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Marketing Research         Pharmaceutical Executive, March 1990

A Sharper Competitive Edge in Marketing

Editor's note: Dr. Murray Simon is president of D/R/S HealthCare Consultants, a marketing research firm in Charlotte, North Carolina, specializing in communications with health care providers.

As the marketplace becomes more consumer-driven, one way for pharmaceutical companies to better understand and capitalize on the provider-patient relationship will be through more tightly  focused and carefully planned marketing research.

     The oft-heard statement that health care is undergoing rapid and dramatic change is an understatement. Within the last decade, medicine has changed from a well-entrenched, provider-driven service to a predominantly consumer-driven one. Managed care, DRGs and resource-based relative -value scales are forcing physicians to look at medicine as a highly competitive marketplace - it is no longer a private mechanism fueled by the attitude that "the doctor know best." The public is playing a greater role in mapping out its own path to good health. Consumers are demanding more information from their physicians: second opinions are more prevalent than ever before. Patients complain that their doctors are too impersonal and communicate ineffectively: doctors complain that patients fail to read or absorb information given to them and too often listen to advice from nonprofessionals.
     In the midst of all this chaos and confusion stands the marketer of health care products with new product launches, product repositionings, prescription-to-OTC conversions, advertising concepts, promotional programs, and a host of other marketing challenges. Never has there been a greater need to understand through sophisticated marketing research, the dynamic relationship between patients and professionals. It is no wonder that companies often seek outside help in that task. This article describes how to design a research project that will create a competitive advantage and how if needed to select and work effectively with a marketing-research service.
     Marketing products or services to consumers seldom follows a clearly defined, unobstructed pathway. No other area of product marketing is equivalent to that of the health care provider positioned between the marketer and the consumer. The provider has a potentially profound influence on consumer buying habits and that influence is out of the direct control of the manufacturer.
     In the United States there are approximately 640,000 physicians, 147,000 dentists, 68,000 osteopaths, 1.3 million nurses, 247,000 therapists, 160,000 pharmacists, and 65,000 hygienists. Assuming that all these practitioners have an average of 10 patient contracts per day, their potential impact on the decisions of the health care buying public is of enormous significance. Thus, if pharmaceutical manufacturers are to successfully meet the challenges of competitive marketing, they must continuously monitor the roles of the health care provider and patient. It is imperative that marketers understand as fully as possible the interaction between provider and patient - that they know what is going on in those professional offices and pharmacies. All too often the realities differ from the perceptions - perceptions based on faulty information.
     Though computers have made it possible to accumulate data faster, too often the mass of data becomes a mess of data that defies organization. It also tends to tell how people behaved, not why they behaved in certain ways. Advance planning of specific research needs can help produce data in a more usable, ordered form: yet despite a great need for customized, provider-oriented research, more is not being done - for two basic reasons:

Precepts of Planning
There is no denying that customized marketing research with health professionals can be difficult, expensive, and sometimes disappointing. But the difficulties, expense, and disappointments can often be reduced with careful development of the project. The return on investment can be substantial. The following are some factors to bear in mind when planning a custom-research study.
     Choose research partners carefully.
If researchers were to conduct a marketing-research study in the Soviet Union, they should be familiar with its cultures. Russian society tends to be inwardly directed and inherently suspicious of outsiders who question it. Health care providers are not unlike Russian society: they speak their own language, erect walls for self-protection, and are inherently suspicious of outsiders who ask them questions. It is very important that those doing marketing research in health care have a knowledge of its inner-workings. Checking references is essential. Some outside marketing-research services base their claims of experience in the health care field on one or two studies. Some claim health care literacy based on the use of part-time nurses who function as medical dictionaries in human form. Not all studies require a high degree of medical expertise: however, that determination should be made before interviewing and hiring a researcher.

All too often a research project begins with, "Let's get some feedback on this," and doesn't develop further in terms of project design and protocols.

Educate research partners. It seems to have been decreed that marketing-research projects must be done on short notice. In addition to potential problems with recruitment, that situation can also lead to inadequate moderator-researcher preparation. Because many projects involve complex products or issues, preparation is essential. The best way to get ready for a study is to have as much available literature as possible in the researcher's hands at the start of the project. That can include abstracts of clinical studies, detailing materials, advertisements, sample inserts, product samples, and reports or questionnaires from previous studies. Face-to-face client-researcher meetings are far more productive if they occur after the materials have been studied. Meetings should be used not only to outline and clarify goals and objectives, but to bring the research team "up to speed" as well. Whether it be a quantitative or qualitative study, the quality of preparation will have a bearing on the quality of results.
     Another essential part of the education process is the clarification of company policy:

Good specs are essential. All too often a research project begins with, "Let's get some feedback on this." and doesn't develop further in terms of project design and protocols. Much of this problem can be eliminated by clearly and completely defining the study objectives. Some of the important questions in developing research guidelines should include:
     Are we looking for qualitative or quantitative input? It is best to decide early whether the information is needed to predict statistical behavior or to gain a better understanding of potential and existing attitudes. There can be a considerable difference between the cost of a qualitative study versus a quantitative study. In general, the cost of a qualitative study tends to be lower than that of a quantitative study; however, there is a definite trade-off in the number of responses received.
     Are our needs best met by a mailed survey, telephone interviews, face-to-face interviews, focus groups, telephone focus groups, or a combination? In deciding on the best method, several factors must be considered:

Other questions follow:
     Who are the proper respondents for this study? Although it may seem obvious, this particular information is sometimes not clearly defined in the protocol. A recent series of focus groups having to do with supply-buying habits called for the recruitment of physicians who "had been in practice more that five years." This was amended to include "and currently have a part or full ownership in practice" because the individual responsible for placing orders and signing check usually has a partnership status.
     Mixing specialists and general practitioners in focus groups can be an effective way to minimize recruitment problems and maximize the diversity of information, but care must be taken to recruit a well-balanced mix. It may not be advisable to convene mixed groups of dermatologists and plastic surgeons for a discussion of the treatment of scarring acne - particularly if the discussion will involve fees. Poor recruitment will result in inferior information.
     How many respondents do we need for a valid study? This carries a certain degree of subjectivity. Having more than eight respondents in a focus group tends to limit individual participation and affects the depth of responses. To determine sample size for a quantitative study, it is sometimes necessary to back into it: what is the budget, what is the cost per response, is this a sufficient sample size for this study? If the study is primarily attitudinal in scope, a sample size of 250-300 well-qualified responses should provide excellent results. If the study is to determine practice or buying patterns, a larger sample size may be required.
     Is geographic diversity of concern? Issues relating to usage patterns and pricing sensitivity frequently show regional variation among health care providers; however, attitudes toward patients, manufacturers, pharmaceutical companies, or pharmacists often do not. A "local" study will cost less than a broad, geographic one.
     Exactly what questions have to be answered? Marketing researchers occasionally feel like locomotives pulling a train onto which freight cars are continuously being added. The shorter and more concise the interview or questionnaire, the less expensive the study. It is considerably more difficult to get a physician to respond to a 20-minute interview than a 10-minute one. A great deal of time and effort must be spent in construction questions and questionnaires. Health care professionals can quickly become impatient with statistically oriented questions, and the accuracy of their responses may be highly suspect. Questions having to do with numbers of patients treated and percentages of time spent on various procedures should be interspersed among others of a nonstatistical nature.
     What is the best approach to recruitment? A well-thought-out recruitment script is essential. How can gastroenterologists be convinced to participate in a study having to do with laxatives? Financial incentive alone is seldom sufficient to ensure participation. The topic should be of interest; potential respondents should feel that they  will learn something new. If the study is about laxatives, it may be prudent to have recruiters stress a secondary aspect of the study such as "the future of medicine." Recruitment should always emphasize that the project is pure research and not sales oriented.
     Would abstracts, concept statements, or print materials be helpful? In studies involving new products or services with which the practitioner may not be familiar, it is important to use print materials. Providers often become impatient when asked to conceptualize from verbal-only input: they are trained to evaluate and make decisions base largely on physical evidence. The clearer the respondents'' understanding of the subject matter, the better the responses.
      When should the study be done? Often research projects are started on a need-it-yesterday basis. The average time necessary to recruit physicians for a focus group or interview will vary considerably depending on the specifications. In most instances, the information has to be give to the receptionist on a first call with a follow-up call for the doctor's decision. At least two weeks should be allocated to recruiting for 75 or fewer providers/ respondents. In general, the more stringent the requirements for qualification, the longer the recruitment time.

Health care providers are often impatient with conceptualizing from verbal-only input; they are trained to make decisions based largely on physical evidence.

     How are the results reported back? Is a full report necessary or will a summary report do? Should the raw data be tabulated in-house or should the researchers do it? Will a presentation be needed? Would video tapes of the focus groups be of help to those who could not attend? Are standard tabs sufficient or will statistical analysis be necessary? Do code sheets have to be approved prior to final reporting? All of these factors affect the cost of a project and should be weighed in the protocol - budget development stage.
     Monitor the progress of the study. Questionnaires should be prescreened to determine if any of the questions are not sufficiently clear or are improperly sequenced. With focus groups, progress reports on recruitment are important. Use them to evaluate the effectiveness of the recruitment script. The incentive being offered must be appropriate for the area or type of practitioner. If the project involves a mail survey, weekly reports on the returns are necessary. Early warnings of problems allow times for adequate control of damage. If possible, the progress of a telephone survey should be monitored by listening to actual interviews on a supervisor's phone. For client-viewed focus groups or one-on-one in-depth interviews, ready access to copying, word processing, or typing services can facilitate midstream discussion guide or concept-statement changes by the pharmaceutical company.
     Report results promptly. The project specs should make clear when data or reports are due and in what form, such as raw data, tabulation and tables, graphs, summary report, or full report. Computer programs can provide rapid data processing and tabulation capabilities, and the client should expect finished tables and graphs within a previously agreed upon time. In the case of   focus groups or one-on-one in-depth interviews, a top-of-mind summary - usually 10 or fewer pages - should be in hand within two weeks of the final interview.
     The researcher and the pharmaceutical company should both adhere to reporting dates whether the study is qualitative or quantitative. The best results are generally obtained when the project is still fresh in everyone's mind. It is therefore prudent to keep the process moving forward on schedule. Report drafts or interim tables submitted for consideration should not be subjected  to lengthy or delayed review. On the other hand, they should also not be shrugged off lightly with, "Just send us whatever you've got."

Partners In Vision
An experienced marketing researcher is someone with exposure to a number of related products and markets who should be able to provide perspective based on that exposure. The projects should be undertaken as a partnership between the researcher and the pharmaceutical company to generate information that will help the project sponsor. Although cost is usually a concern, consideration should be given to the advantages of working regularly with a small pool of researchers. Over a period of time, these people will have developed an understanding of the company, its products, and its services, leading to greater consistency and continuity in the research.
     The average research and development cost of bringing a new drug to the U.S. market is about $125 million.These escalating costs point to the importance of evaluating the marketplace during strategy development and execution. Custom marketing research is an essential tool for that purpose. In a recent report, "Winning the Marketing Challenges of the '90s With Marketing Research," Fackleman and Adams concluded: Whether marketing research is considered a competitive advantage or relatively unproductive, overhead will depend largely on the quality and abilities of researchers themselves - but it will also depend on the vision and confidence of the organizations they serve." ¤

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