February 2010

Out on a Limb: Ad salutem

Jordana Bieze Foster, editor

“Clients don’t always know what’s best.” — Peggy Olson, Mad Men

As true as it is in advertising, it may be even more true in healthcare. As evidence, this issue features not one but two articles on the ongoing battle to improve patient compliance—a battle practitioners have been fighting since even before the halcyon days of the three martini lunch.

Maybe it’s the influence of all those Super Bowl commercials, but I’m particularly intrigued by the advertising-inspired concept of marketing risk as a means of improving compliance (see “Marketing risk: Beyond diabetic foot education,” page 47). After all, advertising is all about changing behavior.

As Jeffrey Robbins, DPM, and colleagues describe, the idea of marketing risk as a public health initiative focuses on those people who lack the motivation or the ability to change on their own. Key elements are incentives for desired behavior,  consequences for unwanted behavior, and pithy slogans like “Death by Tobacco” that communicate an incentive or, in this case, a consequence succinctly and clearly.

These concepts are presented as a population-based strategy that has been successful with regard to smoking cessation, among other public health issues. But there’s no reason why they couldn’t also be employed by individual practitioners.

And really, to some extent, marketing risk is what some practitioners are already doing. In our cover story (“Keys to compliance in O&P,” page 18), an oft-repeated theme is that many patients are more likely to wear a brace or other device if they understand its purpose. Or, put a different way, if they understand the consequences—pain, deformity, functional impairment—of not wearing the device. Other patients are more likely to wear a device if it makes them “cool”—definitely an incentive—by virtue of the cartoons or sports logos that adorn it.

Other aspects of marketing could be adapted in the same way. A pithy message that communicates the consequences of non-compliance (Robbins et al suggest the term “malignant diabetes”) could be widely disseminated using posters, brochures, e-mail blasts, internet ads, YouTube videos. Patients who demonstrate compliance could be eligible for discounts or prizes—even the honor of being “patient of the month.” And those incentives could be promoted in similar ways.

Granted, compliance is difficult to quantify short of embedding activity sensors in a patient’s device, but asking patients to complete a therapy journal could be an alternative. Yes, they could falsify journal entries, but doing so would at least require giving the topic some thought, which in many cases would be an improvement. And a falsified journal won’t be very convincing without clinical improvement to accompany it.

The thing about marketing, though, is that it can’t be solely based on games and gimmicks. Patients, like other types of customers, will see right through those tactics. As important as changing patient behavior is making sure they understand why that change is necessary. But an advertising-inspired approach can accomplish that too.

As real-life ad man David Ogilvy said, “I do not regard advertising as entertainment or an art form, but as a medium of information.”

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