What is the role of the patient in CME?
David Williams
3C Strategy
Many recent articles both here on pharmaphorum and elsewhere are recounting the changing world of pharma. The once secure and predictable world of pharma, where R&,D developed new products that were marketed to doctors to prescribe and make money for pharma to re-invest in R&,D, is changing. It is changing in many ways. No longer are doctors the sole recipients of pharma’s marketing efforts. Conversations have opened up between pharma and all manner of influential and decision-making individuals and groups, and the strategy today is to embrace all of these new stakeholders in a true collaboration of minds to improve the well-being of the general public.
Whilst the so-called ’lifestyle’ drugs are a big part of this, the main emphasis remains on the early diagnosis and management of disease and, of course, the ultimate beneficiary of this is the patient.
The patient did not feature in the old world except as a willing recipient who took without question the medicine and care that was prescribed. This has fundamentally changed and, today, the patient plays an increasingly influential role in the process of prescribing drugs.
The Internet has, of course, played a major role in shifting the balance of power in the doctor-patient relationship. The doctor is no longer regarded as someone whose judgement and decisions are automatically accepted. People are becoming more interested in their own well-being and are regularly questioning doctors on matters to do with diagnosis and management of their condition. Patients have easy access to information and there is an increasing consumer awareness of drugs.
Social media is also having a huge impact on the relationships between patients, their doctors and pharma. There are those much better qualified than I who can tell you about the bright future that exists for social media in healthcare. This was reflected by various patient advocates at the 3rd European CME Forum held in Berlin at the end of last year.
"The patient did not feature in the old world except as a willing recipient who took without question the medicine and care that was prescribed."
Delegates heard that the web has completely transformed the way patient groups can communicate with their members and gone are the days when patient groups could be criticised for not representing the views of their members. Patient groups are now discussing, surveying and contacting their members on a far more regular basis with the result that patient groups are increasingly an influential part of healthcare systems around the world.
This was billed at the Forum as the ‘mobilisation of patients’, a term that generally fills doctors with dread at the thought of patients turning up at their surgeries armed with folders full of misinformation and ready to do battle. Admittedly, there are some battles being fought evidenced by the occasional headline when NICE or some other regulatory body reacts to what is broadly termed ‘public pressure’ and rescinds on a previously contentious decision, but these are mostly at national or even European level.
Despite the concerns of some delegates, the family doctor generally has little to fear from what is today the well-informed patient posing intelligent questions and referencing notable case studies that, in a true collaborative manner, could lead to better management of his or her condition. As any management college will tell you, part ownership of a decision or course of action is more likely to result in that course of action being adhered to. The same applies here so that doctors (and pharma companies) should benefit as patients are more likely to adhere to their treatment if they have been part of the decision-making process.
One delegate to the Forum who had worked on patient empowerment provided evidence that greater knowledge by patients of their condition generates greater compliance with medication and produces better outcomes, and more informed patients are more able to access the system to their own good effect and have better survival chances.
What does this mean in terms of CME?
Patient advocacy has the potential to strengthen education and best practice. Designed and arranged in such a way as to encourage open discussion, the Forum considered this statement candidly.
"…doctors (and pharma companies) should benefit as patients are more likely to adhere to their treatment if they have been part of the decision-making process."
While a newly-diagnosed patient will most likely get up-to-speed on his or her disease pretty quickly, access to information is crucial so that patients (or their families) can take informed decisions about understanding the disease, finding the right doctor, locating other patients and deciding on therapy. Improved information can improve outcomes and, for this and many other reasons, patient advocacy groups have evolved dramatically to support and inform patients, to provide better access to treatment and to collaborate with clinicians and industry.
There’s that ‘collaborate’ word again. Many doctors are not used to having to work with their patients to reach an equitable outcome. Most are not trained to manage such encounters and some are even scared of the possible compromise decisions they may be led towards. I’m not sure whose responsibility it should be to assist these doctors, but surely it is in everyone’s best interests to support this collaboration in any way possible.
Can this be part of CME? It would be education in its broadest sense but I believe that pharma companies and their supporting agencies could have a role to play here as long as the usual rules of good CME practice are adhered to.
Of course, the public view is already acknowledged at some levels in the development and delivery of CME. Referred to as Lay Involvement (patients, carers and the public) in the UK, individual needs are assessed via patient questionnaires regarding the general behaviour of individual doctors and how individual doctors interact with patients.
Most medical colleges in the UK have a lay advisory group, development and delivery of educational activities can be run by lay organisations, include lay input or promote a lay perspective, and quality assurance and feedback can be delivered via a repeat of the patient questionnaire.
So there is the opportunity for patients to get involved with their doctor’s revalidation if they wish, although a comment from the floor illustrated a level of concern about lay input into the revalidation of doctors. There is obviously some work to do to convince everyone that this could be a good thing.
"…pharma companies and their supporting agencies could have a role to play here as long as the usual rules of good CME practice are adhered to."
CME Outcomes Measurement
Finally, the involvement of patients in CME outcomes measurement was discussed. As already mentioned, patients have been involved for some time in the identification of unmet educational needs and in defining of educational programme objectives, so why are they not encouraged to assess whether those objectives have been met?
We were informed at the Forum that in their recent review, the UK General Medical Council (GMC) favoured patient and carer questionnaires to inform personal CPD plans. The Royal College of Nursing also believes this to be a good idea stating: “the involvement of the public in the questionnaire feedback on a doctor’s performance is a major step in ensuring public trust through the 21st century”.
However, the Picker Institute Europe (a not-for-profit organisation that builds and uses evidence to champion the best possible patient-centred care), disagreed saying: “we emphatically disagree with the GMC’s position that patient and public involvement in revalidation is one way of inspiring confidence in the way that revalidation will work”.
Not very collaborative you might think but, while this debate continues, there are others who are seriously considering introducing patients to assist in CME outcomes measurement, particularly when it comes to assessing CME’s impact not just on learning, but on the day-to-day practice of physicians.
After all, what better way to assess any service than by going to the end-user?
What better measure for the impact of CME than patient level data?
Closing comments concluded that patient groups can support and complement doctor and nurse education. Patient involvement will strengthen, not weaken the education of professionals.
About the author:
David Williams is owner and Managing Director of 3C Strategy Limited, an independent communications and CME consultancy. He has over 30 years international experience taken from both within pharmaceuticals and from a broad range of agencies supporting the industry.
David can be contacted at david@3CStrategy.net
To find out more about this meeting please visit www.europeancmeforum.eu
To what extent should patients be involved in CME outcome measurement?
