted—even in places that go undetected by the major search engines and other commercial tools. • As a pioneer and leader in social cognition systems, we have conducted hundreds of studies. We have been advancing our systems since 2007 and have applied our software across the Internet as well as within TV and radio. Wool.labs 2010 (Confidential) 17
  • 18. TM About WebDig Survey • WebDig Survey is the lead component in our Crowdsourcing tool set and is a robust question builder, deployment and analytics system that supports over 25 different question types along with branching and conditional logic . Security is also robust and flexible. • Surveys are quick and easy to create and can be deploy via email, standalone webpages or embedded into websites. Survey branding is easily customized. • Results can be viewed in real time through an executive dashboard. • We have deployed hundreds of surveys to thousands of participants throughout the US and the world. Wool.labs 2010 (Confidential) 18
  • 19. Steve Chiles CONTACT Schiles@woollabs.com (610)331-5865 Follow: @woollabs Wool.labs 2010 (Confidential) 19