Tag Archives: practice

Changing Doctors’ Practice Dynamics With Covid-19 And Beyond

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Unexpectedly, the answer to an onerous question surfaced just around a year’s time. In my article on this blog, written on April 08, 2019, I raised a question – “Would ‘Connected Healthcare’ Catch Pharma Players Off-Guard?” Interestingly, an unexpected and abrupt turn of events in the global healthcare space, including India, triggered by Covid-19 pandemic, signals an early dawn of an evolving reality, related to ‘Connected Healthcare’, in India.

Never ever, I reckon, the Government realized so well that continuation with a fragile public healthcare infrastructure is self-defeating for the country. Allocation of financial resources, at least 2.5 percent of the country’s GDP, for its rejuvenation – powered by AI-based modern digital technology, would help avoid overburden on the healthcare system. This will mean, saving more lives and also a significant reduction of morbidity, especially in a situation, like Covid-19 pandemic. Good health can propel good economy, more effectively.

That’s why, ‘connected healthcare’ – by effectively linking requisite ingredients of all health-related information that medical professionals and the patients would need, appears to be the new reality. This process is being facilitated by rapid acceleration of usage of various digital platforms, by both healthcare consumers and providers. Thus, it is becoming increasing clear now that leveraging digital technology with innovative mindset and a fresh pair of eyes, will be the way forward, in India, as well. It seems very likely, when considered from two angles:

  • What several research data reveals about an increase in usage of digital platforms by healthcare consumers and providers, before and during Covid-19 pandemic. Especially because, this struggle appears to be for a long haul.
  • Most countries are currently struggling to navigate through highly contagious Covid-19 outbreak and simultaneously trying to chart a workable pathway for avoiding similar eventualities in the future.

In this article, I shall try to focus on Covid-19 induced changes in doctors’ practice dynamics – based on research studies, while revisiting the subject on ‘connected healthcare,’ and its relevance now – also in the years ahead.

Research studies capture a new and growing awareness: 

The recent findings from the “Digital Doctor 2020” survey, which is a ‘21-country study of Doctors’ perspectives on digital and connected health, highlight some interesting points. This study was conducted just before the global outbreak of Coronavirus. Some of its findings were also deliberated inan article published in the PharmExec.com on April 23, 2020. The paper is titled, ‘How Prepared Were Physicians for the COVID-19 Digital Upswing? Some of the key points, as reported, are worth noting:

  • Although, the awareness of drug prescribers of different digital technologies related to healthcare is high, how these technologies work in healthcare was unknown to many doctors at the time of the Digital Doctor 2020 survey. It came out that clear benefit statements, will be welcomed when there is such a steep learning curve.
  • Regardless of face-to-face interactions still remaining preferred choice before the pandemic, online channels are on the rise and accelerating with COVID-19 lockdown.
  • Benefits of using connected health devices for patient management and treatment are widely recognized and is believed to play a key role in the future. The respondents agree, even their patients are now more interested in their own health data, as they are gaining control over their weight, diet and physical activities.

Highlighting that their research data over the last few weeks showing increasing usage of digital solution to respond and adapt to the new realities of Covid-19 pandemic, the author of the article concluded: ‘For a long time, digital solutions have often been considered an option; now they have become a necessity.’ To understand the emerging scenario, let us now look at the preferred communication channels of the doctors – pre-Covid-19 outbreak. 

Preferred channels of doctors pre-Covid-19 outbreak:

According to the Ipsos survey of pre-Covid-19 outbreak, face-to-face communication with Medical Representatives (MR) used to be the most favored channel of the doctors, as follows:

Channel Med. Rep Speaker Program Conf. E-detail Journal Ads Med. Liaison E-mail Direct mail Pharma website
Pref. % 35.2 11.7 10.0 8.4 8.4 8.8 8.4 5.0 4.1

However, on April 14, 2020, Ipsos shared the results of their interim research conducted, together with M360, among doctors, conducted during Coronavirus outbreak. The preliminary findings indicate, Covid-19 will permanently alter physician practice dynamics. A clear shift in the engagement model with them – away from in-person detailing, throws several significant questions on the traditional physician engagement template of the pharma players.

It also signals another fundamental change in the physicians’ practice dynamics, as Covid-19 seems to have changed practicality of having face-to-face communication between the representatives and doctors, as before. This situation makes ‘connected healthcare’ a reality – as we move deeper into the everyday- evolving scenario.

Some unexpected and significant changes surfaced in a month: 

The above research also flagged, the following two important changes, among several others, triggered by the Coronavirus outbreak:

  • The mean number of sales representative visits dropped from 15.7 before the Coronavirus outbreak to 1.3 in just the following month, during the pandemic 
  • Overall preference and effectiveness of e-detailing also improved, significantly, where any non-personal communication and interaction with drug companies, either through sales representatives or by others, were considered as e-detailing. 

This brings me back to the question, how are doctors feeling about this never before shift in their practice dynamics?

How are doctors feeling about a never before shift in their practice dynamics?

The ongoing research on this critical area captures a new reality, where many doctors, especially those who are not directly engaged in combating the Covid-19 pandemic, are clearly feeling a shift in their practice dynamics. Curiously, the new feeling of a shift also includes, the way these doctors interact with different drug companies, mostly through their Medical Representatives.

These inklings of the doctors are expected to get translated into some fundamental changes in the real-life situation, as we all sail through the life-changing time caused by Covid-19. Especially, considering the requirements of a new normal – social distancing, wearing a mask always while on outdoor, and several other norms as prescribed from time to time.

‘Connected healthcare,’ is expected to take its place on the center stage:

In this situation, ‘connected healthcare,’ which used to be more discussed than practiced, is expected to take its place on the center stage. It is necessary in the present situation for remote consultations, primarily for chronic ailments – for effective disease management and treatment. More so, as in the current situation individual health awareness of a large population, even in India, is increasing with an accelerated speed, perhaps more than ever before.

Thus, this is the right time to focus on ‘connected healthcare’, powered by AI-based digital technology. It has immense potential to help the Indian population getting immediate medical attention at a lower cost, with an improved access, for all. Though these are early days, it appears the ball has started rolling in the right direction, as the recent draft guidelines of the Indian Council of Medical Research (ICMR) indicates: ‘Patient can WhatsApp, SMS or email consent for Covid-19 clinical trials.’

Conclusion:

Still today, there is no sign of even temporary flattening the disease progression curve in India. As on May 10, 2020 morning, the recorded Coronavirus cases continue to climb sharply to 62,939 with 2,109 deaths, which is rising in India faster than most other countries. On May 07, 2020, AIIMS director again warned that Covid-19 pandemic is yet to peak in the country. “According to modeling data and the way our cases are increasing, it is likely that peak can come in June and July,” he added.

But is it getting worse? Despite stringent lockdown, there has been a surge in cases, which can also be attributed to higher levels of testing. However, from a doubling rate of 11.5 days on May 3, it has shortened to 10.3 days, which means that cases are doubling in quicker time. Each set of 10,000 cases is now increasing at a more rapid pace than the preceding set, highlighted an editorial of a leading news daily.

With a vaccine still elusive, the government had been banking mostly on the lockdown to break the chain of transmission of the virus. Meanwhile, the World Health Organization (WHO) has said: ‘Deliberately infecting healthy people with Coronavirus may speed Covid vaccine studies,’ reflecting more uncertainties in this area. It is also not likely that the country will cease to have any problems with its fragile public healthcare infrastructure and delivery system, even after flattening the disease progression curve.

Along with many other Covid-19 induced life-impacting changes, doctors’ practice dynamics are also expected to undergo a metamorphosis, lasting for an indefinite period. Consequently, I reckon, it’s about time, even for the pharma industry to voluntarily adopt ‘connected healthcare’ as a future way of life. One can get a glimpse of it in the Covid-19 clinical trial draft guidelines of the ICMR. Nonetheless, ‘connected healthcare’ comes with a clear signal of reducing the cost of healthcare and improved patient access, having the potential to effectively mitigate a sizeable part of the precipitated healthcare crisis, caused by Coronavirus.

By: Tapan J. Ray   

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Pharma ‘To Endeavor More To Be What It Desires To Appear’

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Reputation is one of the most fundamental requirements for long-term sustainability of any business, without facing too much of avoidable distraction, or even a tough headwind from any hostile business environment. This fact is, of course, no-brainer. We all know it, yet continue faltering – often not so very infrequently.

Before proceeding further, let me recapitulate, how has the Oxford Dictionary defined reputation? It says, reputation is ‘the beliefs or opinions that are generally held about someone or something.’ Or in other words, it is ‘a widespread belief that someone or something has a particular characteristic.’

The subsequent logical question then arises – how to gain reputation? Again, this was very aptly captured long ago by none other than Socrates, when he said: ‘The way to gain a good reputation is to endeavor to be what you desire to appear.’

Taking a leaf from this quote, in today’s article, I shall focus on whether pharma is making enough endeavor to be what it desires to appear in the eyes of its stakeholders, and the public at large. If not, what are the ways forward.

Not all of it is pharma’s own creation:

The host of reasons for pharma’s adverse public image, may not necessarily be its own creation. Some of these could well be lying miles away from its operational domain. For example, articles such as, what appeared on July 7, 2017 in the BMJ titled, ‘We need to end cut practice in Indian healthcare,’ doesn’t seem to be much related to pharma’s direct business operations. But in many respects, the subsequent unprecedented announcement of the Maharashtra government on enacting a new law called the “Cut practices in Medical Services Act, 2017”, casts a darker shadow, not just on the doctors’ reputation, but also covers the health care industry, in general, including pharma.

Nevertheless, a commonly perceived nexus between the doctors and pharma companies, or for that matter alleged malpractices in many hospitals, also prompts a rub-off adverse perception – indirect though, on pharma’s overall reputation. Such barriers also need to be carefully navigated through.

While moving towards this direction, effective management of consumer perception is also of critical importance. For, reputation is a complex blend of both reality and perception, where perception is believed to contribute around 66 percent, and reality – about 33 percent, in various organizational efforts to gain business reputation.

Changing from a dogmatic to pragmatic approach:

The above area of adverse perceptual impact causing further dents in pharma’s reputation, is understandable, as these are beyond its control, as such. Nonetheless, what is difficult to fathom, why does pharma continue to remain so dogmatic in recreating a make-believe image, that continuously gets negated by its own actions on the ground.

To illustrate this point when I briefly look back, one of the critical themes around which, especially the research-based global drug industry has been trying to gain reputation, over a long period of time, is woven around – ‘innovation’. Concerned pharma players keep trying to gain consumers’ trust and reputation by trying to make them believe that pharma is one of the most innovative industries in the world, thus possibly trustworthy.

The same tradition continues even today. Millions of dollars are being spent through various communication and advocacy campaigns, hoping to drive home this point. Nonetheless, the current reality is that the pharma consumers hardly believe that the industry is particularly innovative today. I discussed that point in my article of July 26, 2017, appeared in this blog.

Therefore, I shall not dwell on that area again. Instead, let me try to arrive at, how is this dogmatic approach going way off the mark from consumers’ expectations, repeatedly. More importantly, why it calls for a rather pragmatic approach from pharma to gain reputation, taking well into consideration – what the patients’ or patient groups’ expectations are from the industry, based on meticulous research findings.

Patients’ recent perception on pharma reputation:

A recent report by ‘PatientView’ – a leading specialist in understanding the patient movement, and its impact on health care, captured perceptions of patient groups on the pharma industry, in this area. The report is titled, ‘Corporate Reputation of Pharma in 2016 – The Patient Perspective.’ The phrase ‘corporate reputation’, as defined in the study, is the extent to which pharma companies are meeting the expectations of patients and patient groups, and was assessed by the following three types of measures:

  • How pharma’s corporate reputation compares with that of seven other healthcare-industry sectors.
  • How pharma’s corporate reputation has changed over the past five years.
  • How good or bad the pharma industry is at various activities.

The results of this study are based on a survey conducted between November 2016 to early-February 2017 on 1,463 patient groups; 46+ specialties in 105 countries. 47 pharma companies were assessed on seven indicators of corporate reputation, as follows:

  • Patient centricity
  • Patient information
  • Patient safety
  • Useful products
  • Transparency
  • Integrity
  • Effectiveness of patient-group relationships

47 companies surveyed include names, such as AbbVie, Allergan, Amgen, Astellas, AstraZeneca, Bayer, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eisai, Eli Lilly, Gilead, GSK, Hospira, Janssen, Merck & Co, Merck KgaA, Mylan, Novartis, Novo Nordisk, Pfizer, Roche, Sandoz, Sanofi, Takeda, Teva, UCB and Valeant.

Some of the key findings of this survey are as follows:

  • In 2016, just 37.9 percent of respondent patient group thought that the pharma industry had an “Excellent” or “Good” corporate reputation. Whereas 44.7 percent of patient groups had said the same in 2015.
  • In 2016, only 23 percent of patient groups thought that pharma’s corporate reputation had improved over the previous five years. Whereas 28 percent of patient groups had said the same in 2015.
  • In 2016 (as in 2015), pharma continued to be ranked 5th out of eight healthcare sectors (ahead only of generics, for-profit, and not-for-profit health insurers).
  • Patient groups thought that pharma’s ability to conduct activities of importance to them declined in 2016. Patient groups were more sceptical in 2016 even about pharma’s ability to innovate, which is an important patient-group measure of confidence in the industry.
  • Regarding the quality of pharma’s innovation across several geographic areas: patient groups in New Zealand expressed the least confidence in pharma’s ability to innovate; and those in Greece, the most.

What should pharma do?

Keeping the above findings in perspective, the consequent question that arises in this area is, what should pharma do to improve its patient centricity, and thereby to gain trust and reputation?

It is interesting to note that pharma companies should ‘consider the cost of drugs’, has featured as one of the top three, in the 14-point plan proposed by the 460+ patient groups in the above study, as follows:

  • Partner with patient groups
  • Provide more or better patient services
  • Consider the cost of drugs
  • Try to understand patients
  • Develop better medicines
  • Be transparent
  • Involve patient groups in the design
  • Look at continuity of care
  • Listen to patients
  • Help patients in a holistic way
  • Increase participation in clinical trials
  • Offer training
  • Concentrate on safety
  • Tailor services to individual patients

Conclusion:

Thus, the bottom line is, among various stakeholders, patients and patient groups, play a critical role in pharma to gain reputation. Winning their trust is widely considered as the substratum to get this process rolling, effectively. In that sense, pharma players individually, and the pharma industry collectively, need to have innovative, and game changing strategic plans to win the patients’ trust, for a long-term gain in reputation.

Repeatedly trying to communicate that life-changing medicines exist, because of pharma’s years of efforts in painstaking research and development that are hugely expensive and time-intensive, doesn’t seem to be working much, any longer. Patients are increasingly expecting improved access to drugs for various treatments, coupled with related value added services, from the drug players.

In such a scenario, many top drug companies, on the other hand, publicly express: ‘we are patient-centric’. This creates a logjam, as it were, to take pharma’s ‘patient centric’ endeavors from this point to where the patients’ expectations really are. Thus, I reckon, it’s time for pharma to deeply introspect and act on what Socrates had advised a long time ago, ‘‘The way to gain a good reputation is to endeavor to be what you desire to appear.’

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.