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"Return On Education" presentation by HealthEd and Amylin Pharmaceuticals, EXL Digital Pharma West 2011, San Francisco. Presenters: Susan Eno Collins and Susan M. LaRue
Citation preview
Return on Education™—Leveraging Patient Education to Improve Treatment Outcomes
Susan LaRue, RD,CDE, Clinical Education Specialist, Medical Relations and Information, Amylin Pharmaceuticals, Inc
Susan Eno Collins, RD, CHES, SVP, Health Education, HealthEd; Community Leader, SurroundHealth.net
04/07/2023 2
Give us the next 30 minutes and we will… Give you an introduction to Return on Education™—a framework you
can use to develop effective programs
Show you a case study where we incorporated the framework
Share the positive results we got
Hopefully, answer your questions
Return on EducationTM: Starts with a behavior-based approach for developing programs
3
Develop Objectives
Uncover Insights
Choose Behavior Model
ProgramDevelopment
and Refinement
During (In Development)Post (After Program Launch)Pre (In Planning)
LaunchCapture and Analyze Results
04/07/2023 4
Desired Action
And includes a Return on EducationTM framework for evaluating the outcomes of the program
Customized based on program objectives
Examples include
‒ Screening/diagnosis
‒ Talking with HCP
‒ Fill initial Rx
‒ Take Rx as prescribed
‒ Conversion
‒ Use of device
Program
‒Engagement
‒Reach
‒Frequency
Symptom alleviation
HEDIS measurement
Function
Clinical measures
Business
‒Length on therapy
‒ Increased sales
‒Rep access
Program/Business Impact
Health Outcomes
Education Impact
Persuasion
(“This is important to me”)
+
Clarity
(“I understand and can apply what I am learning”)
+
Insight-driven content
(“This relates to me and my life”)
+
Reaction to tactic/program
(“This has been worth it. I have learned something new.”)
Case study: Effects of Patient Education Support Program on Pramlintide Adherence
04/07/2023 6
Acknowledgement
• This case study is based on the following publication:• Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on
pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.
• We wish to thank the lead author, Gayle Lorenzi, RN, CDE, University of California at San Diego, for her expertise and contributions
04/07/2023 7
Pramlintide is taken as an adjunct to mealtime insulin Analog of the hormone amylin
‒ Hormone cosecreted with insulin by the beta cells in the pancreas
‒ Deficient in people with type 2 and type 1 diabetes
Adjunct treatment for people with type 2 or type 1 diabetes who take mealtime insulin
Injectable
Taken prior to major meals
‒ A major meal is >30 grams of carbohydrate or > 250 calories
Offers improved blood glucose control
‒ Fewer blood sugar swings throughout the day
‒ Added benefit of potential weight loss
04/07/2023 8
The numbers shed light on the product’s challenges 3
‒ Patients taking pramlintide at meal times may already be taking 4 shots of insulin a day
‒ Pramlintide becomes 3 additional shots to integrate into a daily routine
50%1
‒ Adherence to medicines across multiple chronic conditions, including diabetes
50% in 2 months2
‒ About 50% of patients starting pramlintide discontinued therapy within 2 months
Sources: 1. World Health Organization: Adherence to long-term therapies: evidence for action. Geneva, World Health Organization, 2003. 2. Data on file. San Diego, CA., Amylin Pharmaceuticals, Inc.
04/07/2023 9
Why did patients stop treatment? Their answers revealed a need
Did not lose weight
Additional injections requiredSide effects (volunteered)
Too expensive
Dosing regimen too complicated
Lack of effectiveness (volunteered)
Source: Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.
Potentially 57% of reasons for discontinuation can be addressed withadditional education/realistic expectations
28%
20%15%
13%
9% 5%
Main Reason for Discontinuing PramlintidePercent of Patients
(N=127)
To develop our program, we started with the Return on EducationTM approach
10
Develop Objectives
Uncover Insights
Choose Behavior Model
ProgramDevelopment
and Refinement
During (In Development)Post (After Program Launch)Pre (In Planning)
LaunchCapture and Analyze Results
04/07/2023 11
Program objectives were based on behavior-change principles
Set realistic expectations at the beginning of treatment
Build problem-solving and communication skills
Increase sense of self-efficacy (“I can do this”)
04/07/2023 12
Trying to take a walk in patients’ shoes (uncovering insights)
Moti
vato
rs
•Healthcare provider knowledge
•Realistic expectations•Hope for improvement•Adjustment period/need for flexibility
•Insulin/appetite changes•Weight loss
Starting Pramlintide Therapy
Moti
vato
rs
•Improved glucose levels, fewer fluctuations
•Improved AIC•Perceived benefits of therapy
•Increased sense of control of diabetes
•Weight loss•Less insulin
Maintaining Pramlintide Therapy
Barr
iers
•Additional injections•Side effects•Therapy disappointment•Impact of changes on family dynamics
•Suboptimal dosing; fewer benefits realized
•Life demands
Barr
iers
•Lack of healthcare provider support and education
•Frustration: different routine and considerations
•Unanticipated hyperglycemia
•Injection burden and treatment complexity
•Unexpected side effects
04/07/2023 13
Behavior models provide a blueprint for program design
Hunch and Intuition
Feels right Seems cool This type of program
worked before Have seen other programs
designed like this
Program designed using Social Cognitive Theory
Evidence-Based Approach
Design based on understanding of behavior
Models suggest how to create program to have an impact
Create unique, tailored solutions to problems
04/07/2023 14
Designed for clarity by integrating health literacy principles
“One out of 3 Americans have basic or below basic health literacy skills”
Source: National Center for Education Statistics. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. (NCES 2006-483). http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483.
“I have challenges accessing, understanding, and using
health information “
Applying the Return on EducationTM approach to develop the program
15
Develop Objectives
Uncover Insights
Choose Behavior Model
Post (After Program Launch)Pre (In Planning)
LaunchCapture and Analyze Results
ProgramDevelopment
and Refinement
During (In Development)
04/07/2023 16
Maintaining Pramlintide Therapy
Newsletters
Co-pay card
Share Your StoryFeedback survey
24/7 Information and education
Outbound/Inbound calls with nurses
Starting Pramlintide Therapy
In-officestarter kit with
demo video
Newsletter with expert and patient interviews
Welcome kit with goal setting and wellness map
Co-pay card24/7 Information
and educationOutbound/inbound
calls with nurses
Program design was mapped to insights…
Moti
vato
rs
•Healthcare provider knowledge
•Realistic expectations•Hope for improvement•Adjustment period/need for flexibility
•Insulin/appetite changes•Weight loss
Starting Pramlintide Therapy
Moti
vato
rs
•Improved glucose levels, fewer fluctuations
•Improved AIC•Perceived benefits of therapy
•Increased sense of control of diabetes
•Weight loss•Less insulin
Maintaining Pramlintide Therapy
Barr
iers
•Additional injections•Side effects•Therapy disappointment•Impact of changes on family dynamics
•Suboptimal dosing; fewer benefits realized
•Life demands
Barr
iers
•Lack of health care provider support and education
•Frustration: different routine and considerations
•Unanticipated hyperglycemia
•Injection burden and treatment complexity
•Unexpected side effects
04/07/2023 17
To create a holistic, integrated experience Maintaining
Pramlintide Therapy
Newsletters
Co-pay card
Share Your StoryFeedback survey
24/7 Information and education
Outbound/Inbound calls with nurses
Starting Pramlintide Therapy
In-officestarter kit with
demo video
Newsletter with expert and patient interviews
Welcome kit with goal setting and wellness map
Co-pay card24/7 Information
and educationOutbound/inbound
calls with nurses
Outcomes of a Behaviorally Based Program
Did the Return on EducationTM approach work?
19
Develop Objectives
Uncover Insights
Choose Behavior Model
ProgramDevelopment
and Refinement
During (In Development)Pre (In Planning)
LaunchCapture and Analyze Results
Post (After Program Launch)
04/07/2023 20
Education Impact
Persuasion
Behavior Change Model Metrics
Change in Knowledge
Change in Attitudes
Change in Skills
+Clarity
Clear by Design
+Insight-driven content
Tone
Relevance
Accuracy of Information
+Reaction to tactic/program
Satisfaction
Appeal
Usefulness
Needs Met
Impact
Intended/Actual use of materials
Return on EducationTM framework guided the evaluation plan
Customized based on program objectives
Examples include
‒ Screening/diagnosis
‒ Talking with HCP
‒ Fill initial Rx
‒ Take Rx as prescribed
‒ Conversion
‒ Use of device
Desired Action
Program
‒ Engagement
‒ Reach
‒ Frequency
‒ Enrollment
‒ Channel preference
‒ Site visits
Symptom alleviation
HEDIS measurement
Function
Clinical measures
Business
‒ Length on therapy
‒ Increased sales
‒ Rep access
‒ Market expansion
Program/Business Impact
Health Outcomes
04/07/2023 21
Program was relevant
Q: Would you like to have more, less or about the same: Information about organizing my medicines
About the Same
Less More No Response
44%
11%
31%
14%
75%: same or more vs. 11% less
75% of respondents want the same or more level of information about organizing their medicines
Source: Data on file. San Diego, CA., Amylin Pharmaceuticals, Inc.
Program had high appeal
Q: Would you like to have more, less or about the same: Tools for talking with my HCP
About the Same
Less More No Answer
47%
13%
24%
16%
71%: same or more vs. 13% less
71% of respondents want the same or more tools for talking with their HCP
Source: Data on file. San Diego, CA, Amylin Pharmaceuticals, Inc.
04/07/2023 23
Series10
10
20
30
40
50
60
70
80
90
65% 67%70%
79%
67% 65%
80% 81%
Survey 1 (N=358)
Program was usefulPe
rcen
tage
of P
atien
ts
Patients Wanted:
The same/more frequent diabetes information
The same/more frequentnewsletters
The same/longer duration of calls
The same/more frequent contact
Source: Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.
24
Prompted patients to talk with their HCPs
Q: The Support Program has helped me talk with my HCP about my pramlintide treatment
Agree Disagree Neither agree nor disagree
No Answer
51%
6%
39%
4%
Most respondents agree that the program helps them talk with their HCPs
Source: Data on file. San Diego, CA, Amylin Pharmaceuticals, Inc.
04/07/2023 25
Series10
20
40
60
80
10088%
84%80%
94%89%
85%
Survey 1 (N=358)
Perc
enta
ge o
f Pati
ents
Patients Reported:
High self-reported compliance and persistency
On and continuing therapy the first 3 months
Dosing 2 or 3 times daily
Administration of maintenance dose
Source: Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.
04/07/2023 26
Improvements were demonstrated
Patients in program were on pramlintide 50% longer relative to those not in program
Source: Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.
Program refinement based on analysis
Using the Return on EducationTM approach to refine
©2011 HealthEd Group, Inc. 28
Develop Objectives
Uncover Insights
Choose Behavior Model
ProgramDevelopment
and Refinement
During (In Development)Pre (In Planning)Post (After Program Launch)
LaunchCapture and Analyze Results
04/07/2023 29
Teachable moments shouldn’t be missed Web enrollments make up 50% of enrollees and often occur outside of
business hours of call center.
Video on BRAND.com creates continuity and familiarity
Video-based FAQs feature call center nurse
04/07/2023 30
Educational game developed to address confusion about Major Meals
Brand.
BrandBrand
04/07/2023 31
One barrier and motivator still had to be addressed
Moti
vato
rs
•Healthcare provider knowledge
•Realistic expectations•Hope for improvement•Adjustment period/need for flexibility
•Insulin/appetite changes•Weight loss
Starting Pramlintide Therapy
Barr
iers
•Lack of healthcare provider support and education
•Frustration: different routine and considerations
•Unanticipated hyperglycemia
•Injection burden and treatment complexity
•Unexpected side effects
A challenge and opportunity for you
You can use the Return on EducationTM approach to createa solution that promotes action and change
33
Develop Objectives
Uncover Insights
Choose Behavior Model
ProgramDevelopment
andRefinement
During (In Development)Post (After Program Launch)Pre (In Planning)
LaunchCapture and Analyze Results
04/07/2023 34
Desired Action
And evaluate your Return on EducationTM
Customized based on program objectives
Examples include
‒ Screening/diagnosis
‒ Talking with HCP
‒ Fill initial Rx
‒ Take Rx as prescribed
‒ Conversion
‒ Use of device
Program
‒Engagement
‒Reach
‒Frequency
Symptom alleviation
HEDIS measurement
Function
Clinical measures
Business
‒Length on therapy
‒ Increased sales
‒Rep access
Program/Business Impact
Health Outcomes
Education Impact
Persuasion
+
Clarity
+
Insight-driven content
+
Reaction to tactic/program
04/07/2023 35
This is a complicated recipe
04/07/2023 36
What patients have to manage day to day can also be complicated
“My Day”
37
Discussion
Hands On
Audiovisual
Seeing
HearRead
Digital solutions can help make learning more effective
Within just a few minutes of leaving the doctor’s office, patients may remember less than 50% of the critical information the doctor shared.2
HCP Office Visit
90%
60%-70%
40%-50%
10%-20%
5%-15%
Retention ratesof different learning
styles1
1. Adapted from Edgar Dale’s “Cone of Experience.
2. Davis TC, Williams MV, Marin E, Parker RM, Glass J. Health literacy and cancer communication. CA Cancer J Clin. 2002;52:134-149.
04/07/2023 38
Which can lead to positive health outcomes
“My Health”
THANK YOU! Time for your questions
04/07/2023
04/07/2023 40
To contact us Susan LaRue [email protected]
Susan Eno Collins [email protected]
To obtain a copy of this presentation, go to www.healthed.com