Hospital TV the Right Way

Many hospitalized patients, confronted with an immediate health threat and looking for ways to pass the time between visting hours, are prime candidates for health messages delivered through a unique medium: direct-to-patient (DTP) television networks. But there's a catch. Although such networks give pharma an excellent opportunity to reach a highly motivated audience with disease and treatment education and product promotion, the hospital-based DTP market is as risky as it is attractive.

Pharma companies must respond to the heightened sensitivities of healthcare providers, patient advocates, and regulatory bodies concerning traditional direct-to-consumer (DTC) advertising in the hospital environment. As several companies have found, one false move can do irrevocable harm. Seeing the opportunity to capitalize on its high-profile brand, in the mid-'90s CNN's "Better Health Network" repackaged its healthcare stories and broadcast them along with DTC commercials. That effort drew wide criticism from hospitals, which proclaimed that neither the presentations nor their educational components were appropriate for patients or their healthcare providers.

The September 2002 launch of "The Patient Channel," owned by General Electric Medical Systems and NBC, reconfirmed the need for pharma companies to tread lightly in this controversial arena. (See "Risky Business.") By applying mass media concepts and implementation strategies to a niche environment, both the CNN and NBC broadcasters set up their own roadblocks to success.

Risky Business

One savvy market survivor-the 20 year-old "Newborn Channel," whose advertisers are largely packaged goods and OTC drug manufacturers-tailored content to its audience. And a successful new entry, Cardinal Health's Pyxis Patient-Station, which offers patients and hospi-tal staff bedside access to the internet, e-mail, patient education programs, and internal hospital systems, indicates that the hospital-based broadcast market is alive and well.

This article argues that pharma companies shouldn't be daunted by the complexities of using this effective marketing tool, because the benefits of being a trusted and accepted sponsor of educational programs on a DTP television network can outweigh the risks. On the plus side, pharma can

• reach a pre-qualified audience

• win pre-qualified customers

• convert customers

• establish long-term loyalty

• improve long-term compliance by teaching patients about health regimes when they are most motivated to learn

• gain the trust of all stakeholders.

Controversial Content

For most audiences, TV is powerful by virtue of its universality and accessibility. In the hospital, it offers a distraction for patients and visitors and provides companionship during long, lonely nights. TV's intimacy enhances its ability to influence through sound, image, graphics, and packaging.

That power was demonstrated in a 1999 study published in the Archives of Internal Medicine that looked at hospital inpatients' comprehension of a 20-minute educational video addressing the advantages and disadvantages of a prostate-specific antigen for prostate cancer screening. In the study, male patients showed a 78 percent improvement in the number of questions they could correctly answer two weeks after viewing the video. Most interesting was that the men, aged 45-70, had no history of prostate cancer or treatment for prostate disease.

One concern about the use of this powerful tool is the effect that promoting pharma products could have on patients and families. Charlene Stokamer, director of patient health education for the Veteran Administration's New York Harbor Healthcare System, has no quarrel with pharma doing its job, but she objects to certain methods used to "entice a vulnerable and captive audience." She particularly objects to what she describes as "selective disclosure." She says, "Pharma is obliged to disclose risk and side-effect information, but how they do that has an impact. They might not disclose the bad as openly as they promote the good."

Broadcasters and their pharma sponsors need to clearly differentiate educational material from promotional content. That is the central issue that provoked consumer backlash to the "Patient Channel's" strategy as it was depicted in the Wall Street Journal article covering its launch. GlaxoSmithKline showed that such differentiation could be done-and done well-when it underwrote an educational segment on its AIDS treatment Combivir (lamivudine/zidovudine) featuring sports icon Magic Johnson. Aimed at African–Americans newly diagnosed with AIDS and HIV, the purely educational content fosters Combivir's image as a brand and GSK's image as a company whose primary focus is patient care. That, in turn, promotes trust among patients and healthcare providers who see the program.

Nevertheless, GSK's success doesn't mean that detractors' issues aren't real. In-hospital networks often blend different kinds of information: DTC commercials, infomercials, talk shows, and news. Such networks offer educational programs-on topics such diabetes control, post-surgical recovery, and pain management-that appeal to hospital inpatients. Ads that support those programs often address the same diseases or treatments covered in the non-commercial part of the mix, making it difficult for patients to distinguish between educational and promotional content. Thus, programming formats that are acceptable for traditional commercial television are neither appropriate nor effective in the hospital and can create confusion and mistrust.

Program Effects

In a public television environment, controversy is often an appropriate way to present information. The best journalists attempt to address both sides of an issue, while debates and roundtables are an important way to discuss serious concerns. But in a hospital setting, where patients are fearful, confused, and in need of mastering the facts about their condition and how to treat it, those approaches are counterproductive. The use of models and actors to play the roles of doctors or patients in infomercials and newscasts is equally damaging.

Needs Assessment

Meanwhile, the in-hospital DTP broadcasting market is huge, growing, and hungry for information. Given the aging US population, annual hospitalizations-currently estimated at 40 million-are projected to increase. Older hospitalized patients often have multiple and chronic health concerns and therefore need several medications. They often go home with more than one prescription. Adding family caregivers involved with those patients' recovery will substantially expand the reach of hospital-based communications.

Hospital discharge data indicate that most patients are hospitalized for primary ailments related to major drug therapy categories such as cardiovascular, oncology, and respiratory. And if they have secondary chronic conditions, those often relate to the categories of diabetes, pain, and arthritis. Hospitals are required to provide patient education, in part, to maintain accreditation status with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the nation's most important standards-setting accrediting body in healthcare.

So seriously does JCAHO take patient education that the Patients' Bill of Rights-which must be posted in every accredited hospital-includes the right to health information and education.

Still, according to the "Eye on Patients Report," a 1996 study by the American Hospital Association and Boston's Picker Institute for Patient Education, when patients are discharged from the hospital they are most concerned about being adequately prepared to manage their health. Of the 13,363 patients interviewed in that study

• 30 percent said they were not told about "danger signs"

• 31 percent said they were not told about side effects

• 37 percent said they were not told when they could expect to resume normal activities

• 33 percent reported problems in getting 'important questions' answered

• 34 percent were afraid to ask or did not know what to ask providers about their concerns.

The period before patients' discharge from the hospital is also a great time for pharma companies to do strategic marketing. At bedside, an ethical, useful specialty health channel can help provide answers to patients' common questions, reinforce education from healthcare professionals, and allay patients' fears. It can also encourage patients and their families to stay tuned for education on topics such as medication use and post-hospital healthcare.

Pharma's Challenges

There are a few things pharma should keep in mind when developing DTP strategies, programs, and materials:

Remember who's in charge of patient education. Meeting JCAHO's patient education standards is left to individual hospitals, with selection and final approval in the hands of directors of education and their committees. Ninety percent of the time, those are nurses who work in collaboration with multi-disciplinary teams as gatekeepers. Getting their buy-in is the first critical step to acceptance. And the only way to get it is to have a credible educational product.

"What hospitals need for patient and family education, is easily accessible, pertinent information presented in a realistic manner," says Kathy Gamble, a manager in the department of nursing and patient services for Shands at the University of Florida.

Education directors review programs with the following criteria in mind:

• accuracy and length

• audience's literacy level and learning styles

• cultural sensitivity

• participants with whom viewers can identify.

Tailor material to the needs of the hospitalized audience. The tone must be reassuring and engaging-no screaming ambulance sirens or journalistic exposes Viewers should be drawn in, not scared away or turned off. Educational material should focus on explaining medical conditions, treatment options, and the long- and short-term effects of compliance. The latter often include medications' side effects. For example, a side effect of opioid analgesics is constipation, which, for many patients, is as much an issue as pain management. The logic is that a sponsor that helps patients deal with constipation is a company that helps create compliant patients.

Repurposing pharma-sponsored mainstream health television programs or segments is not a wise approach. Those are frequently tied too closely to time-sensitive news, or they are too specific to particular brands or medications. Pharma-initiated programs-such as Fujisawa's series of branded transplant videos-are not as dated, but they also focus on specific products, use actors or models, and are generally too long.

In their widely referenced 1996 book, Teaching Patients with Low Literacy Skills, Celilia Doak, Leonard Doak, and Jane Root advise: "Segments with run time of eight minutes or less are preferable. When the segment contains some humor and a number of scene changes that build interest, the viewer's attention can be held for more than eight minutes. For example, a 13-minute segment on mammograms involving a tense discussion, argument, humor, and scene changes can seem to have a shorter viewing time and thereby hold attention longer."

The authors suggest that it's most effective to "select titles that focus on behavior changes and how to make these changes. Videos with a heavy factual content are boring to most people, and furthermore, the viewer is soon overwhelmed with the sheer number of facts presented and the attention is lost."

Understand the influencers and their clients. Just as pharma companies profile prescribers and prescription users, they should profile the hospital market, starting with front-line healthcare practitioners. Make no mistake: Without support from hospital staff, an educational product, service, or message is condemned to the shelf. Those care providers measure a product's utility by the amount of knowledge and satisfaction it gives to patients, by its effect on patients' health, and by its contribution to the staff's own efficiency.

Consider a healthcare practitioner's day: With a 1:5 staff-to-patient ratio, the practitioner never stops. All five patients need medication, help in and out of bed, test results, answers to their concerns, and education about their condition. Practitioners must record all those transactions on every patient's chart. That leaves very little time for quality interaction.

To lighten the practitioner's load, patients and their families or visitors could be watching education-driven messages on TV, learning how to manage their conditions, and learning what questions to ask their in-hospital specialist or their primary care physician. Pharma-sponsored educational material isn't just education in a void. It's delivered in a setting that can help patients make better use of their time and resources-and help them interact with doctors and nurses more efficiently as well.

Find a credible broadcaster. A DTP television network should repeat primary education programs and contain complementary content. The multiple viewing opportunities offered by repeats increase the chances that patients will retain what they learn. Complementary content would include information about secondary ailments that might affect a patient's primary condition. Thus, a patient admitted for heart failure who also has uncontrolled hypertension or arthritis needs to learn to manage pain and control hypertension to manage their heart condition.

To ensure balance, a DTP network should also include programs produced by medical societies, disease-related associations, consumer advocacy groups, and medical institutions. The broadcaster carrying a company's DTC ad campaigns and DTP education must also have enough rapport with hospital staff and patients to engender their support in gathering program impact data through questionnaires with patients and front-line staff. After all, both hospitals and pharma marketers need to know if they are getting a good return on their investment.

Raise awareness internally. To keep a DTP television network-and pharma's DTC advertising or sponsored segments-top of mind, pharma companies must put a hospital-staff-specific marketing strategy in place. The hospital's CEO, CFO, and other top-level administrators may have signed off on the service, but that doesn't mean that patients know it's available.

For the most part, healthcare professionals are not marketers, writers, producers, packagers, promoters, or media planners. Pharma companies should not assume that hospitals and their staffs know or follow basic marketing principles. That's why it is essential, after securing a DTP program's acceptance within appropriate hospital units, to market it to front-line influencers such as nurses, social workers, and even pharmacists. They, in turn, can help raise awareness of the program's availability to patients.

Although gifts and incentives to hospital personnel are ruled out, communicating the program's educational value to patients can go a long way toward getting hospital staff to support the company's program. Using such strategies, pharma marketers can ensure the company gets the best ROI for its DTP broadcast spend. (See "Program Effects.")

For a brand to succeed in this market, commitment to an ethical approach is necessary and has short- and long-term benefits for patients, practitioners, and pharma. In a 2000 study, "The Educational Value of Consumer-Targeted Prescription Drug Print Advertising," published in the Journal of Family Practice, the authors state, "If the industry were to be prodded into taking a more educational stance in its consumer-targeted prescription drug advertising, the impact of this shift on physician–patient interactions would need to be investigated. A more educated patient may take less time to treat and counsel, might show greater adherence to treatment regimens, and could assume greater responsibility for his or her own health."

Thus, education can be a key factor in repositioning pharma's image: from an emphasis on profits to a commitment to partnership in patient care.