Nieslen and IMS research findings from the new survey Understanding Trust in Over-the-Counter Medicines: Consumer and Healthcare Provider Perspectives.

1. Understanding Trust in OTC Medicines: Consumer
and Healthcare Provider Perspectives
Prepared by Nielsen and IMS
Released March 6, 2013

2. Contents
 Objectives
 Executive Summary
 Research Plan and Survey Design
 Key Findings: Consumers
 Key Findings: HCPs
Understanding Trust in OTC Medicines – March 6, 2013 2

3. Objectives
CHPA Wishes to Understand the Drivers of Trust in
OTC Medicines Across Various Constituencies
• The Consumer Healthcare Products Association (CHPA) launched the
Your Health at Hand initiative to underscore the value and solutions
OTC medicines provide to American families, to healthcare providers,
and to the U.S. healthcare system overall.
• In support of that initiative, CHPA is interested in conducting research to
examine what builds trust in OTC medicines across key audiences:
– Consumers
– Physicians
– Pharmacists
• Key Research Objectives:
– What drives trust in OTCs among consumers and healthcare professionals?
– How do trust drivers in OTCs differ between consumers and professionals?
– How do trust drivers differ by key consumer and professional groups?
Understanding Trust in OTC Medicines – March 6, 2013 3

4. Objectives
Survey Respondent Snapshot
• Surveyed adult consumers of all ages regarding 12 types of conditions;
doctor visits ranged from 0-10 times per year.
• Consumer respondents included households (HHs) with the following:
demographics:
– HHs with kids<4
– HHs with kids 4-11
– HHs with kids 12-17
– Multi-generational HHs
– Respondents <65
– Respondents aged 65+
– Those who care for an adult outside of home
• Healthcare professional (HCP) respondents included:
– Primary care physicians (PCPs)
– Nurse practitioners (NPs)
– Pediatricians (Peds)
– Pharmacists (Pharms)
Understanding Trust in OTC Medicines – March 6, 2013 4

5. Contents
 Objectives
 Executive Summary
 Research Plan and Survey Design
 Key Findings: Consumers
 Key Findings: HCPs
Understanding Trust in OTC Medicines – March 6, 2013 5

6. Executive Summary
Executive Summary
• Patient outcomes, efficacy and safety perceptions are the most important
drivers of OTC trust across consumers and various HCP segments.
– Consistency is a key theme across all segments.
– Efficacy compared to a prescription is a key dynamic between consumer, PCP, and NP.
– Four HCP segments have a very high degree of agreement.
– Trust drivers vary little across types of OTCs taken (cough & cold; allergy relief; pain medication; upset
stomach OTCs).
– Pediatricians as well as consumer households with children <12 also need to know the product is safe to
give to children under 18.
Works consistently Patient outcomes Efficacy Safety
Rank Consumers PCPs NPs Peds Pharms
1 Working Is a treatment that Is a treatment that Is safe to give to Is a treatment that
every time helps me achieve helps me achieve children under 18 helps me achieve
(9%) successful patient successful patient (20%) successful patient
outcomes (17%) outcomes (23%) outcomes (22%)
2 As effective Is something I Is something I Is a treatment that Is something I
as a know will work know will be as helps me achieve know will work
prescription consistently (15%) efficacious as a successful patient consistently (14%)
(8%) prescription (13%) outcomes (19%)
3 Few side Is something I Is something I Is something I Is made with
effects (8%) know will be as know will work know will work ingredients that I
efficacious as a consistently (11%) consistently (11%) know to be safe
prescription (13%) (12%)
Understanding Trust in OTC Research – March 6, 2013 6

7. Executive Summary
Executive Summary
• HCPs feel that OTCs can relieve symptoms before or without a prescription.
– PCPs most frequently selected the statement, “To relieve symptoms before recommending a prescription
treatment.”
– For NPs and Peds, the statements were essentially equivalent “To relieve symptoms before recommending a
prescription treatment” and “To relieve symptoms without recommending a prescription treatment.”
– Pharms felt OTCs are… “To relieve symptoms without recommending a prescription treatment.”
– Note that “To relieve symptoms while also referring patient” is not highly rated.
• HCP views of OTCs are important, as many consumers use OTCs without
seeing a healthcare professional.
– 84% of consumers say they trust their doctor’s advice on what OTC medicine they should take or give to
others.
– Households with kids <12 are less likely than other households to use OTCs without a doctor’s visit, but most
households with kids <12 are still using OTCs without a doctor’s visit.
• Consumers were more likely to say they have readily used allergy relief
OTCs for symptom relief compared to other OTCs.
– Respondents were more likely to occasionally use the remaining OTC segments to alleviate symptoms.
– Seasonality may influence these results as the survey was fielded during Hay Fever season.
• About 98% of PCPs, NPs, and Pharms and 90% of Peds reported that:
– They either “have no reservations recommending OTC medication to patients and caregivers” or “recommend
taking OTC medication and encourage caregivers and patients to read and carefully follow instructions.”
Understanding Trust in OTC Medicines – March 6, 2013 7

8. Contents
 Objectives
 Executive Summary
 Research Plan and Survey Design
 Key Findings: Consumers
 Key Findings: HCPs
Understanding Trust in OTC Medicines – March 6, 2013 8

9. Research Plan and Survey Design
Survey Design – Overall and HCP Respondents
• The research plan addresses the survey’s objectives regarding trust
drivers in OTC medications.
• Nielsen and IMS partnered to conduct surveys among consumers
(Nielsen) and healthcare professionals (IMS) to help understand and
demonstrate what drives consumers and healthcare professionals to
trust OTC medications.
Healthcare Professionals:
•Approximately 10 minute online survey among 506
healthcare professionals.
•Results were analyzed among key groups:
• Primary care physicians (n=125)
• Nurse practitioners (n=126)
• Pediatricians (n=129)
• Pharmacists (n=126)
•IMS used its prescription database to identify high
volume healthcare professionals for recruitment.
Understanding Trust in OTC Medicines – March 6, 2013 9

10. Research Plan and Survey Design
Survey Design – Consumer Respondents
• 1,500 households (HHs) that recorded purchases of OTC products on
Nielsen’s Homescan Panel in the previous 52 weeks were invited to
participate in a survey about OTC products.
– Survey was available 8/20/12 – 9/10/12.
– The primary shopper was asked to complete the survey for all members of the HH.
• 1,194 respondents completed the survey. 82% of the respondents
confirmed that they purchased OTC products in the past 6 months.
Consumer survey responses were analyzed among
respondents who fall into the following groups:
• Pain relief medication given/taken yielding 461 responses
• Cold, cough, sinus or flu medications given/taken yielding 158 responses
• Allergy relief medications given/taken yielding 183 responses
• Upset stomach/acid reflux/antacid medications given/taken yielding 129 responses
• Medication taken by respondent yielding 658 responses
• Medication given to child/step-child in the home yielding 273 responses
• Households with Kids<4 yielding 60 responses
• Households with Kids 4-11 yielding 158 responses
• Households with Kids 12-17 yielding 130 responses
• Multi-Generational HHs yielding 39 responses
• Hispanic yielding 65 responses
• Non-Hispanic yielding 1,129 responses
• Respondents <65 yielding 778 responses
• Respondents Aged 65+ yielding 196 responses
• Care for Adult Outside of Home yielding 343 responses
Understanding Trust in OTC Medicines – March 6, 2013 10

11. Research Plan and Survey Design
Assessing Consumer and HCP Trust in OTC Medicines
• Both survey designs measure relative importance of potential trust
drivers.
Respondents answered approximately five minutes of profiling
questions, followed by approximately five minutes of an exercise
where they looked at 12 sets of four attributes that were repeated
in different patterns to result in an overall ranking of 20 trust
attributes.
Understanding Trust in OTC Medicines – March 6, 2013 11

12. Contents
 Objectives
 Executive Summary
 Research Plan and Survey Design
 Key Findings: Consumers
 Key Findings: HCPs
Understanding Trust in OTC Medicines – March 6, 2013 12

13. Consumers
Efficacy and Safety Perceptions Are the Most Important
Drivers of OTC Trust
Working every time, as effective as a prescription, few side effects, doctor recommended, and
safe ingredients are the most important pillars of consumers’ trust.
Relative Importance of Attributes Studied (on a scale of 1-10)
Is something I know will work every time 9.1
Is something I know will be as effective as a prescription 8.3
Is something that does not have many side effects 8.3
Is recommended by my doctor 7.7
Is made with ingredients that I know to be safe 7.6
Is backed by clinical research that it is safe to use 6.7
Is a brand I trust 6.5
Is backed by clinical research that it will effectively relieve… 6.5
Is recommended by my pharmacist or in-store healthcare… 6.4
Is something I would use before seeing a doctor 5.5
Is made by a company I trust 4.8
Is made with ingredients I recognize 4.4
Is available as a store brand 3.5
Has easy to understand instructions 3.3
Is safe to give to children under 18 2.9
Is something I would recommend to friends or family 2.6
Has been endorsed by a person, group, or information source I… 2.1
Is recommended by friends or family members 2.1
Is something my mother used to use or give to me 1.2
Is something I’ve seen advertised 0.3
Q10. Which of the following is most important and which is least important when you decide which <MEDICATION> that are available over-the-
counter you trust taking (giving to your child/step-child)?
Understanding Trust in OTC Medicines – March 6, 2013 13

14. Consumers
Trust Pillars Are Similar Across the Four OTC Categories
Safe for children <18 is more important for Cough & Cold and Allergy Relief, but differences are not
significant.
Relative Importance of Attributes Studied (on a scale of 1-10)
9.1
8.8
Is something I know will work every time
9.1
9.3
8.2
8.3
Is something I know will be as effective as a prescription
8.7
8.6
8.4
8.1
Is something that does not have many side effects
8.3
Pain relief medications 8.2
Cough, cold, sinus, or flu 7.5
medications
Allergy relief medications 7.7
Is recommended by my doctor
8.0
Upset stomach/acid
7.6
reflux/antacid medications
Q10. Which of the following is most important and which is least important when you decide which <MEDICATION> that are available over-the-
counter you trust <taking/giving to your child/step-child>?
Understanding Trust in OTC Medicines – March 6, 2013 14

15. Consumers
Consumer Trust Attribute Insights by Demographic
Category
• For HHs with children under 4 years-old, the most important trust attribute in
deciding which OTC medication to take or give to a child is that the medication is
recommended by their doctor.
• When choosing a medication for themselves, survey respondents choose a brand
they trust.
• Multi-generational HHs, Hispanic HHs, and HHs who care for an adult outside of
their home place a high value on pharmacist or in-store healthcare professional
recommendations.
• Multi-generational HHs trust products with easy-to-understand instructions.
• HHs with children under 0-17 years-old want to know the product is safe to give
to children under 18 years-old.
Q10. Which of the following is most important and which is least important when you decide which <MEDICATION> that are available over-the-
counter you trust taking (giving to your child/step-child)?
Understanding Trust in OTC Medicines – March 6, 2013 15

16. Consumers
Consumers Use OTCs to Relieve Symptoms without
Seeing a Healthcare Professional
% respondents by OTC usage
82
To relieve symptoms without seeing a healthcare 84
professional 75
77
21
To relieve symptoms before seeing a healthcare 23
professional 15
11
25
To relieve symptoms following a healthcare 12
professional's advice 26
21
Pain Relief Medication Cough and Cold Allergy Relief Upset Stomach/Acid Reflux/Antacid
Q8. When have you or others in your household used each type of over-the-counter medication? Please select all that apply for each type of
medication.
Sample Size = 969
Understanding Trust in OTC Medicines – March 6, 2013 16

17. Consumers
OTC Use with a Visit to a Healthcare Professional is
More Likely to Occur in Households with Younger Kids
• Households with children under 4 years-old are more likely to
use OTC medicines to relieve symptoms before seeing a
healthcare professional.
• However, households with children under four years-old are
more likely to see a healthcare professional for relief from
symptoms of colds, flu, fevers, or coughs (versus other
consumers).
• Households with children ages 4-11 years-old are more likely
to use OTC medicines to relieve symptoms before seeing a
healthcare professional and/or following a healthcare
professional’s advice.
Q8. When have you or others in your household used over-the-counter medication? Please select all that apply.
Understanding Trust in OTC Medicines – March 6, 2013 17

18. Consumers
More Consumers Readily Use Allergy/Relief OTCs than
Other OTCs
Q9. Which statement below best describes how you feel about medications that are available over-the-counter?
Sample Size = 931
Understanding Trust in OTC Medicines – March 6, 2013 18

19. Consumers
Most Consumers Visit HCPs 1-2 Times per Year
Q6. For each household member, please answer the following questions: Frequency of
visiting any type of doctor or healthcare practitioner in the past year
Sample Size = 974
Understanding Trust in OTC Research – March 6, 2013 19

20. Consumers
Most Consumers Buy Based on Symptoms and Trust
Their Doctor’s Advice on OTCs
17%
Strongly or
Somewhat
Disagree
Sample Size = 974
Q12. Below are statements that may or may not describe you. We would like to know how much you personally agree or disagree with each statement.
Understanding Trust in OTC Medicines – March 6, 2013 20

21. Consumers
Older Consumers Are More Likely to Use OTCs Based on
a Healthcare Professional’s Recommendation
Respondents who were over 65 years-old were more likely
to use OTCs when recommended by a doctor or
healthcare professional.
Q9. Which statement below best describes how you feel about medications that are available over-the-counter?
Understanding Trust in OTC Medicines – March 6, 2013 21

22. Consumers
Respondents with Kids Are More Likely to Use the
Internet for Diagnosis
•Respondents were most likely to “almost always turn to the
Internet to diagnose my/others symptoms”:
- When the medication is taken by child
- Households with children under 4 years-old
- Households with children under 12 years-old
Q12. Below are statements that may or may not describe you. We would like to know how much you personally agree or disagree with each statement.
Understanding Trust in OTC Medicines – March 6, 2013 22

23. Consumers
Higher Education Levels Lead to Better Understanding of
Ingredients and Being Asked for Advice
Top 2 Box Summary - % of respondents who Strongly Agree/Somewhat Agree
I choose which over-the-counter medication to buy based on 91%
90%
the symptoms it treats 90%
I trust my doctor's advice on what over-the-counter 85%
83%
medication I should take or give to others 86%
When it's available, I prefer to use over-the-counter 67%
70%
medications versus a prescription 68%
I know what over-the-counter medications to take or give to 65%
66%
others to feel better faster 64%
61%
I avoid going to the doctor unless I absolutely have to 62%
60%
I understand what the ingredients in different over-the- 52%
64%
counter medicines do 64%
I avoid taking or giving others any type of over-the-counter 26%
23%
medication 25% Female High School or Less (227)
I almost always turn to the Internet to diagnose my/others 19%
27%
symptoms 24%
Female Some College (283)
19%
I avoid taking any type of over-the-counter medication 13%
20%
Others often ask me for advice about what over-the-counter 19% Female College Graduate (388)
26%
medications they should take 29%
Q12. Below are statements that may or may not describe you. We would like to know how much you personally agree or disagree with each statement.
Sample Size = 974
Understanding Trust in OTC Medicines – March 6, 2013 23

24. Consumers
Family Health Influencers are more likely to use OTCs before seeing a
healthcare professional or based on a healthcare professional’s advice
Q8. When have you or others in your household used each type of over-the-counter
medication? Please select all that apply for each type of medication.
% respondents by OTC usage
84%
To relieve symptoms without seeing a healthcare
professional
86%
37%
To relieve symptoms following a healthcare
professional's advice
32%
32%
To relieve symptoms before seeing a healthcare
professional
23%
Family Health Influencers (Strongly/Somewhat Agree - Others often ask for advice on what over-the-counter medicines
they should take)
General Consumers
Understanding Trust in OTC Research – March 6, 2013 24

25. Contents
 Objectives
 Executive Summary
 Research Plan and Survey Design
 Key Findings: Consumers
 Key Findings: HCPs
Understanding Trust in OTC Medicines – March 6, 2013 25

26. All HCPs
Successful Patient Outcomes, Consistency and Efficacy
Were the Top 3 Trust Attributes Rated by Most HCPs
Q6. Which of the following attributes (listed above) is most important and which is least important when you decide which OTC Medication you trust
to give to yourself or others in your household?
Understanding Trust in OTC Medicines – March 6, 2013 26

27. Primary Care Physicians
PCPs Largely Recommend OTC Medications to Relieve
Symptoms Before Recommending a Prescription Treatment
Q4. When have you recommended each type of over-the-counter medication? A. To relieve symptoms instead of recommending a prescription treatment;
B. To relieve symptoms before recommending a prescription treatment; C. To relieve symptoms while also referring patient to another healthcare
professional’s advice
Understanding Trust in OTC Medicines – March 6, 2013 27

28. Nurse Practitioners
NPs Mostly Recommend OTC Medications to Relieve
Symptoms Either Before Recommending or Without
Recommending a Prescription Treatment
Q4. When have you recommended each type of over-the-counter medication? A. To relieve symptoms instead of recommending a prescription treatment; B. To
relieve symptoms before recommending a prescription treatment; C. To relieve symptoms while also referring patient to another healthcare professional’s
advice
Understanding Trust in OTC Medicines – March 6, 2013 28

29. Pediatricians
Pediatricians Mostly Recommend OTC Medications to
Relieve Symptoms Either Without Recommending or Before
Recommending a Prescription Treatment
Q4. When have you recommended each type of over-the-counter medication? A. To relieve symptoms instead of recommending a prescription treatment; B. To
relieve symptoms before recommending a prescription treatment; C. To relieve symptoms while also referring patient to another healthcare professional’s
advice
Understanding Trust in OTC Medicines – March 6, 2013 29

30. Pharmacists
Pharmacists Recommend OTC Medications to Relieve
Symptoms Either Without Recommending or Before
Recommending a Prescription Treatment
Q4. When have you recommended each type of over-the-counter medication? A. To relieve symptoms instead of recommending a prescription treatment; B.
To relieve symptoms before recommending a prescription treatment; C. To relieve symptoms while also referring patient to another healthcare professional’s
advice
Understanding Trust in OTC Medicines – March 6, 2013 30

31. All HCPs
Most Specialists Either Had No Reservations
Recommending OTC Medications or Would Encourage
Patients to Read and Carefully Follow Instructions Before
Taking the OTC Medication
64.3
60.3
52.8
45.0 45.6 44.2
38.1
33.3
9.3
0.8 0.8 0.8 0.8 1.6
Q5. Which statement (in the table above) best describes how you feel about OTC Medication that are available over-the-counter?
Understanding Trust in OTC Medicines – March 6, 2013 31

32. All HCPs
Patients and Caregivers Visit Different HCPs for Different
Reasons
Healthcare Professionals Top Reasons Consumers Visit Respondents
Primary Care Physicians Asthma; Cough and Cold
(n=125)
Pediatricians Asthma; Cold; Allergies; Routine Checkup
(n=129)
Pharmacists Cough; Headache/Migraine; Allergies
(n=126)
Nurse Practitioners Anxiety/Depression; Upset Stomach/
(n=126) Heartburn/Digestive Symptoms; Allergies
Q11. What are the reasons that patients and caregivers have come to see you in the past year? Please select all that apply.
Understanding Trust in OTC Medicines – March 6, 2013 32