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October 2003 Behind the Closed Door By Elisabeth Pena blank canvas … or marketing opportunity? The exam room is an ideal frontier for pharmaceutical marketing messages. Companies that develop desk-top anatomical models, wall charts and graphs, and exam-table paper are gaining access to the inner sanctum, which was once considered off limits. The goal is to trigger conversations between physicians and patients about medical care and treatment options in this intimate and private setting. The key advantage of exam-room products for pharmaceutical companies is that they can position themselves as being an asset to the doctors. These products can put them in a partnership with the doctor by offering them a tool that they can use to help their patients. The exam room is where the prescribing decisions are made. That is why it is so important that pharmaceutical companies have a substantial presence there. Exam Room Facts Between 80% and 90% of a physician’s time is spent in the examination room The majority of promotions are competing for the physician’s attention in only 10% to 20% of the day Physicians see an average of 200 patients per week, and every patient enters the examination room 55% of consumers shop at a retail location within one hour of leaving a physician’s office 94% of all consumers shop at a retail location within three hours after leaving a physician’s office 82% of all consumers believe an advertisement they see in their physician’s office compared with TV, radio, or print Eight of 10 consumers surveyed responded that they were interested in obtaining pamphlets and educational information made available at their doctors’ offices; but only 27% of patients reported reading a pamphlet or booklet while they wait to be examined Source: Supply Marketing, King of Prussia, Pa. For more information, visit supplymarketing.com. One of the key advantages of exam-room marketing compared with traditional marketing is the ability to reach a focused audience. As patients wait to see the physician in the exam room, their attention is on the visit and on formulating questions to ask the doctor. This provides marketers with an opportunity to reach an audience that is likely to be receptive to their message. “One of the first rules of real estate is location, location, location,” says Michael Green, VP of corporate marketing at Medi-Promotions Inc. “This is the same rule that applies to positioning a brand message — the exam room, where doctors write prescriptions.” This location, however, has not always been accessible. Most often, marketers try to reach physicians through traditional means such as sales reps, promotional products, and direct mail. In the past, marketers have had limited opportunity to get into the exam room. This, however, is starting to change as more companies aggressively look for ways to bring their marketing messages front and center. “There always has been the quest to find different ways to penetrate the doctor’s office to try to influence decisions in the exam room,” says Andrew Burstein, chief marketing officer at Supply Marketing. “Exam-room programs are designed to be the last image — and most effective image — before a prescription is written or a treatment decision is made. A brand’s competition may have spent $100 million on a marketing program, but if we can effectively spend $100 in the exam room, that brand will win.” Oftentimes these materials are used to complement pharmaceutical companies’ existing promotional efforts. “We find exam-room marketing to be beneficial,” says Ellen Marth McKim, executive director of marketing at Salix Pharmaceutical Inc., which uses branded anatomical models to create a presence for one of its brands. “This is one portion of our total campaign. While the models we give physicians are not the main focus of the brand program, they are a great support for the campaign.” In fact, companies view exam-room marketing as a pull-through opportunity. “Patients can see a product’s TV commercials and read the ads, but when they are actually in the exam room, they are more receptive and are reminded to ask their doctor about a drug they saw on TV,” says Patrick Kallestad, director of product development at GrapharmiX. Additionally, patients in an exam room are an easily defined audience. The exam room allows marketers to target specific groups, such as men, women, or children, not to mention patients who are visiting a specialist. The segmentation the exam room provides enables marketers the ability to supplement mass-media advertising by targeting a specific drug to the appropriate patient. “This is an opportunity to target patients who are in the exam room for maybe 10 or 15 minutes with nothing to do and no distractions; they will be able to devote their full attention to an educational component that is in front of them,” says David Walker, executive VP of marketing at GrapharmiX. “When patients get into the exam room their whole mindset shifts and they are thinking about possible questions that they want to ask the physician.” In addition to making a last-minute patient connection, marketers also can use the exam room to create a constant presence for their brand in the place where physicians spend most of their time. “The exam room is where the prescribing decisions are made,” Mr. Green says. “Doctors don’t prescribe in the waiting room, or their office, or in a hallway, but while they are in the exam room, after they have made their diagnosis and decided to make a therapeutic decision. That is why it is so important that pharmaceutical companies have a substantial presence in there.” Traditional giveaways to physicians, such as mugs or pens with a brand logo, may not make it into the exam room. Branded items that can be used in the exam room enable marketers to make sure that the material is going to be seen, unlike a mug, which may end up with the office manager or in a drawer. “If we provide a physician with free examination-table paper, it gets used and it is the biggest billboard in the doctor’s office,” Mr. Burstein says. “On this six-foot billboard we can put trivia questions, or we can teach patients about symptoms that they may have that they might not be aware of. When a physician walks into the exam room the patient can be knowledgeable about the therapeutic category and has the proper questions to ask the doctor.” By raising patient awareness, exam-room tools can aid the physician with patient care. “Physicians want something to make their jobs easier and to make them more efficient with patient care,” says Taylor Grant, director of product development for Health on Hand. “Doctors, as well as their office staff, feel overwhelmed. A large part of the positioning of our exam-room products is to help physicians.” The challenge is getting a marketer’s piece in the exam room and connecting with the audience once in there. “The exam room is certainly where the opportunity is and also where the challenge is,” says Stacey Singer, president of MBS/Vox. “Doctors and patients come together in the exam room with different motivations, knowledge, and expectations. So the challenge is how to bring these two very different people together. This is the opportunity with these tools.” The Tools ools for the exam room can be broken into two categories, according to Scott Galloway, president of GPI Anatomicals: purposeful items and educational items. Purposeful items are those that the doctor would use as part of the exam, such as tongue depressors and penlights. Educational items are those that a doctor would use to explain a condition to a patient, such as a wall chart or anatomical model. Both kinds of tools can carry product-specific branding. “In the industry, we are all aware that many of the materials brought to a physician’s office lay on shelves and are not used,” says Joseph Gattuso, chief strategic officer at MBS/Vox. Ms. Singer agrees that if a tool is useful for the physician and the staff or the patient, it will become a part of the exam room. “If the sales rep or marketer can convince physicians that a promotional exam-room item is going to be time efficient for them and will help them have a more motivated and informed patient in terms of compliance, they will use it,” she says. Items that educate and engage the patient are of great value to physicians. They increase awareness on the part of the patient and lead to a better understanding of the prescribed treatment regimen. “If a model is not well made, patients are not going to understand what is really happening within their body or what the consequences of no treatment might mean,” Mr. Galloway says. Designing valuable educational exam-room pieces requires a different strategy from that of a simple promotional item used in detail calls or as part of traditional direct-to-consumer marketing campaigns. One of the biggest differences between these is that the educational piece for the exam room has a longer promotional life cycle. “We have anatomical models for pharmaceutical promotion that have been in doctors’ offices for more than 10 years,” Mr. Galloway says. “Those products may have gone off patent a long time ago, but the doctors still use the models to explain a specific condition.” To make sure that exam-room promotional materials find a home, MBS/Vox recommends that each piece should meet four criteria. First the materials have to provide the patient and physician with information and knowledge. Second they should provide information in a meaningful way, such as giving an example of how the medication prescribed will address a disease. Third, the item should have an emotional aspect. And fourth, the item should be well designed. “One of the things that we have found is that there are some conditions where it is almost impossible to get the physician and the patient emotionally engaged,” Mr. Gattuso says. “There are certain categories where there is almost no energy. We also have found that patients often will go away and not really understand what the physician said. The doctor thinks he has covered things that perhaps he really hasn’t. Any tools that dramatically improve this dialogue are important.” Opening Doors s. Grant also believes that if an exam-room tool engages the patient, it will make the doctor’s job easier and lead to a better relationship with the sales rep delivering the product. “If a doctor gives patients a brochure, maybe they will read it; but most of the time they will not,” she says. “Tools that people can take with them and use will get them engaged and thinking about their health. That is something that will make a physician’s practice better, which in the end is what they are going to appreciate from the sales reps.” Mr. Galloway says the educational exam-room tools have another advantage: they can help the sales rep attain an audience with a physician. “There is a useful purpose to these pieces,” he says. “If it’s of greater value to physicians, they generally will take a little extra time to meet with the rep.” Ms. McKim has found that the branded anatomical models provide a point of discussion with the physicians. “Usually an anatomical model has something to do with a disease and the drug the representative is promoting,” she says. “Therefore there is a good tie between the drug that the rep is speaking about and the model, and the rep can use the model to show how the drug works.” The functionality of an exam-room piece is what can give a sales rep an edge over other reps with promotional items that are not designed to aid the physician’s practice. “On a more complex level, exam-room tools actually help physicians interact with their patients,” Mr. Burstein says. “An educated patient is the best patient. So if the patient knows what type of questions to ask the doctor or knows how to explain to the doctor what is bothering him or her, the doctor can diagnose the proper treatment.” But Ms. McKim says not all physicians are receptive to receiving promotional exam-room pieces. “A lot of physicians do not like promo items in the exam room.” she says. “The sales reps’ job is to convince the physician that the particular exam-room piece is of value. If they are not able to do that, there is nothing a marketer can do except work with the staff.” Mr. Burstein says the only instances where he has found physicians who do not want exam-room pieces is if they support a competing drug, but because exam-room tools are so powerful, it becomes a conflict because patients definitely interact with these pieces. Examining Results easuring return on investment for this type of marketing, however, is difficult. “Prescriptions are one thing that people can try to look at, but another is time spent — how much time did the doctor spend with a patient on that visit and subsequent visits,” Ms. Singer says. “Doctor-patient satisfaction, patient understanding, patient trial of a medication, long-term compliance, and persistence are other things that can be measured; clients are just starting to look at and measure those aspects comprehensively.” Mr. Galloway believes that the ROI of educational items in the exam room can be tremendous because the materials not only promote the brand but also help the patient understand the consequences of not following the prescribed treatment. “Patient education in the exam room can result in the patient following the script to completion,” he says. “That means more refills and a healthier outcome for the patient.” According to Ms. McKim, measuring the effectiveness of an exam-room marketing tool is difficult at best. And unlike journal advertising, where the marketing message can be measured through quantifiable studies, the company has to rely on anecdotal stories from reps who report whether the physician likes and uses the tool. On a different front, Ms. Grant suggests that exam-room marketing has an impact on a pharmaceutical company’s image. “The best ROI for exam-room marketing of pharmaceuticals is going to be the company’s image,” she says. “The pharmaceutical industry really has done more than any other industry in this country to improve people’s health and quality of life, yet right now the industry is in the midst of a public-relations nightmare. Functional exam-room marketing tools give companies a way to be a part of a health-improvement effort rather then just selling people drugs.” Regardless of the metrics used to measure the effectiveness of exam-room marketing, experts do not dispute that the exam room is an important place for a marketer’s brand message to be. “Doctors are in the exam room daily, so promotional pieces that are kept in the exam room are used everyday,” Mr. Galloway says. “The more useful and educational a promotional piece is, the more valuable it will be to the doctor who uses it. And that’s all going to translate to the bottom line. If it works for the doctor, it works for the pharmaceutical company.” PharmaVoice welcomes comments about this article. E-mail us at firstname.lastname@example.org. Scott Galloway The content of promotional pieces in the exam room is very important because some of these pieces are going to be there for a long period of time. Creating Effective Physician-Patient Communication and Marketing Marketing prescription drugs is a complex undertaking. Patient education is of prime importance. In looking at the form and design of in-office materials, three criteria become essential for effective in-office marketing materials: Time Sensitivity. Physicians have tremendous demands on their time. As a result, all materials must be designed in a way that facilitates efficient and focused physician-patient dialogue. Interactivity. Materials must engage both the physician and patient. These can be high-tech formats, such as interactive computer programs, or low-tech, such as hard-copy printed materials. Regardless of the format, materials must be compelling, thus encouraging physicians to identify patient concerns and encouraging patients to ask questions about their condition or its treatment. Customizable. Materials must be developed in a way that they can address different patient types and needs. For example, a patient who is newly diagnosed with a chronic condition may have different communication needs than an established patient who is struggling with long-term compliance and persistency. Source: Joseph Gattuso and Stacey Singer, MBS/Vox, Wayne, N.J. For more information, visit commonhealth.com. Stacey Singer and Joseph Gattuso High-tech approaches are not necessarily required to meet any of these criteria. The way printed materials are designed by format, graphics, and language can achieve these criteria — if the creator of these materials has insight into the patient, the physician, and the realities of medical practice today. Exam-Room Marketing David Walker Everybody has a message but the timing of that delivery is important. Exam-room applications complement the marketing mix that our clients already have out there. Tools of the Trade A variety of tools are available for marketers who want to create a presence for their brand in the exam room. The following are some of the companies that offer tools that can be used to convey a brand’s message to physicians and patients. Formedic Communications Ltd. Formedic provides effective point-of-prescription promotion to physicians in clinics and offices helping clients achieve their marketing objectives through customized, targeted programs. Formedic’s programs are designed to complement personal and nonpersonal promotional efforts. Formedic reaches more than 168,000 high-prescribing physicians with its patient-record forms. All of Formedic’s practice-management tools are provided free of charge to physicians upon request. This is made possible through the sponsorship of participating pharmaceutical companies. “Formedic focuses exclusively on reaching physicians with product promotion when patients are seen and prescribing decisions are made,” says Raj Singh, VP and general manager, of Formedic. “It is the one promotional vehicle that equalizes the promotional impact of every product.” GPI Anatomicals Inc. GPI Anatomicals provides branded anatomical models for use in physicians’ exam rooms. The company’s line of 55 educational stock models include all major organs, joints, and the spine, and they can be customized. The stock models cover a wide range of specialties for both humans and animals. Nearly every part of the human anatomy is represented, from skin, bones and arteries to eyes, brain, kidneys, prostate, breast, lung, and teeth. A newer line for veterinarians include canine hip, knee, jaw, heart, and ear. The company also specializes in the design of models for pharmaceutical promotion. “The advantage in using an anatomical model is in the reduction of time spent explaining a condition to a patient,” says Scott Galloway, president of GPI Anatomicals. “If a physician verbalizes what is going to happen with a treatment, the patient may not understand. Better comprehension is more likely when patients are looking at a model. Consider for example, a gastric ulcer. If there’s a model available patients can look at it, pick it up, and touch it. This is a benefit to both patient and doctor. It takes less time to explain the physical condition with a model. The exam room is where these pieces need to be.” GrapharmiX Media Inc. GrapharmiX provides products for the physician exam room such as branded table paper and an interactive lenticular wall chart, which has a 3-D effect and changes images when a patient walks past it. “We have quite a few innovative marketing applications that are designed to stimulate the patient’s interaction with the physician and the staff,” says David Walker, executive VP of marketing at GrapharmiX. “These exclusive and patented applications are designed to motivate the patient to discuss conditions that might have otherwise gone undiagnosed.” “We think of our exam-room table paper as a billboard opportunity that includes three components — education, inspiration, and added value for patients and consumers,” says Patrick Kallestad, director of product development at GrapharmiX. Health on Hand Health on Hand produces branded organizer systems to keep track of vital information about a person’s health. The company’s products include the Pocket Health Organizer, which fits in a pocket or purse; a wallet card, which gives medical personnel critical health information in an emergency; and a larger, more comprehensive Personal Health Organizer, which is designed to create a comprehensive record of health and provide valuable information on disease prevention. The Health Organizers also are available in disease-specific models, such as for asthma, diabetes, cholesterol, blood pressure, and weight control, which provide additional information on how to manage these conditions. “These products give patients an easy way to record and track their basic health information and history, and that helps doctors spend less time going over the same old information and gives them more time to discuss new treatment options and prevention,” says Taylor Grant, director of product development at Health On Hand. “For a patient who is diagnosed with a chronic condition, the doctor can use these books as a tool to discuss the condition with the patients and outline what the patients need to do to manage their care on a daily basis. The product also gives patients lists of questions to ask doctors and a place to write down additional questions. If patients get actively involved in their care they will follow their treatment plans and they will get better care from their doctors.” Medi-Promotions Inc. Medi-Promotions’ flagship Medi-Scripts program provides physicians with prescription pads that contain advertising. The program offers pharmaceutical marketers access to more than 200,000 physicians and allows advertisers to reach their target audience by physician, specialty, therapeutic category, and/or prescribing level. “Prescription pads are a great vehicle for getting in the exam room; a doctor starts the day with two things, a stethoscope and a prescription pad, and has both of those at all times,” says Michael Green, VP of corporate marketing at Medi-Promotions. “The prescription pad offers a limited amount of space so we work with our clients to take their existing full page or multipage ad and revise it so that we are able to get a quick brand message across in the limited amount of time the doctor has. We like to leverage all the efforts that go on outside the exam room — the rep meeting with the doctor, the journal ads, direct mail, and CME meetings — and bring them in the exam room and into the small real estate of the prescription pad.” Supply Marketing Inc. Supply Marketing delivers free branded office supplies to a network of more than 400,000 physicians and their patients. One of the company’s lead strategies is to put brands on examination table paper. Other exam-room communication tools the company provides include dental bibs, baby-scale liners, scale liners, paper towels, examination gowns, adhesive bandages, and pillow cases. “We offer a comprehensive marketing program where we have doctors opt into programs with us and we deploy promotional exam-room materials into their offices for a predetermined period of time,” Mr. Burstein says. “A pharma company can come to us and say ‘we’d like to reach pediatricians in this specific market,’ and we can reach into our network of doctors and find out which pediatricians in that area have opted in and we can then deploy this program.” Andrew Burstein Physicians are more open to seeing sales reps with these exam-room products, compared with seeing other reps, because they need these products. Patrick Kallestad Exam-room educational tools aim to empower patients to ask more questions, which can result in more scrips written. Waiting-Room Marketing: The Right Time, the Right Place arketing prescription drugs is a complex undertaking. Patient education is of prime importance. Physician involvement is key to success. FDA requirements must be met, and consumer advocates have demands. TV ads alone offer reach and generate consumer awareness but many pharma marketers looking for targeted, measurable, efficient programs are incorporating the physician’s waiting room into the media mix. Waiting-room marketing, such as the AccentHealth Waiting Room TV Network, can deliver targeted messages to patients at the point of care. Proximity to the doctor, perceived physician endorsement, and a targeted health-conscious audience make the waiting room an ideal environment for pharmaceutical messages. Consumers are educated and entertained while they wait to see the doctor. Programming can include up-to-date news and information on nutrition, fitness, and diseases that affect them. According to RoperASW, the uncluttered, zap-free, health-relevant AccentHealth environment has demonstrated: • Unaided ad recall up to four times as high as commercial TV • Physician-patient dialogue: 63% of viewers discuss medication with the doctor • Receptivity: 82% of viewers find ads on AccentHealth to be more believable than those seen on commercial television Through a pre-post research study of brands from the allergy, proton pump inhibitor, sleep aid, and COX-2 inhibitor categories conducted by IMS Health, AccentHealth has demonstrated return on investment as high as 8:1, with increases in new prescriptions, market share, and physician penetration. By expanding point-of-care initiatives. pharmaceutical advertisers can reach consumers while they are thinking about their health, before they discuss medications with the doctor and before they fill their prescriptions. Patient education is invaluable for increasing awareness and compliance, and physician’s offices are the best place to reach patients when they are most receptive to health messages. Physicians appreciate being involved, and their support will add credibility to any pharma campaign. Source: Edith Hodkinson, VP of marketing, AccentHealth. AccentHealth is a source of health news and information produced by CNN and cohosted by CNN medical correspondent, Dr. Sanjay Gupta. For more information, visit accenthealth.com. Ellen Marth McKim Physicians aren’t always open to exam-room marketing. They don’t want to feel like they are selling their patients on drugs. Experts on this topic Andrew Burstein. Chief marketing officer, Supply Marketing Inc., King of Prussia, Pa.; Supply Marketing is a marketing communications company that creates products and services and maintains brand awareness in physicians’ exam rooms. For more information, visit supplymarketing.com. Scott Galloway. President, GPI Anatomicals Inc., Lake Bluff, Ill.; GPI Anatomicals is a manufacturer of anatomical models for pharmaceutical companies. For more information, visit gpianatomicals.com. Joseph Gattuso. Chief strategic officer, MBS/Vox, Wayne, N.J.; MBS/Vox, a CommonHealth agency, is a research-based consultancy specializing in physician-patient communication. For more information, visit commonhealth.com. Taylor Grant. Director of product development, Health On Hand, Clearwater, Fla.; Health On Hand produces organizer systems to help patients keep track of vital information about health, as well as organizers for pharma sales reps. For more information, visit healthonhand.com. Michael Green. VP, corporate marketing, Medi-Promotions Inc., Hasbrouck Heights, N.J.; Medi-Promotions provides point-of-decision promotional programs to the healthcare industry. For more information, visit medipromotions.com. Edith Hodkinson. VP, marketing, AccentHealth, New York; AccentHealth is the media division of Axolotl Corp., which provides Elysium Web-based applications for about 12,000 healthcare professionals nationwide. For more information, visit accenthealth.com. Patrick Kallestad. Director of product development, GrapharmiX Media Inc., Orlando, Fla.; GrapharmiX provides access to the patient-exam room through innovative marketing approaches. For more information, visit grapharmix.com. Ellen Marth McKim. Executive director, marketing, Salix Pharmaceuticals Inc., Raleigh, N.C.; Salix is a specialty pharmaceutical company. For more information, visit salix.com. Raj Singh. VP and general manager, Formedic, Somerset, N.J.; Formedic is a supplier of patient-record forms that are designed to streamline practice management, increase efficiency, and decrease office overhead. For more information, visit formedic.com. Stacey Singer. President, MBS/Vox, Wayne, N.J.; MBS/Vox, a CommonHealth agency, is a research-based consultancy specializing in physician-patient communication. For more information, visit commonhealth.com. David Walker. Executive VP, marketing, GrapharmiX Media Inc., Orlando, Fla.; GrapharmiX provides access to the patient-exam room through innovative marketing approaches. For more information, visit grapharmix.com.