AFib and Stroke: A Hot Topic in Patient Education for Cardiovascular Marketers

Only half of patients with atrial fibrillation know they are at a heightened risk for stroke.

I’m pretty amazed if the results of this study, sponsored by the American Heart Association, are correct.

Both my husband and my father have a history of AFib. And fortunately, I feel like the risks of stroke were one of the first things their doctors discussed. Apparently, others aren’t doing as good a job, which tells me that cardiovascular marketers have a big job to do in terms of education.

The survey examined what AFib patients perceive to be their biggest health risk. It also measured respondents’ knowledge of stroke, warning signs of stroke and stroke prevention strategies.

While nearly all patients claimed to understand the definition of stroke, just more than half defined it in correct terms.

Of those diagnosed with AFib:

• 42 percent said they were most concerned about the potential of heart disease or MI

• 10 percent said they were most concerned about becoming diabetic

• Only 8 percent of respondents said they believed stroke was their greatest health concern

• 25 percent said they believed they were not at a risk for stroke, even despite their condition

• 25 percent said they did not know

Two-thirds of the patients said their healthcare provider spoke with them about their elevated risk of stroke with AFib, yet among these patients, 21 percent said they were told they were not at risk for stroke.  Huh?

“Patients need to be aware of this risk and have serious conversations with their healthcare providers about what they should be doing to prevent stroke,” Mark Estes III, MD, professor of medicine at Tufts University School of Medicine in Boston, said in a statement.

Uh, yes.  I agree.

Twelve Questions Your Cardiovascular Marketing Should Be Able to Answer

Empowered patients are more assertive than ever when it comes to selecting physicians.

This trend is pretty close to home for me right now, as I am trying to help my husband select an orthopedic surgeon for a major knee procedure. Having worked in health care marketing for a long time now, I can certainly recite all of the standard things to look for: board certification, education and fellowships, years in practice, hospital affiliation, etc. I also know that I tell my clients to pay attention to online satisfaction scores and reviews.

But somehow, these standard measures seem to be falling short for me. And it seems I’m not alone. I recently found a great post from Steve Wilkins, who says, “empowered patients today are being taught to be less patient, more critical and more assertive.”

He has authored a list of 12 evidence-based questions every patient should ask prospective physicians:

1.  How would you describe your communication style?

2.  How do you inform patients of lab test results?

3.  How long after you get your lab results before I can expect to be notified?

4.  What percent of your patients have had their recommended screenings?

5.  Will you take the time to understand and respect my beliefs and opinions about my health and communications preferences?

6.  What percent of your patients are non-compliant with respect to taking their medications or otherwise following treatment recommendations?

7.  If I need to be hospitalized, who would my doctor be? You or some hospitalist?

8.  What safeguards do you have in place to prevent communication hand-off errors should I be hospitalized or seen in the ER?

9.  How do you feel about my bringing a friend or my spouse to my visit?

10.  Do you encourage patients to ask you about health information they have found on the Internet?

11.  For patients needing additional information, do you have a list of recommended websites you can give me?

12.  Will I get a written post-visit report summarizing what occurred at each visit, including medication and self-care instructions?

Very interesting. How many of the physicians you represent would have great answers to these questions?  I am going to recommend that our clients circulate these questions to their physicians (right after I jot them down to take to the next orthopedic surgeon appointment for my husband.)

A Point of View on Physician Communication Programs for Cardiovascular Marketers

Economic pressure, technology mandates and looming questions about health reform make physician engagement more challenging than ever.

Hospital/physician business models are changing too.

More than half of physician practices in the United States are now hospital-owned, and that number is expected to continue to rise as health systems examine the establishment of successful Accountable Care Organizations and physicians look for relief from practice management stress and greater work/life balance.

More employed physicians doesn’t necessarily make physician relations easier. In fact, the politics of building relationships to support employed physicians and maximizing the hospital’s investment can be quite challenging.  And, health systems can’t automatically assume that employed physicians are referring all of their patients to their hospitals. That loyalty has to be earned.

Getting Started

Whether the audience is owned or independent physicians and whether the objective is recruitment or training, physician engagement programs must be presented as win/win propositions.  In order to be willing to invest their time, physicians must be able to recognize clear benefits such as:

• Education about hospital services that will improve patient care
• Education about hospital updates that will affect their daily work
• Assistance in practice improvements
• Resources for identifying challenges/solving issues
• Help in networking

Balancing Personal Interaction with Time Demands

In many ways, a personal meeting is still the most powerful tool for physician communication. Kicking off a new program with an in-person meeting is ideal, when possible, because it can build trust and stimulate immediate engagement.

Keys for success include:

• Structuring the meeting as a dialogue vs. a monologue
• Allowing for questions and allowing physicians to have a role in guiding the conversation
• Positioning the program as an information resource that will result in tangible benefits
• Being clear and succinct
• Providing networking opportunities

Leveraging Technology

While in-person interaction is ideal, it’s not very realistic over the life of a program. Demands on physicians’ time are greater than ever before. But the good news is that physicians are also embracing technology at greater rates than in the past.

A full 72 percent of U.S. physicians now use smartphones, according to Manhattan Research’s Taking the Pulse report, which tracks physician adoption rates of various information technologies. And they are also increasingly comfortable with using tablets, such as iPads for electronic medical records, etc.

Arguably, this collision of time challenges and technology adoption should drive the strategy for most physician engagement programs of the future — especially those that include a multi-phase curriculum or other messages that must be delivered over time. Digital channels allow for personalization, flexibility in consuming messages and potentially completing assignments on a physician’s own terms. Key tactics to consider:

• An online physician portal
• An intranet by department, service line or individual hospital
• A private Facebook or LinkedIn group to promote group discussions and updates
• A mobile app that can be updated with new modules as appropriate
• Personalized e-mails with short messages about particular program components and links to appropriate resources
• Text message updates
• Printed materials, e.g., overview brochure and “sell sheets” for various topics to augment online tools. All printed pieces should be succinct, quick reads that are easy to scan.

How are your physician engagement strategies changing with the times?

Improving the Cardiovascular Patient Experience with Electronic Medical Records

The mandate to transition hospital and clinic records to a digital format by 2015 could dramatically impact the patient experience.

Much to my chagrin, I had to visit my doctor’s office yesterday.  Fortunately, I do not get sick very often, and when I do, I am not a very “patient” patient.

However, I was kind of excited about one part of yesterday’s experience.  I was offered a chance to sign up for a new program called MyChart, “ a free, easy and secure way to view my health information and communicate with my healthcare team.”   Providers around the country are using this and similar products.

When I got home, I promptly logged in and spent a few minutes reviewing past test results and looking at other features like prescription renewals and appointment setting.  I realize I’m probably more of a geek than most people, but I love the fact that I can now quickly view historical cholesterol readings, etc. any time I please.

Apparently, some providers are dragging their feet a little bit when it comes to embracing electronic medical record (EMR) technology.  However, I found a great blog post from Dr. Eric Van De Graaf, a cardiologist at Alegent Health.

He says he is now “favorably inclined” toward EMR after using it for about seven months.

He also gives a great list of pros and cons.

Advantages of EMR:

• Ability to access it from virtually anywhere  – from an emergency room, a home computer and potentially a portable device. No more waiting until the office opens on Monday to get a hold of a chart.
• Legibility – Dr. Van De Graaf says, “doctors’ handwriting is the stuff of legend.”
• More thorough notes – the system addresses issues that could be skipped, e.g., family history, previous procedures and drug intolerances.
• More streamlined billing – better documentation means better reimbursement
• Fast and accurate prescription refills – most EMR systems send orders directly to pharmacies, saving time for both patients and providers
• Better communication between primary care doctors and specialists – notes can be electronically transmitted within minutes after a patient visit

While all of these features seem to potentially enhance the patient experience, Dr. Van De Graaf offers a few words of warning about EMRs that could potentially detract from the experience.

Disadvantages of EMR:

• Temptation to focus on the computer instead of the patient “This is the complaint I hear more than any other when it comes to patients’ experiences with our new system: My doctor spent the whole visit staring at the computer screen. The method that works best for me is to build my note before and after I see the patient and to never access the computer in the exam room, an approach that allows me to devote my entire attention to the patient during their visit,” says Dr. Van De Graaf.
• Stilted, mechanical language that is sometimes difficult to interpret – nuances of patient documentation could get lost in a chart where most of the information comes from pick-lists and check-boxes.
• Takes too much time – voice recognition systems can be fraught with errors, and Dr. Van De Graaf says the current generation of EMR software is nowhere as quick as a Dictaphone.
• Information overload – when all medical information is distilled to a database it can be difficult to discern what is truly important from what is trivial. In order to bill for the visit the doctor has to select a diagnosis from a list of approved terms, rather than simply describing a symptom. Thus, simple aches and pains mentioned in passing become diagnoses that stick with the patient (a stiff knee becomes degenerative joint disease, a cough becomes bronchitis, constipation becomes irritable bowel syndrome).
• A great deal of emphasis on using the computer as the intermediary in the course of clinical communication – Before EMR, if a patient called with a question, a nurse would take down the details and call the doctor for a response.  Now, the patient’s question gets sent to a “tasking in-box” where it will languish along with dozens of lab and x-ray results until the doctor logs on to a computer to address them, which can be tough in the course of a busy day.

Dr. Van De Graaf also refutes early government claims that global adoption of EMR would decrease errors and thereby save the US healthcare system $80 billion. “My personal opinion is that this is nothing more than wishful thinking as I have yet to come across a situation where my computer has saved me from committing an error in the course of patient care.”

Despite its pitfalls, in the end, Dr. Van De Graaf’s overall opinion of EMR is positive.  “I like being able to provide my patient a note as they walk out the door; I appreciate having full access to their history when I see them in the ER in the middle of the night; I love having a list of all their prior procedures and surgeries at my fingertips; and, most of all, I value the legibility of Times New Roman over Doctor Scrawl Italic.”

As a patient, the move to EMR seems great.  I appreciate Dr. Van De Graaf’s inside look and balanced opinion as a physician who has been using the system. How is EMR working in your organization?

Cardiovascular Update: Exercise is the Fountain of Youth

If exercise can keep mice from becoming prematurely gray, imagine what it can do for heart patients.

It’s no secret that physical activity is beneficial in countless ways, but new research published last week in The Proceedings of the National Academy of Sciences, says exercise reduced or eliminated almost every detrimental effect of aging in mice that had been genetically programmed to grow old at an accelerated pace.

In the experiment, lab rodents that carry a genetic mutation affecting how well their bodies repair malfunctioning mitochondria were studied.  Mitochondria are tiny organelles within cells that combine oxygen and nutrients to create fuel for the cells.

Many scientists consider the loss of healthy mitochondria to be an important underlying cause of aging in mammals.

The mice in the study lacked the primary mitochondrial repair mechanism, so they became extremely frail and decrepit early in their lives.  All were dead before reaching a year of age.

Except the mice that exercised.

Half of the mice were allowed to run on a wheel for 45 minutes three times a week, beginning at three months. At eight months, when their sedentary lab mates were bald, frail and dying, the running rats remained youthful.

• They had full pelts of dark fur, no salt-and-pepper shadings.
• They also maintained almost all of their muscle mass and brain volume.
• Their hearts were normal. They could balance on narrow rods, the showoffs.
• Most remarkable, even though they still had the mutation that should have affected mitochondrial repair, they had more mitochondria over all and far fewer with mutations than the sedentary mice.

The researchers said they were surprised by the magnitude of the impact that exercise had on the animals’ aging process.  Intuitively, one would expect that exercise would affect mitochondrial health in muscles, including the heart, since past research had shown a connection. However, they had not expected that it would affect every tissue and bodily system studied.

Very interesting and certainly more incentive to practice what we preach to patients.

Practice Management Issues for Cardiovascular Marketers

Marketing support is becoming an increasingly critical differentiator in physician recruiting efforts.

To that end, understanding practice management issues can be an important piece in building strong physician relationships.

Economic downturn, technology mandates and health reform continue to cause stress.  The resulting administrative costs and reimbursement challenges continue to be major areas of concern according to the results of a survey recently reported in Cardiovascular Business.

Here are some survey highlights:

• 41 percent of doctors reported their practice is doing worse this year compared to last year; 26 percent reported their practice is doing better than last year and 31 percent reported no change.
• 73 percent reported the computers in their practice are more than three years old on average and 21 percent are five to six years-old.
• 69 percent of doctors reported being satisfied to extremely satisfied with their career despite these challenges.

Doctors were also asked to report their practice’s top negative pressures and positive trends in a series of open-ended questions.

Issues relating to practice administration (31 percent), insurance and reimbursement (26 percent) and difficult patients (11 percent) were the top negative pressures on the practices.

Positive trends were led by advancements in medicine (22 percent), patient quality (19 percent) and improvement in the healthcare workforce (15 percent).

As marketers, we would never develop a consumer campaign without a thorough analysis and understanding of key insights and attitudes.  We would never craft a message without addressing consumers concerns.

Yet, so many hospitals and health systems have been using the same, tired physician recruiting and development strategies for years.  This survey is a good reminder to use the same discipline we employ with consumers in creating physician campaigns.  Health systems that understand physician challenges and provide leadership in developing tangible solutions to ease their pain will certainly come out ahead.

Fighting Obesity Through Cardiovascular Marketing

When it comes to helping patients lose weight, it seems success is tied to the delivery of the message.

It’s that dreaded time of year.  I love the holidays, and I really love holiday parties with all of their delicious decadence.  I have my favorite rituals – the bartender at a client party who makes the perfect martini, the amazing hors d’oeuvres buffet at my dear friend’s club event, my mother’s pie.  I could go on, but suffice it to say, it’s critical for me to be “extra good” between holiday events to avoid packing on extra pounds.

In general, I am a healthy eater, and fortunately, I have never faced a serious weight problem.  However, I can certainly empathize with the struggles that many cardiovascular patients face in maintaining a healthy weight as part of their ongoing lifestyle management programs.  As it turns out, communicating about weight loss using empathy seems to achieve better results than a tough-love approach.

As part of a recent study published in the American Journal of Preventive Medicine, researchers learned that doctors talked about weight in 69 percent of appointments. However, only 38 percent of physicians said they’d been trained in behavioral counseling.

Three months following the appointments,

• patients of doctors who had a more empathetic communication style had lost an average 3.1 pounds
• patients of doctors who were more critical gained an average 0.4 pounds, according to the study.

Another study published in the Journal of the American Board of Family Medicine revealed that word choice also matters when motivating patients to trim down.

Most physicians used the term “weight” in discussions with patients, the term also viewed most favorably by patients. The terms “BMI,” “unhealthy body weight,” “unhealthy BMI,” “weight problem” and “excess weight” also fell in the range of “desirable” to “neutral” for patients.

However, the least-desirable term to patients, “fatness,” was also the least popular among physicians. “Excess fat,” “obesity,” “heaviness” and “large size” also rated poorly with patients and were rarely used by doctors.

I’m noticing a trend in social media right now, as hospitals and their marketing partners appear to be posting a lot of content this month about holiday eating strategies. I think the findings in these studies serve as good reminders for all of us as we communicate about the importance of a healthy weight as it relates to heart health, both during the holidays and throughout the year.

Speed-Dating for Cardiovascular Marketers

Some hospital marketers in Texas are growing business through doctor-patient “speed dating.”

At “Doc Shop” events at Texas Health Harris Methodist Hospital Hurst-Euless-Bedford, patients and physicians sit paired at tables. The physicians describe their practices and specialty areas and the patients explain their situations and discuss what they are looking for in a doctor. After five minutes, the patients rotate and begin another conversation with the next physician.

So far, they’ve done it with OB/GYNs, pediatricians and primary care physicians.  Would this work for cardiologists?  I’m not sure.

Potential patients were informed about the events through e-mail and social media.   Physicians were alerted via e-mail and administrator visits.

“Younger physicians and physicians that want to build their practice are more interested,” said Mary Lou Wilson, director of women’s services.

Kristen Vallery, MD, FACOG, is an OB/GYN on the hospital’s medical staff who decided to participate in a Doc Shop because she was the newest member of her practice and was looking to gain patients.

“The Doc Shop helps you see what may be the concerns of the patients currently seeking healthcare because there’s usually a trend,” Vallery said.

Apparently, Vallery has gained about 12 new patients as a result of the program and even more through new patients referring friends.

The effort is certainly affordable, as each Doc Shop costs only about $600, most of which is spent on lunch for physicians and patients.

Clearly, the effort seems to be working for these primary care areas, but could it work for a specialty like cardiology?

Maybe.  As positive outcomes for cardiology patients continue to rise, cardiologists are increasingly becoming long-term health advisors.

Patients who have an initial incident that require an emergency procedure and/or hospitalization are becoming more savvy when it comes to choosing a physician to manage their follow-up care.

Dr. Vallery of Texas says the program’s value goes beyond attaining patients.

“The cool thing is you know when the people come to you they’ve already prescreened you, so the barriers are down to begin with,” Vallery says. “You’re able to get a lot done when they come in. It streamlines things more than it would normally be.”

What Cardiovascular Marketers Can Learn From Family Physicians

We are here.  We are listening.  We are healing.

The below video touting this mantra was recently shown at the 2010 American Academy of Family Physicians annual meeting in Denver.

Good reminders for all of us.

Cardiovascular Marketing Question: How Soon is Too Soon?

Getting patients “back-to-normal” faster seems to be a trendy marketing message these days.

A competitor in one of my client’s markets has seemingly blasted this message on every airwave, outdoor board and print ad available.

At first blush, it seems like a great strategy.  After all, isn’t that what we’re all trying to do?  Help people regain the ability to live “normal” lives again?

If I’m a provider with data to back up that claim, why wouldn’t I want to capitalize on it?

Maybe because “faster” isn’t always really better in the long term.

A recent news report says that two weeks after having a mild heart attack following an overtime victory, Michigan State Coach Mark Dantonio coached the Spartans’ game against Wisconsin from the hospital.

“Coach D was with me the entire game,” the defensive coordinator Pat Narduzzi said. “I won’t show you any of the texts, but he was texting and calling the entire game. I’ve never been on the phone so much during a game, so he was with us the entire game.”

Seriously, Narduzzi was asked, Dantonio was calling plays?

“Good God, yes!” said Narduzzi

Really?  Those of you who know me personally understand that I am a huge sports fan.  I get that the duties of a head coach are incredibly serious. However, I have to say that I was taken aback by this report.

Shouldn’t this coach be resting?  The guy had a heart attack while coaching a game.  Now he’s doing the same high-stress activity while he’s still in the hospital?

Clearly, I do not have a detailed understanding of Coach Dantonio’s case, and I am not medically qualified to judge his actions.

However, I do think I’m qualified to question the wisdom of certain messaging strategies.   And Coach Dantonio’s story definitely makes me cringe a little at focusing a strategy on getting people back to normal faster.

By the way, Michigan State won the game 34-24, in case you’re wondering.