Physician Communication Study Reveals Top Influencers

Star Life Sciences Medical Monitor™
2013 Healthcare Communications Study Among Physicians
©2013 Star Group Communications, Inc.

Healthcare Communications Study Among Patients | ©2013 Star Group Communications, Inc. 2
Star Life Sciences partnered with Plesser & Clifford,
a 30-year-old market research company specializing
in medical marketing research, in designing
and implementing this study.

• Background, Objectives and Research Methodology
• Executive Summary/Implications
• Detailed Findings:
Sources of Physician Information
- Which communication channels have the greatest influence with physicians
- Influence of the internet
- Influence of pharmaceutical sales representative
Keeping Patients Informed
- Ways in which they share information
- Beliefs on effectiveness of direct to consumer advertising and why
Opinions onTopical Issues in MedicineToday
- Opinion of the Patient Protection and Affordable Care Act and why
- Opinion of importance of electronic health records and why
• Appendix: Screener and Questionnaire
Contents

Background, Objectives
& Research Methodology

• Star Life Sciences wishes to build its learning base about where physicians are
turning to keep professionally informed and in turn, what sources do they direct
their patients to in order to keep them informed.
• Some of these questions asked are the same as questions asked in a similar Star Life
Sciences Medical Monitor™ report conducted in 2007. Where possible, results will
be compared.
• Star Life Sciences also is interested in physicians’ opinions about two topical issues
in medicine today: the Patient Protection and Affordable Care Act and electronic
health records, and how these issues might affect their practices.
Background & Objectives
Background & Objectives | Research Methodology

Research Methodology
• Online survey
• Physicians in the Reckner database were invited to participate in the survey
via an email.
• All data collection was completed between January 18 and January 24, 2013.
The respondent quota of 100 physicians was fulfilled.
Specialists*
Allergy
Anesthesiology
Cardiothoracic Surgery
Dermatology
Gastroenterology
General Surgery
Hematology
Nephrology
OB/GYN
Urology

Sample Characteristics
Although these were not screening criteria, the physicians represented
the following groups:

Executive
Summary

Physicians are significantly more influenced by peers than any other potential channel
of information when trying to stay informed professionally.
Rating Communication Channels
Executive Summary: Information Sources

Specifically, physicians keep abreast
of what is going on in their area of
medicine by reading articles in
professional journals, going to
conferences, conferring with peers,
consulting key opinion leaders, and
meeting in person with pharmaceutical
representatives.These results have
not changed since the 2007 Star Life
Sciences Medical MonitorTM
Study.

When asked which 3 sources they rely on most, articles in professional journals,
conferences, and in person with drug representatives are ranked in the “Top 3” most
often. Websites/internet searches receive as many responses as talking to peers and
are the most regularly relied upon sources of information. Some of this may be due to
the fact that journals are only published periodically and conferences are often annual
events, while the internet is constantly available.

In spite of the fact that computer ownership has increased since 2007 and that approximately
half the physicians in this study use a smart phone and/or iPad, they do not depend on the web
more heavily than in 2007.They may be going to the web more often, but they do not rate the
pharmaceutical or healthcare websites more important than they did 5 years ago. Although
pharmaceutical companies may be allocating more of their budgets to digital marketing, it has
not made significant inroads in changing the ways physicians like to get information or in their
belief that this information is useful to them.
Communication Influencers

Although pharmaceutical companies continue to decrease the size of their sales
forces, according to the physicians, pharmaceutical representatives still play a
vital role—especially for the physicians in smaller practices.
Importance of Pharmaceutical Representatives

Although physicians are utilizing the web via their phone and iPads to look up
information, they still favor older methods to share the information they find with their
patients.They are only occasionally directing their patients to websites, preferring to
distribute printed material.The 2013 Medical MonitorTM
study showed that both patients
and physicians use the internet to look up medical information. However, physicians
only occasionally direct their patients to the web, suggesting one of the following:
• A gap between what physicians want and what they find on the web
that prevents them from directing their patients there.
• The belief that printed materials are of more use to their patients.
Preferred Method of Sharing
Information with Patients
Executive Summary: Keeping Patients Informed

The perceived effectiveness of direct-to-patient advertising is mixed. Approximately
one-third believe it is effective, but the same number believe just the opposite or
have no opinion.Those who believe it is ineffective feel that it is sometimes biased,
confusing and can often mislead patients.Those that feel it is effective say that it raises
awareness and opens lines of communication.
Effectiveness of Direct-to-Patient Advertising
Executive Summary: Keeping Patients Informed

40% say they are not happy and their concerns center around quality of care, costs and
the intrusion of government into healthcare.
39% have no opinion. Of those, one-third say it is too soon to tell, one-third say they
are confused about parts of it and one-third fear it might hurt their practice.This group
may be made to feel better if they were educated more about the Act.
Only 21% are happy it passed citing it is for the greater societal good.
Physicians are Not Happy About
Passage of the Act
Executive Summary: Patient Protection and Affordable Care Act

While a sizable portion of both groups say they are uncertain about the Act, patients
currently are more optimistic than physicians.
Perceptions of the Act:
Physicians vs. Patients

The majority of the physicians (61%) felt electronic health records were important.
Only 19% felt they were not.There was a correlation between the size of the practice
and views of electronic health records. Only 47% of the physicians in solo practice felt
they were important. As the size of the practice grew, so did the importance placed on
electronic health records.
Importance of Electronic Health Records
toYour Practice

Although not specifically asked if they made the switch in this study, we know from
the open-ended comments that comfort with electronic health records correlated with
increasing familiarity and a greater degree of adoption.
• Those who felt electronic health records were not important to their practice had, for
the most part, not adopted the method yet.
• Those who were in the process of adopting electronic health records were having
adjustment issues.
• Those who had fully integrated electronic health record systems into their practice
praised the systems and felt they would never go back to paper charts.
An Image Issue
Executive Summary: Electronic Health Records

Detailed Findings
Sources of Physician Information

Physicians were asked to evaluate
how important each of 20 potential
sources of information were in terms of
keeping them informed professionally.
The “Top 5” sources of influence are
all peer related.
Communication Influencers Ratings
Detailed Findings: Sources of Physician Information

Physicians were also asked
to indicate which 3 sources
they rely on the most.The
“Top 3” sources they rely
on are articles in professional
journals, conferences and
drug representatives.

Although some new categories
were added, results to this question
were very similar to the 2007 Star
Life Sciences Medical MonitorTM
study. Peer-related sources top both
years’ lists followed by direct sales.

Physicians were also asked how often they use their highest-ranked sources.
Because professional journals are published only monthly and conferences tend
to be held annually, the source used most often for information is general internet
searches.
Communication Influencers Frequency

Although pharmaceutical companies continue to decrease the size of their sales
forces, according to the physicians, pharmaceutical representatives still play a
vital role especially for the physicians in smaller practices.
• Total: 76% of all physicians feel the representatives are very important
or important.
• Solo/Small: 33% of the physicians in solo practice feel the representative visits
are very important, 50% feel they are important. Similarly, 22% in a small group
feel the representatives are very important, 54% important.
• Large/Corporation: While maybe not quite as critical, physicians in larger
groups still feel the representatives are important.
Importance of Pharmaceutical
Sales Representatives

• Physicians were asked, “When thinking of new digital technology, which
of the following devices do you use to gather information for your patients
or practice?”
• Half the physicians are using a smart phone to gather information. Almost half
are using an iPad at least occasionally.
• 72% of all the physicians felt they were using technology more than they were a
year ago. 28% felt they were using it the same amount as a year ago.
Usage of New Devices to Gather
Information for Patients

Detailed Findings
Sharing of Information with Patients

Although the physicians are utilizing the web via their phones and iPads to look
up information, they still favor older methods to share the information they find.
• Physicians were asked, “Which of the following methods/vehicles do you use to
share information with your patients and how often?”
• Physicians share information with their clients mostly verbally followed by
giving them printed material.
• Occasionally physicians are directing their patients to websites. (Note:These
numbers are consistent with the Patient Compliance Study where we found
approximately half the patients say they utilize the web to get information
on medications.)
Usage of New Devices to Gather
Information for Patients
Detailed Findings: Sharing of Information with Patients

Physicians were asked to rate how effective they felt direct-to-consumer
advertising by pharmaceutical companies was for accurate patient information.
Physician reactions to direct-to-patient advertising is mixed:
Direct-to-Consumer Advertising for
Accurate Patient Education
Detailed Findings: Sharing of Information with Patients

37% of the physicians feel that direct-to-patient advertising by pharmaceutical
companies is ineffective for accurate patient education.
The primary reasons why physicians believe that direct-to-patient advertising by
pharmaceutical companies is “Very Ineffective” or “Ineffective” are:
• Confusing - Patient has the potential to misunderstand
• Misleading - Ad has the potential to misinform and misdirect the public
• Biased - Presents incomplete picture
• Does not influence prescribing behavior
Rating Direct-to-Consumer Advertising Ineffective
Detailed Findings: Direct to Consumer Advertising

Confusion: Over half the physicians who feel the advertising is ineffective feel
this way because they believe the advertising is confusing to patients and has the
potential to be misunderstood.
• “Patients do not understand all of the information or what other medications
they should consider”
• “Patients misunderstand most info”
• “Confusing to patients; implies product may be helpful for conditions patients
do not have”
• “Not convinced my patients know how to interpret information”
• “The patient is frequently confused or doesn’t truly understand the information”
• “Confuses patients.They get inundated with advertisements and trust nothing”
• “Patients see and hear what they want to see and hear and I have to re-educate
them about the product and the disease”
• “All of the warnings confused and scared them”
Rating Direct-to-Consumer Advertising Ineffective

Misleading: Some of the physicians feel the advertisements are misleading or
inaccurate in ways that can mislead or misinform the patient.
• “Most ads don’t tell a patient why they should use the product. People come
in and ask for something that doesn’t even treat what is wrong with them.
Only sometimes is the information accurate. All of the side effects listed also
scare them”
• “Pharmaceutical company not interested in accuracy”
• “Patients may not have accurate information or have unrealistic expectations by
the time physician gets questions related to direct marketing”
• “Usually just frightens patients due to all adverse events listed”
• “Can be very misleading for patients”
• “They think that the advertised medicine is the answer and that there
are no alternatives”
Believe “Ineffective”Verbatims

Biased: Some of the physicians feel the ads are biased.
• “It is biased obviously”
• “I think they want to push the most expensive and profitable products”
• “It is a quick biased message to the patient. It does not take into consideration
the individual patient’s issues”
• “Obviously usually biased and inappropriate for the specific patient”
Don’t Influence Behavior: Some of the physicians feel the ads just don’t work to
influence behavior.
• “Patients know that they are designed for profit”
• “Don’t find it helpful”
• “Patients seem to pay little attention to the pharmacology”
• “Do not get read”
Believe “Ineffective”Verbatims

companies is neither effective or ineffective for accurate patient education.
Reasons: Almost half the physicians who rated direct-to-patient advertising
as neutral (neither effective or ineffective) questioned the effectiveness of the
advertising regarding prescribing behavior.The remainder of the comments raised
the same concerns as the physicians who rated it as ineffective.The reasons cited
are:
• Confusing
• Misleading
• Biased
Rating Direct-to-Consumer Advertising “Neutral”

Effectiveness:The majority of these physicians just don’t see it influencing their
patients behavior.
• “Occasionally effective”
• “Sometimes helpful and sometimes not helpful”
• “Patients want to talk to doctors”
• “Patients ask occasionally, but do not necessarily believe what they read”
• “It can depend on the product as well as the information being delivered”
• “The information has too many “qualifiers”
• “I feel like it leads to more questions than answers”
• “Patients most often go by their primary care recommendation, especially if it
has been a long-term relationship”
• “I don’t see much in terms of patient asking for products that have directed
patient advertising”
• “I do not get much feedback from my patients that they sought out information
directly from pharmaceutical companies”
• “Patients do not care much about it”
Believe “Neutral”Verbatims

Confusing:
• “Because there are so many risks discussed, confuses patient”
• “Sometimes too much info for patients”
• “They usually don’t listen closely or catch the “fine print”
• “Confuses the patient”
• “Patients have a great deal of anxiety concerning the legally required, AE info”
• “Most patients do not understand what they are being told”
• “Most patients don’t understand material”
• “Often patients don’t have the ability to clearly understand/integrate information
presented in such a short amount of time/space”
• “Patients may not get a clear understanding”

Misleading:There were a few comments that implied physicians felt information
conveyed was misleading.
• “The information does not provide enough detail about the drug side effects”
• “It causes excess unnecessary discussion and review of a product that is not
needed or very expensive on the patient’s formulary !!!”
• “I think direct to patient advertising is biased in favor of the pharmaceutical
company.Then patients get preconceived ideas about what they need/want
which makes it difficult for me to make good recommendations for them. On
the other hand the ads often provide information to patients that they
otherwise would not get”
Biased: Physicians also felt the ads can be biased.
• “I feel that patient advertising by pharmaceutical is bias”
• “Sometimes it is bias”
• “Potential for bias in promoting”
• “The information will often be in favor of the pharmaceutical company”

companies is effective for accurate patient education.
Reasons:The primary reasons why physicians believe that direct-to-consumer
advertising by pharmaceutical companies is “Very Effective” or “Effective” are:
• Effectiveness in changing patient and prescribing behavior
• Raises issues and awareness
• Opens up communication with patients
Rating Direct-to-Consumer Advertising Effective

Effective/Change Rx Behavior: Over half of the physicians in this group who
commented believe the ads are effective in changing prescribing behavior.
• “They are providing truthful information which is monitored by the FDA.
It is effective”
• “Provide new information clarification on meds”
• “Patients listen to them”
• “Their ads are FDA filtered and approved”
• “Many patients ask about drugs they have seen advertised”
• “Previous experience with direct-to-consumer advertising has yielded
many requests for products”
• Patients do ask about the products that they see on television
• “Powerful form of media”
• “PATIENTS LEARN FROMTHE EXPERIENCE”
• “I do think it helps the patient educate themselves”
• “It helps us administer Rx the patients need, making them more educated
on the topics”
Believe “Effective”Verbatims

Raises Issues and Awareness:These physicians believe that exposure to the ads
raises patients’ awareness to different treatment options.This awareness for the
most part is viewed positively but sometimes it can have an adverse effect.
• “Makes them more aware of treatment”
• “Has raised awareness for products previously underutilized, like Mirena IUD”
• “Patients are exposed to products they might be otherwise unaware of”
• “I think it makes patients aware of medical conditions and that treatments are
available, but the medications that are advertised to patients are not always
the best ones for them”
• “Raises awareness of issues and options”
• “Patients often have some knowledge of new products. Sometimes that
‘knowledge’ is inaccurate”

Opens Up Communication Channels: Many of these physicians believe that the
ads help to get their patients to make appointments and gives them something to
discuss in the office visit.
• “Patients come in asking questions”
• “It can be a way to start a discussion about a certain disease or a certain disease
process. If I mention a med and they have heard about it onTV, it reinforces the
importance of that med”
• “Patients bring up the subject after seeing it on theTV”
• “Patients know more about available options and come in asking for my opinion
about them”
• “They set the appointment up to ask specific questions on their disease or
treatment options”

Detailed Findings
Perceptions of Passage of Patient
Protection and Affordable Care Act

Physicians were asked, “Which statement describes your reaction to the passage
of the Patient Protection and Affordable Care Act: Happy it Passed, No Opinion,
Need to Wait and See or Not Happy, Don’t Like It.”

21% of the physicians were happy the Act passed.The majority of those
physicians who were happy it passed mentioned they believe that everyone
should have insurance for the greater good of society.
• “Everyone should have health insurance”
• “It will provide insurance coverage for more people and give more
attention to outcomes”
• “It will help patients who are uninsured to get the care they need”
• “Support universal coverage”
• “Healthcare is the responsibility of a civilized society. It helps me
care for my patients”
A few mentioned that the Act is just the first step we need toward Universal
Healthcare.
• “I want to eventually see single payer.This is the first step”
• “We need universal healthcare”
• “First step towards universal healthcare”
• “We should have universal healthcare”
“Happy Act Passed”Verbatims
Detailed Findings: Patient Protection and Affordable Care Act

Some felt it would lead to better quality of care overall or for special groups.
• “Believe people will be taken care of better”
• “More people will get insurance. Quality will be looked for”
• “We take care of so many patients with no insurance so in a way we are already
paying for those patients (but not in a meaningful way which requires
preventive care)”
• “Improved access to women’s healthcare”
• “There are plenty of poor people in my state and it will help them unless our
governor blocks it”
• “Better for children”
• “I treat the indigent population-under insured and uninsured”
• “Improved healthcare for children”
“Happy Act Passed”Verbatims

Physicians were also asked what they saw as the implications of the Affordable
Care Act on their practice. Among those who were happy it passed, half were
optimistic that it would bring them more business and that it would mean better
care for their patients.
• “I will be busier because more people will qualify for insurance”
• “It should be good for my patient population. Not sure of any drug co. impact”
• “More kids will have access to care; may strain our ability to provide same”
• “More business as more patients are insured. Hopefully we can work on disease
prevention rather than treatment”
• “Provide means to share data and provide safer patient care”
• “Good, good and good”
• “More paperwork but better patient access and compensation”
“Happy Act Passed”Verbatims: Impact on Practice

Approximately 20% of physicians that were happy it passed were concerned
about the impact it would have on their practice.
• “We will work harder for less money”
• “Will try to ratchet down costs and may prevent innovation in the
pharmaceutical industry by decreasing benefits of developing new drugs”
• “Confusing initially”
• “Still will be overworked and underpaid.”
• “Not clear yet”
• “Will have more cost for insurance”
“Happy Act Passed”Verbatims: Impact on Practice

39% of physicians were reserving judgment on the Act. Of those physicians who
had no opinion, about one-third basically felt it was too soon to tell and they
wanted to wait and see.
• “No effects seen yet”
• “Waiting to see how effects. Like that more patients are covered”
• “Because I need to wait and see what happens”
• “Has not had an effect on me. Everyone agrees healthcare system is not good
but cannot agree on what to do about it. At least Mr. Obama has made an effort
to improve it. Awaiting details of full implementation”
• “As Nancy Pelosa said let us pass it and then we can read it.There is a lot of
information that has not been made available to the public”
• “Prefer to decide over a bit more time”
• “This law will be reworked over the next 20 years.This is not final form”
• “TOO MANY PROS AND CONS, WE HAVETO WAIT”
“No Opinion” on the Act Verbatims

Another third had no opinion and were confused about some aspects of the Bill in
general:
• “Not sure how accepting patients will be and how it will affect the reimbursement”
• “I am in favor of healthcare for everyone, but not sure that the Act will solve our
problems of how to implement the affordability of healthcare for all”
• “Too confusing to know all of the potential implications”
• “Not sure of the specifics, especially related to the indigent population which is a
significant percentage of our patient population”
• “Very complex bill--not sure how much of it will actually happen. So far it has been
quite good”.
• “I am still learning all of the ramifications. For instance, I still don’t know if
Medicaid will be expanded in PA to cover more patients”
• “I think in theory it makes sense but the details will be very, very problematic. How
does it control costs?”
• “I am not sure it is cost effective”
• “I really don’t think anyone knows how ACO’s are going to work”
• “I don’t completely understand it’s ramifications”

Others with no opinion were concerned about how it might affect their practices.
• “I’m not sure what all of the ramifications will be and how it will impact
my practice”
• “Not sure what it will mean to my practice in the long run”
• “I’m not all together sure what this will mean for myself and my practice”
• “It has some good aspects and some bad, especially in relation to mandatory
use of EHR. Primary care needs to be rewarded and nobody seems to
realize that”
• “I believe the expanse of what is covered in the legislation is too wide and
broad for me to make a determination at this time. I will see how it impacts my
practice of medicine as the laws unfold”
• “I am not sure of the impact of this in my practice”
The remainder just had a basic distrust about the Act.
• “It will probably fail like every other initiative”
• “I have seen the national health in UK and other countries, which is not
good for the patients”
• “I don’t trust the government”
• “There are many angles which still need to be proven”

Approximately half the physicians that had no opinion about the Act passing were
also uncertain how it would affect their practice and they were going to wait and
see.
• “We have no idea right now but fear the worst”
• “Do not know - wait and see”
• “I really don’t know what to expect”
• “Can’t give good opinion at this time”
• “Hard to tell at this time”.
• “Too soon to know”
“No Opinion” on the Act: Impact on Practice

About 25% feel it will have a negative impact regarding costs and
reimbursements.
• “I AM CONCERNED ABOUT PATIENT LOAD AND REIMBURSEMENT”
• “Decreasing reimbursements, inability to use many vouchers for patients,
less samples”
• “Unchanged and possibly increased cost of care and decreased income
for practitioners”
• “I am in favor of every American having a basic level of insurance, but I suspect
costs will escalate. I feel pharmaceutical reps provide a valuable service
bringing information into the office setting, especially in smaller towns and
rural areas”
• “I see more documentation; more time spent on paperwork; perhaps more
new patients, but less compensation”
• “Less income for physicians, probably same care for patients. It will make
dealing with pharmaceutical companies more difficult”

About 20% of this group feels it will have a negative effect on their patients or their
practice in general.
• “I think it is going to make it more complicated and confusing for all of us”
• “It will be the end of private practice and lead to delivery of care by committee.
Physicians will be less professional and more like employees. Companies will
deal with companies, not physicians”
• “I believe these represent further obstacles between myself, my patients and
other entities that are imposed by the government”
• “More paper, more and more people looking over my shoulder”
• “Influx of newly insured patients but not enough Drs. to go around”
• “Patient care will suffer”
• “I am concerned that the government will be reimbursing doctors less to insure
more! Also, I am concerned that patients may not have access to all available
specialists and procedures if the government “rations” healthcare. Our state of
Illinois is not capable of administering these programs with its current deficits!!”
• “A few mention potential for good to come of it”
• “More regulations but also potential for additional patient visits”
• “Hopefully make things better for the patient”
• “Family Practice will only be more in demand”

The largest group of physicians, 41%, were not happy the Act passed. A little over
one-third of the physicians who were against the Act had concerns about the effect
it would have on the quality of healthcare services in this country.
• “I think it will stifle innovation and creativity in medicine”
• “Hospital and physicians will become at odds and potentially physician
to physician”
• “Will cause more of my patients to lose their private insurance and increase
the number with Medicaid”
• “There are too many reasons to list but I feel like this will only hurt physicians and
in the long run quality patient care”
• “Will promote cookbook medicine, increase insurance premiums, mandates
medical coverage that violates certain religious beliefs, will gut Medicare, and
will put many on Medicaid who will find no physician to see them”
• “Increases unfunded patient roles with no providers to care for them. More
regulations and government interference”
• “I think as always it looks at supply side of the equation and completely
eliminates the issues regarding demand side and its associated responsibilities”
“Against” the Act Verbatims

• “Again an added expense which also reduces quality of care”
• “Will make access to docs take longer and cost more”
• “Unsustainable, very expensive and increased the deficit. I would have favored
a block grant to states to manage their own Medicaid”
• “There are not enough physicians to take care of 30 more million patients and
maintain quality. Rationing will occur. I witnessed this in Canada”
• “No evidence of cost-saving. Limits care. Practices cookbook medicine.
More paperwork”

One-fourth the physicians who were not happy it passed mentioned the
associated costs as the reason.
• “Increase cost to patient and decrease reimbursement to physician”
• “Too many hidden costs and no provision for increased providers to take care
of dramatic increase of patients added to system”
• “Extra taxes. Penalizes working families”
• “It is going to raise the premium for everybody”
• “Just another tax”
• “Terrible economic impact, extra-medical community control of
medical practice”
• “Used to practice in Canada. Within 3 years the country will be insolvent from
debt from this alone. No chance to pay for this”
• “Too much pork tied to it. Will increase the cost of medicine”

Almost one-fourth mentioned they disliked the intrusion of government into
healthcare decisions.
• “More Gov top down regulations and mandates”
• “Too much government control over healthcare. It will only lead to single payer
healthcare over time and you will see a shortage of doctors. I have much more
to say but there is not enough time”
• “We need health insurance reform, not mandatory coverage”
• “Personally have appreciated ability to keep my young adult children on my
insurance. Professionally very concerned with amount of bureaucratic/top
down control of changes without regard to differences in regions of country.
Massive consolidation into larger hospital ‘systems’ including consuming of
individual physicians practices”
• “Too much government control”
• “Government intrusion into the physician-patient relationship. Big Brother
telling doctor and patient alike what they MUST do and can NOT do”
• “Reimbursement reductions, government intrusion between patient and Dr.,
bureaucracy, paperwork, sea of regulations”

A few others just had a general dislike for the passage of the Act.
• “Shoved down our throats, never proven to be of benefit, another way to
screw docs”
• “Too much onerous regulation involved for my office”
• “Too complicated. Will ruin economy”
• “I think affordable healthcare should mean a limit on healthcare after a certain
age and more supervision of ancillary services that seem superfluous or even
abusive in their marketing”
• “More work, less pay”
• “There needs to be shared accountability with patient responsibility for their
own healthcare”

Among the physicians who were against the Act, about one-third had reservations
for their practices regarding expenses and reimbursements.
• “Decrease reimbursement, patient costs will go up, fewer brand name choices
so less relationships with drug reps”
• “I see them paying less and wanting more. Demanding guaranteed outcomes,
increasing our cost and exposure to deliver healthcare”
• “I have long been concerned with lack of awareness of the importance of ‘cost
of care’ among my peers and this will now be ‘forced on us.’That is a positive.
The amount of ‘red tape’ and expansion of large organizations/cumbersome
bureaucracies will do little to improve healthcare. EMR’s have been ‘forced’
on practices with little evidence that they are ready for ‘prime time’ at least
in my center”
• “I think there will be less payments for me and more for the government who
will spend my money telling me what and how I should practice medicine”
• “I think it will increase costs, lower efficiency and make physicians more
resentful of government intervention”
• “More red tape which reduces dollars available for patient care. More expenses
to my practice with no way to recover the increased overhead like all
other businesses”
• “Will have to raise prices and limit access”
• “Less reimbursement, less joy in practice”
“Against” the Act Verbatims: Impact on Practice

About 20% had concerns over quality of patient care.
• “Government intrusion to patient-physician relationship, rationed care
and pharmaceutical access”
• “Too much intrusive State and Federal control with poorer quality and
care outcome”
• “I am retiring now. But I feel sorry for my kids and grandkids. Patient care will
be unavailable in the first six months”
• “Less personal patient care”
• “More work, less personal and patient time. No reward for it”
• “Volume will increase. Quality will go down. Have to be selective which patients
to accept as now I will be rated on results which means if I have a lot of high
risk patients I will be low rated and less compensated”
• “Patient care will be decreased in direct contact with providers who are actual
physicians, with increased waits and expense for care”

About 15% mentioned issues with the pharmaceutical companies.
• “More cost conscious, less on quality will hurt pharma”
• “More bureaucracy from Health Exchanges. More dependence on generic
medications putting the squeeze on pharma. More efficient pharma reps.”
• “Hard to say but the pharmaceutical industry is getting killed. R&D going away.
No reason to invent and progress”
• “We’ll limit care. Unfortunately patients will be forced to use generic medicine
which has no proven benefit. Also pharmaceutical companies will limit
further research”

About 10% felt it would be so bad it would restrict or make them give up
their practice.
• “It will likely motivate me to leave the practice of medicine much sooner than I
had intended or would like to”
• “Will probably cause me to restrict my practice in some way. Will certainly
impact my personal style of medical practice. Will probably curtail interaction
with drug reps”
• “Already felt and closed my private practice. Now employed by a hospital’s
group practice”
• “Everything will be regulated and controlled.This will lead to major frustration
and I will likely leave the field of medicine”
• “It will most likely impact my decision to stay in practice”

• Star Life Sciences asked both 100 physicians and 100 patients about the Patient
Protection and Affordable Care Act as part of the 2013 Star Life Sciences Medical
MonitorTM
study.
• As shown in the following chart, while a significant portion of both groups were
in a wait and see mode, patients were more favorable (35% Happy) toward the
Act than the physicians (21% Happy).
Physicians vs. Patients

Detailed Findings
Importance of Electronic
Health Records (EHR)

• Physicians were asked, “What is your opinion of the importance of electronic
health records to your practice?”
• The majority of the physicians (61%) felt electronic health records were
important. Only 19% felt they were not.
Importance of Electronic Health Records
Detailed Findings: Electronic Health Records

• There is a very high correlation between size of practice and views of the
importance of electronic health records.
• As the size of the practice grows, electronic health records are deemed to be
more and more important.
Size of Practice

Although not specifically asked if they made the switch in this study, we know
from the openended comments that comfort with electronic health records
correlated with increasing familiarity and a greater degree of adoption.
• Those who felt electronic health records were not important to their practice
had, for the most part, not adopted the method yet.
• Those who were in the process of adopting electronic health records were
having adjustment issues.
• Those who had fully integrated electronic health record systems into their
practice praised the systems and felt they would never go back to paper charts.
Electronic Health Records Face an Image Problem

19% of all physicians indicated that electronic health records were unimportant
to their practice. Of this group, 90% were in solo or small private practice. None
of them had adopted it into their practice so their views were based on image.
They mention the following reasons for not wanting to switch to electronic
health records:
• Overall image issues
• Cost of switching
• Quality of care issues
• Belief in old-school methods
“Very Unimportant / Unimportant”Verbatims

Many of the comments of those who felt EHRs are unimportant concerned
overall image issues.
• “Don’t have them, everyone who does hates them”
• “I don’t use it nor trust its accuracy”
• “It would just add another headache”
• “Too slow”
• “It creates so much noise that important things are missed”
• “Takes too much time, too little benefit”
• “EHR has caused a lot of problems with follow up care. It is very good for
sending out prescriptions and that’s all”
• “Has not changed the flow of data between physicians, offices and hospitals
which was what was needed”
• “It’s being forced on us”

Other comments from this group mentioned costs.
• “Huge expense”
• “Solo practice, no way can afford it”
• “Will complicate things and cause massive cost increases”
• “Too expensive in dollars and time and don’t add to patient care but
actually hinder care”

There were a couple of comments about the perception that quality of care for
patients would be compromised.
• “Detracts from personal relationships with patients”
• “The way it is currently set up does not help patient care and is inefficient”
Lastly, a couple of these physicians mentioned that they are happy with the
old-school method.
• “We have not switched to EMR. We still do paper charts and it works
well for us”
• “I feel like it is still important to have a record in hand”

20% of all the physicians felt neutral about electronic health records. Half the
comments in this group said they felt neutral because they didn’t have the
system or were just transitioning to one.
Of the other comments many concerned quality of care.
• “Slows down patient care and frequently not reviewed for patient contacts”
• “Slows me down, less patient interaction, leans toward a bland, uninspiring
patient visit note”
• “Slows down the process and does not improve patient care at all. Costly for
nothing unless all EHRs communicate together regardless of which doctor
the patient sees”
• “EHR vendors say improves quality of care but data do not necessarily
support that statement”
• “Takes away quality time with patients”
• “Can be a help or hindrance. Can decrease the doctor-patient relationship”
There were a few other miscellaneous comments.
• “Helpful but time consuming”
• “Another potential source of med info leak and of governmental control”
• “It helps my handwriting and ordering Rxs but otherwise is a silly bother”
“Neutral”Verbatims

35% of all physicians felt they were important.The vast majority of their
comments were positive using words like “easier”, “better” and “help”.
• “Wave of the future”
• “It is easy to see other specialist notes and decrease duplication of
studies, provides multidisciplinary approach, much easier”
• “Aides in transferring records. Keeps up-to-date lists (meds, allergies, etc.)”
• “Simplify my life”
• “Ease of access”
• “Better documentation and tracking”
• “Help us keep accurate information on a patient and allow us to read notes”
• “Keeps things organized and readily accessible”
• “Improved record keeping. I am already on the other side of using EHR so I
am accustomed to them”
• “If implemented properly, have the potential to improve speed of access to
patient history/records”
“Important”Verbatims

• “It helps better co-ordinate some aspects of care and for clinical reminders!”
• “Easy to coordinate care”
• “I like having EHR although it does slow me down is some areas, like
refilling Rxs. I would never go back to paper charts. EHR makes it easy to
copy information from prior visits and not obtain information anew”
A few in this group view them as important, but also as a “necessary evil.”
• “We use them exclusively, but they are odious, waste time, and do not
contribute to the quality of patient care. So yes, they are important in my
practice, but loathsome nonetheless”
• “They have become a necessary evil.They are a tool and like any tool, can be
used in a good way or in a bad way”
• “It will become more important as time goes by. Initially it is difficult
to implement”
• “Hard to learn but useful for keeping and sharing information”
• “They are much more comprehensive but very time-consuming”

26% of the physicians felt electronic health records were very important to
their practice.This group seems to be further along the learning curve and had
integrated them into their practices. All their comments were positive with many
superlatives such as “critical”, “very efficient” and “only way”. Here are some of
their comments:
• “Critical to our practice”
• “Very efficient. Saves duplication of services. Legible”
• “It saves time. Patient gets a copy of her visit every time”
• “Much better for collecting patient data”
• “It is our standard and has been so for years”
• “Better coordination of care (if other physicians on EMR), less orders, can
access from home”
• “More accurate. More efficient. More complete”
• “It provides a very efficient manner to follow and trend patient data”
• “Only way to keep up with all the requirements”
• “Improved access and accuracy of records”
• “Can manage patients hands on with 24/7 availability and share information
easier with care partners”
• “ACCURATE, PRECISE, SAVESTIME”

Appendix:
Screener and Questionnaire

1
SAMPLE SIZE : 100 Doctors
• 90 Primary Care
• 10 Specialists
INVITATION LETTER / SCREENER-Doctors Final
SUBJECT: SURVEY TO REVIEW HEALTHCARE COMMUNICATION
TRENDS AND CURRENT HEALTHCARE TOPICS
We are looking for input from Physicians on their views and use of current and
new healthcare communication vehicles . And your views on certain current
healthcare topics. The survey is simple— a point and click through mostly closed
end questions . It will take ten minutes of your time.
If you wish to participate, please answer the following qualification questions.
1. How many years have you been practicing medicine?
___ 1-5
___ 6-10
___ 11-15
___ 16-20
___ Over 20
2. In which field do you practice?
Primary Care-Quota 90 Specialists- Quota 10
___Internal Medicine ___ Cardiology
___Family Practitioner
___Pediatrician
___Obstetrics and Gynecology ___ Cardiothoracic Surgery
___ Gastroenterology
___ General Surgery
___ Orthopedics
___ Neurology
___ Plastic Surgery
2
___ Urology
___ Vascular Surgery
___ Psychiatry
___ Oncology
___ Hematology
___ Allergist
3.Which best describes your practice:
____ Solo Practice
____Private Group Practice With 2-10 Physicians
____Private Group Practice With Over 10 Physicians
____Corporate or Healthcare System Practice
Thank you. You do qualify. Please click onto this link: _____, and use pass
code: _____.

1
QUESTIONNAIRE –Doctors Final
ONLINE HEALTHCARE COMMUNICATION SURVEY
Welcome to the Healthcare Communication and Current Topic Survey. Please
answer the following questions about your views on the following
1. On an ongoing basis, how important are each of the following sources to
you, in order to keep professionally informed? Rate on this 5 point scale
(1= very unimportant 2=unimportant 3=neither 4=important 5=very
important)
• Articles in professional journals
• Advertising in professional journals
• General internet searches
• Healthcare information web sites
• Pharmaceutical company corporate web sites
• Pharmaceutical company product web sites
• In person meetings with pharmaceutical sales reps
• Conferences
• E-mail blasts
• Electronic newsletters
• Personal mobile device
• Newsletters
• Managed care organizations
• Peers
• Podcasts
• Social media
• Societies/Associations
• Direct Mail
• Mobile applications
• Key Opinion Leaders
• Other___________
2. Please indicate below which three you rely on the most and how often
you use.
Occasionally Often Always
• Articles in professional journals
• Advertising in professional journals
• General internet searches
• Healthcare information web sites
• Pharmaceutical company corporate web sites
• Pharmaceutical company product web sites
2
• In person meetings with pharmaceutical sales reps
• Conferences
• E-mail blasts
• Electronic newsletters
• Personal mobile device
• Newsletters
• Managed care organizations
• Peers
• Podcasts
• Social media
• Societies/Associations
• Direct Mail
• Mobile applications
• Key Opinion Leaders
• Other___________
3. Which of the following methods/vehicles do you use to share
information with your patients and how often?
Occasionally Often Always
___Verbally
___Printed educational material
___Direct to a pharmaceutical product web site
___Direct to a healthcare education/information web site
___Use of new technology such as a tablet/ iPad
___Product insert/prescribing information
___Other__________
4. When thinking of new digital technology which of the following devices
do you use to gather information for your patients or practice?
___Smart phone
___Tablet/iPad
___Other_________
___None skip to Q6
5. Which do you use the most to gather information for your patients or
practice?

3
___Smart phone
___Tablet/iPad
___Other_________
5a How would you describe your use of new digital technology versus a
year ago to gather information for your patients or practice?
___Less
___Same
___More
6. How effective on this 5 point scale is direct to patient advertising by
pharmaceutical companies for accurate patient education?
(1= very ineffective 2=ineffective 3=neither 4=effective 5=very
effective)
6a. Why do you say that?
7.How important is it to have interaction with the pharmaceutical sales
reps that call on you?
8. What is your opinion of the importance of Electronic Health Records to
your practice? Rate on this 5 point scale (1= very unimportant
2=unimportant 3=neither 4=important 5=very important)
8a. Why do you say that ?
9. Which best describes your reaction to the passage of the Affordable
Health Care Act ?
___Happy it passed and is law
___No opinion, need to wait and see
___Not happy, don’t like it
9a. You said ______ why is that?
10.In your view what do you see as the implications of the Affordable
Healthcare Act on your practice in general and specifically in terms of
dealing with Health Exchanges, patient care, costs, and future
relationships with Pharmaceutical Companies?

Tim R. Garde
Managing Partner
Star Group / Star Life Sciences
Synegrated Communications
235 S. 17th Street
Philadelphia, PA 19103
215.875.4313
stargroup1.com
starlifebrands.com
For more information please contact:

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