Direct to Consumer: Don't Wait

When a pharmaceutical product faces tough positioning challenges, sometimes the answer is to focus not just on the messages sent to doctors and patients, but on the messages doctors and patients communicate to each other. That insight lies behind a new approach to marketing known as doctor–patient encounter (DPE) communication. DPE includes the use of targeted waiting-room literature to encourage patients to engage in more proactive conversations with their doctors about specific medications.

Charlene Prounis is managing partner at Flashpoint Medica. She can be reached at charlene.prounis@flashpointmedica.com

DPE: Now More Than Ever

According to market research from the National Council on Patient Information and Education, patients immediately forget 50 percent of verbal information from their doctors. Furthermore, within an hour of leaving the doctor's office, 60 percent of patients cannot recall the actions the doctor suggested they take, and only 35 percent of patients get instructions on how to take their medication.

Glenn MacEachern is marketing manager at, Schwarz Pharma. He can be reached at gmaceach@schwarzusa.com

Patients should understand their diagnoses, be empowered to ask questions, and feel understood by their physicians. But the unfortunate reality is that doctor–patient relationships are often fraught with conflict. Traditionally, patients have viewed doctors as authority figures, and have taken on submissive, passive, and compliant roles. Pharma companies can help build stronger bonds between patients and doctors by developing a DPE strategy that can spark more fluid conversations and promote a branded drug at the same time.

DPE programs are designed to address communication issues and the snafus and clinical missteps that inevitably occur as a result of miscommunication. When the basic elements of a well-formulated DPE are combined, the outcomes are positive. Patients are more adherent to therapy and take better care of themselves, and overall, both patients and physicians are more satisfied.

On the most fundamental level, DPE communication programs should take into account all aspects of human nature. It is human nature to feel ashamed of losing control of one's emotions, just as it is human nature to pick up non-threatening, attractive reading material positioned at eye level in the waiting room of a physician's office. DPE programs should help build relationships, initiate conversations about specific concerns, help generate useful information, provide insight into the patient perspective, and provide a context in which an agreement is reached.

Push for Positioning

Schwarz Pharma's DPE campaign for Niravam (alprazolam, orally disintegrating tablets) is one example of a successful marketing program that was conceived to both spur doctor–patient conversation and differentiate the anti-anxiety drug from similar medications.

Empowered through learning Strategically placed pamphlets and other informational marketing materials in a doctor´s office can help patients better understand their disease and the medication available. This leads to smarter conversations between doctors and patients.

As Schwarz Pharma prepared to launch Niravam for the treatment of anxiety and panic disorder in August 2005, there were several marketing challenges. Besides the traditional struggle to raise awareness about general anxiety disorder (GAD) and panic disorder (PD), and successfully address the stigma related to these disorders, brand managers faced significant competition from generic Xanax (alprazolam, tablets). With all these factors weighing on the success of the drug, the company needed a sound patient-positioning strategy, based on unique and relevant brand-related features.

The Niravam patient-positioning strategy and the resulting Niravam DPE program were created in response to feedback from patients with GAD or PD and input from physician thought leaders. During intensive one-on-one interviews with patients, researchers found that in addition to feeling on edge, being excessively worried, fearing loss of control, being irritable, and lacking the ability to concentrate, patients wanted to achieve four things above all else:

• Control their symptoms

• Take charge at the first sign of symptom onset

• Get immediate relief

• Gain peace of mind.

Meanwhile, physician thought leaders confirmed the need for educational content in the office. Patients needed the encouragement to speak up about their symptoms and ask for help, and to know they were experiencing something the doctor could help them with. The thought leaders also noted that physicians could use some help with the process of differential diagnostics between depression and anxiety disorders. There was an obvious convergence between patients' needs and doctors' needs.

Differentiation Is Key

Although Niravam faced competition in the market, it possesses a key differentiating feature. Unlike conventional alprazolam, Niravam uses orally dissolving technology to quickly liquefy on the tongue without water. This feature allowed Schwarz Pharma to position Niravam to patients in a way that was both relevant (based on its convenience) and differentiating (unique administration). The campaign slogan: "Now you can take charge of the way you feel, because only Niravam's rapid-dissolving tablet relieves symptoms wherever and whenever you need relief."

This positioning strategy, which captured the emotional essence of Niravam, provided the foundation for a DPE-based communication program designed to help patients self-identify with GAD and PD and to seek treatment. More specifically, the Niravam DPE program, aimed at both patients and physicians, was created to ignite a conversation that would ultimately help patients with anxiety disorders to have meaningful conversations with well-informed physicians about their symptoms, and about how to best address those symptoms.

Nuts and Bolts

Schwarz Pharma's program included educational material for patients and physicians, including separate brochures for GAD and PD. The physician and patient brochures featured three main components: education, a test, and communication tips. The educational component focused on defining the disorder based on symptoms, citing prevalence, and acknowledging that despite the existing stigma, GAD and PD are treatable disorders that should not be a source of shame.

The Niravam DPE program combined elements of written and spoken communication, as well as strong visual imagery to capture patients' attention. The literature featured an illustration of a person rising out of a spinning body with a worried face and tense shoulders, conveying the feeling of "spinning out of control." The patient brochures, entitled "Put a Hold on Panic" and "Wind Down Anxiety," were housed in an eye-level display with imagery of the spinning body prominently featured. The display is lighthearted enough to encourage visitors to casually pick up the materials and read them.

Finally, there was one last critical piece of written content in the program—the post-visit, follow-through handout aptly entitled "From the Desk Of Your Doctor." This hand-out not only functioned as a reminder to patients to adhere to their prescribed treatment, but also introduced Niravam to patients. Additionally, this branded element provided requisite safety information and metaphorically extended the conversation that was initiated during the DPE.

By having DPE materials available, patients have a chance to learn more about their ailment, giving them a leg up when it's time to talk to their doctor. Understanding begins with good communication, and there's no better place to start communicating with patients than in the waiting room.