Q uali t a ti v e Expl o r a ti o n :

Qualitative Exploration:Minnesota Patients’ Response to Taking an Increased Role in Healthcare

PROPRIETARY AND CONFIDENTIAL

MN alliance for patient safety 2

Method• We conducted two Online Digital Bulletin Boards (ODBBs)

• Allowed us to recruit participants statewide• Offered financial and logistical advantages over traditional

research methods• Allowed us to capture reactions to communication themes on an

individual basis prior to group discussion• Took place over 5 days 5 hours of input x

~100 respondents• Discussion guide could evolve as we learned

• Separating boards by gender similarities and differences between women and men could be observed

Sample

MN alliance for patient safetyPROPRIETARY AND CONFIDENTIAL

3

• All respondents:• Expressed a willingness to explore new ideas• Had seen a doctor in the last 12 months about chronic condition

or ongoing health issue• Equal gender representation• Between ages 21 to 85 (sample skewed older due to health-

relatedrequirements)

• No past 6 month qualitative research work• Had access to computer for personal use• Passed a technology screen



Limitations

• Sample size for this project was 100+ respondents• Samples of this size are more likely to yield results that are more

reliable, precise, and representative of the population than sample sizes of traditional qualitative research

• Sample was chosen randomly according to defined quotas (for patient behavior and types of illnesses as well as demographics)

• Please keep in mind that this is qualitative research to inform the development of a patient outreach campaign. It provides a more rich contextual type of qualitative feedback than most quantitative surveys can, but it does not have the predictability of a statistically significant random sample quantitative survey



Executive Summary

Men and women agree that they have the primary responsibility for their own treatment and care with respect to their medical issues

Key is to inform them of what that responsibility entails• Most believe it includes acting on next steps (making

appointments, getting tests done, filling prescriptions) and watching for warning signs• Fewer believe that it is their responsibility to

document information (warning signs, next steps, prescriptions taken)• Men and women are least likely to take responsibility

for bringing test results with them to appointments

Proprietary and Confidential MN Alliance for Patient Safety 6

Executive Summary (cont’d)In general, patients tended to take a more active

role in their medical care if:1. they had more serious and/or chronic diseases2. they saw multiple providers (especially if

from different clinics/networks)3. they were older4. they had experienced medical mishaps (first-

or second-hand)


Executive Summary (cont’d)Barriers that MAPS will need to address include

these attitudes and behaviors:“My provider has all my information in my charts”

“My providers belong to the same network and they share my information”

“My pharmacist provides information when I get my prescriptions”

“I can (still) remember – I don’t need to write anything down”

“I don’t think about documenting anything”“I don’t know the questions to ask (my doctor)”“My spouse/mom/child takes care of that for me”


Executive Summary (cont’d)Nearly everyone claimed to keep a list of some

kind (if only a grocery list)Post-it Notes, calendars, and messages posted on

refrigerators with magnets were also commonly used reminder methods

Younger patients were more likely to be “paper- free,” relying on electronic reminders and filing systems

Older patients were more likely to keep hardcopies, sometimes in (elaborate) filing systems


Executive Summary (cont’d)Patients responded well to a to-do list: the steps

were clear, six steps the correct number• They had no suggestions for additions

Presenting the To-do list as in the Theme O radio ad was the most appealing overall:• Women found this approach compelling, supportive,

empowering, and “not preachy”• Men liked the direct approach of this theme and agreed with

the philosophy “You are Your Own Best Medicine”

Taking a serious approach in presenting the To-do list was endorsed by both men and women (although many acknowledged that they preferred – and were more likely to recall - humorous executions in general)


Executive Summary (cont’d)Among the reminder product concepts reviewed, the refrigerator

magnet and note pads were most likely to be used (although perhaps not as effective as actual reminder tools)

Younger patients also liked the electronic options (Smartphone app, USB device), but older/less computer savvy patients were less positive: for them, a pre-loaded file folder or organizer had more appeal

Web videos and one-page information that came from providers were likely to get viewed at least once (and especially in the waiting room or if handed to respondents after an office visit)

Few thought the wallet card would get used or viewed



Detailed Findings

Women’s Organizational Charts:Healthcare Functions

1st place is me (doctor was next most often mentioned in 1st position)

My job is to maintain my well being/to see to it that I take my medications, eat the correct foods, get exercise but be careful not to overdo, and to seek out help when it's needed

It's my husband’s job to emotionally support me and go to doctor's visits if I want him to… go to the grocery store and get something for me if I need it, if I'm sick, etc.

He diagnosed the condition, provided treatment, and instructions for ongoing procedures that I can conduct at home to help relieve the condition and prevent it from worsening.

Usually a spouse/significant other (but also relatives, pharmacists or physical therapists – or no one)

Usually no one

My doctor (or self, if not in first position)

Q. Thinking in terms of the chronic disease or illness you are living with, please tell me: who are the various participants in your treatment and care of your disease/illness and what is the responsibility of each?



Men’s Organizational Charts:Healthcare Functions

1st place is me (doctor was next most often mentioned in 1st position)

I make all my food, blood testing, physical activity and medication schedule decisions. Others can make suggestions but I am the one to make the final decision

She is an integral part of my health team…knows my feelings…can accompany me to visits, listen, can ask clarifying questions, and convey to me things… Without her, I would not be as healthy.

He takes the time to explain things as well as reviewing my diagnostic tests and taking appropriate action.

Usually a spouse/significant other (but also relatives, pharmacists or physical therapists – or no one)

No one (or sometimes friend or relative)

My doctor (or self, if not placed in firstposition)

Friends - they help me keep sane along with bouncing ideas and suggestions off

Q. Thinking in terms of the chronic disease or illness you are living with, please tell me: who are the various participants in your treatment and care of your disease/illness and what is the responsibility of each?




Reactions to To-do List

Number of items on List is right• Most women and men thought that the list contained the

right number of tasks (6)

Too many Too many

Too few

Right number

Women’s Response

Too fewRight number

Men's ResponseThis is a good number. It's thorough

without being overwhelming, and it's also divided into three easy to read

and understand sections.



To-do steps are clear

Clear

Not clear

Women’s Response

I can tell that this check list would

be good to get me to be a little more

aware of my health and maybe

be able to ask more questions.

Clear

NotClear

Men's ResponseIt's clear what whoever wrote that list thinks you should do. What is written is clearly stated.



Patients are polarized in terms of likelihood to bring a medication list (many count on their providers to have)

0 10 20 30 40 50

EXTREMELY UNLIKELY TO DO

SOMEWHAT UNLIKELY TO DO

NEITHER LIKELY NOR UNLIKELY TO DO

SOMEWHAT LIKELY TO DO

EXTREMELY LIKELY TO DO

Medication List

Women Men Combined

I have all this info in my

chart already.

It's too much work to bring with to your Dr appt no matter what your ailment is…It's not gonna get done.

I expect the doctor to do this, not me

This is most important to

me because of the large # ofmed's I take.

A must, as you may see multiple providers, and they may not be aware



of the actions of another doctor.

Most patients also expect their providersto have test results

My doctor already has

access to this on the

computer.

I go to the same network of clinics that

have access to the records.

I do not routinely keep test records, as

the ratios and numbers they contain mean nothing to me.

These medical records I expect to be

kept on file by my clinic, where they

won't get lost, and where people with access to medical

desk reference books and pharmocopiae can decipher the meaning of the

cryptic numbers of the test results.

If this a serious condition I bring the information, if not a major problem or

condition I default to their record keeping.

I always carry my latest tests, because sometimes

they have not received results from another provider that may be necessary for them to

diagnose and treat you correctly.

0 10 20 30 40 50






Test Results

Combined Women Men



Patients with progressive conditions seemmore likely to keep a warning signs list

too many warning

signs for the meds I take

A list is already provided with any prescription… it

would be a waste of time.

If I have paper/pen, and my doc doesn't

give me a printed list, Iwill write it down.

0 5 10

WomenMen

15 20 25 30 35






Write Warning Signs List

Combined

If the doctor would warn me to watch for a

symptom that would indicate a possible

medical condition you better believe it would

be documented



Patients claim that next steps arenoted (if not always documented by

I feel like so far I can remember what I'm

told about any future steps there may be,

so I don't feel the need to write them

down.

0 5 10

WomenMen

15 20 25 30 35






Combined

I go to the same network so I would just listen to the doctor and do what she said. My

condition is not so complex that I need to write it down. I leave the doctors office with steps and recommendations on a print out

anyway--I could refer to that if need be.

I would not think to ask.

them)You should always ask 'where do we go from here'. Good chance to ask if meds should be added,

Write a Next Steps List

reduced, or stopped. Also, what behavioral modifications are

necessary to improve your physical condition

If my doctor gave me next steps verbally, I

would definitely write them down. I would

assume, that this would be printed out for me by

the provider.



Acting on next steps is the step thatmost patients (say they) comply with

Because I have so many appointments,

meds, tests at different clinics I

keep a daily planner which I have with me

at all times.

I care about my well being and my care begins with me. If I don't comply with

treatment I would only harm myself.

0 10 20 30 40

women

50 60 70 80 90






Act on Next Steps

men combined



Patients also claim to watch forwarning signs

I always do this so definitely this one,

even if hypochondriac-ish :)

I probably wouldn't make a list, but if I have concerns I would alert

the doctor

0 10 20 30 40 50 60 70






Watch for Warning Signs

Combined Women Men

For me this is very important because if I don't care about my body who will. AFTER my last surgery I ended up with a staff infection which thanks to me I pushed the panic button

and lucky caught it early before it got out of control.




Reactions to Themes

Themes P and O


24MN alliance for patient safety

Themes H and M



Most Persuasive Theme

O 30%

H 11%

M 4%

P 55%

O 30%

H 28%

M 15%

• An equal number of women picked Themes O, H, and P as “most persuasive”; men preferred P overall, followed by O

Women’s Response Men's Response



P27%



Why Theme “O”

For women:• Compelling (talks directly

to YOU)• Empowering, supportive• “Doesn’t talk down to me”

•For men:

• Many agreed philosophically with “you are your own best medicine”

• Puts patient in charge (appealed to Warriors)

• Addresses the problem (“you need to get involved”) more than other themes

Roughly half claim they would use a prepared folder (visual shown)• Great organizational

aid

• More likely to be maintained

0 10 20 30 40

Extremely unlikely to use

Somewhat unlikely to use

Might or might not be likely to use

Somewhat likely to use

Extremely likely to use

Likelihood to Use Folder

combined men women

This is the best idea ever -

everything can be kept in one

spot - divided for appointments,

blood work, prescriptions, allergies, tests

and so on - It can be carried to

every appointment

also

I love to be organized, but usually don't have the time

to set up something like this for me or

my family. Love it!

This seems way too

clunky and overbearing.

I expect the doctor to be connected

electronically. I don't want to drag all this

around


Both men and women like “Lifesaving”option; less agreement on preferencesfor other options

PROPRIETARY AND

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A B C D E F

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H I J

Preferred Magnet Design

Women Men Combined

MN alliance for patient safety 29CONFIDENTIAL

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