How To Find Out What People Are Like

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1 Doctor-Patient Global Communication Performance Insights from the Worldwide Independent Network (WIN ) of Market Research Fall,

2 Contents 1. Background & Research 2. Context and Methodology 4. Key Findings 6 4. Communication Assessment Tool 7 5. Medication Usage 10 2

3 1. Background & Research Background WIN, the Worldwide Independent Network of Market Research, the largest independent organization of Market Research firms with members in 64 countries, prepared this landmark review of physician-patient communication. Research Physician-Patient communication critically influences the effectiveness of medical education initiatives, treatment decisions and patient compliance to recommended treatments. WIN conducted this ground-breaking study on physician-patient communication throughout the world to provide the healthcare stakeholders with a better understanding on how patients perceive communication skills of their doctor, how patients engage their physician, how treatment choices are influenced, the frequency and preferred modes of interaction and sources of influential information.

4 2. Context and Methodology Methodology and Geographical distribution: In total, the study was carried out in 9 countries. In each country, the most appropriate interviewing methodology was used given local conditions. Fieldwork dates: FieldworkwasconductedbetweenJuly19 th 2011 and October rd Sample: The total size of the sample is cases representative of people. Sample in each country is probabilistic and was designed to represent the general adult population. General coverage of the sample is as follows: 75 national 25 urban Weighting: The data was weighted in two steps to obtain representation by country and worldwide. The data was first weighted to generate data representative of the general population for each country. A second weight, according to the size of the population surveyed, was then applied to obtain global and regional totals. The margin of error per country is between +/-2.4 and 5.66, 19 times out of 20. The table on the next page presents a summary of the methodology used in each country to conduct this survey. Each sample is representative of its country s population in terms of socio-demographic variables. Sample sizes ensure accurate generalizations to the total population and allow a very precise interpretation of the results. 4

5 2. Context and Methodology Country Firm Method Sample Total Population Sampling Method Sample Population represented Margin of Age Weighting variables Fieldwork dates representation by sample error+/- Armenia MPG LLC (Marketing Professional Group) CATI Quota Sampling National Gender, Age Aug Australia Colmar Brunton Online Stratified National Gender, Age, Region Aug Gender, Age, Austria Gallup Austria Face to Face Random quota sampling National Region,Employment, Jun. 20 -Aug Income Bosnia Mareco Index Bosnia CATI Multistage random sample National No Jul Aug Brazil Ibope Inteligencia Face to Face Probabilistic National Gender Age, Employment Aug Bulgaria BBSS Face to Face Random National Gender, Age, Region, Type 18+ Jul. 28-Aug,04 of settlement.90 Canada Leger Marketing Online Random National Gender, Age, Region, language Aug Chile IBOPE Inteligencia Chile CATI Random Urban Gender, Age, Location Aug. 19- Sep China WisdomAsia Online Random Sampling with online Panel (Shanghai, Beijing and Guangzhou) Urban No Aug Colombia CNC (Centro Nacional de Consultoria) CATI Two-stage design applied simple random sampling Urban No Aug Czech Gender, Age, Region, Size of Mareco Ltd. Face to Face Random route sampling National Republic Community Aug Denmark DMA Research Online Random National No Aug Finland Taloustutkimus Oy Online Random Nationl Gender, Age, Region Aug France BVA Online Quota Method National Gender, Age, Region, Occupation Aug Germany Produkt+Markt Online Random National Gender, Age, Region Jul. 25-Aug Greece Centrum S.A CATI 00 10,961,758 Statified Urban 6,51, Region Jul. 18-Aug Hong Kong Consumer Search CATI Random quota sampling National Gender, Age Jul. 0-Aug Iceland Capacent Online Random from our Web-panel National Gender, Age, Region Aug India DataPrompt CATI Random Urban No Jul. 2-Aug Ireland Red C Research CATI Random digital dial including both Gender, Age, Social class National landline and mobile numbers and Regio. Aug Italy Doxa CATI Random National Gender, Age, Region, Size of 18+ Community, Occupation Jul Japan NRC (Nippon Research Center ) Online ,475,664 Random National 99,604, No Aug Kenya Infinite Insight Face to Face Random National No Jul. 0-Aug Lebanon Reach CATI Random National No Aug Luthuania UAB RAIT Face to Face Random Probilty Routine National Gender, Age, Education Aug Macedonia BRIMA Face to Face Multi stage stratified random probability National Gender, Age, Region size, Nationality Sept Pakistan Gallup Pakistan Face to Face Stratified Probability Sampling National Gender, Age, Region, Type 18+ of settlement Aug Palestine PCPO Face to Face Random National No Jul. 20-Aug Peru Datum Face to Face probabilistic, multistage stratified allocation Urban Gender, Region Aug Poland Mareco Face to Face Stratified random Urban No Jul. 28-Aug. 2.2 Romania TNS CSOP Face to Face Stratified Probability Sampling National Gender, Age, Region Jul. 24-Aug Russia Romir Online Random Urban Gender, Age, Region Aug Saudi Arabia PARC CATI Random Urban No Jul Aug South Africa TRS (Topline Research Solutions) Face to Face Random (Johannesburg, Durban, Capetown ) Urban Gender, Age, Region Jul. 29-Aug Korea Gallup Korea Online Random Soft Quota National Gender, Age Aug Sweden CMA Research Online Statified National No Aug Swizterland Isopublic Face to Face Random-quota National Gender, Age, Region Sept. 21-Oct Tunisia EMRHOD CATI Stratified (governorates are strata) National No Aug USA TRiG Online Random National Gender, Age, Region, Race Aug

6 . KEY FINDINGS Doctor-Patient Relationship Around the World 1. Communication effectiveness between doctors and patients is related to being compliant to taking prescribed medication exactly as the doctor directed. 2. Communication Assessment Tool (CAT ) showed the communication between doctor and patients is poor with a very low score of 22.. Asian markets are amongst the lowest on communication effectiveness. 4. Directionally, comparing results from prior years, communication effectiveness between doctors and patients on a global level trended downward. 6

7 5. Doctor Communication Assessment Tool Q. Thinking of your most recent visit, please rate the doctor s communication with you. Compared to last year, fewer citizens rated their doctor as excellent this year in all of the 15 communication assessment categories asked in the survey. Only a quarter or less rate their doctor as excellent in all of the categories. Only 18 of respondents felt their doctor encouraged them to ask question. CAT (Comunnication Assessment Tool) Attributes Talked in terms I could understand How would you rate the care provided by your doctor Paid attention to me (looked at me, listened carefully) Treated me with respect 24 4 Greeted me in a way that made me feel comfortable 2 29 Showed care and concern 2 0 Understood my main health concerns 2 0 With only 25, talk in terms I could understand this is the attribute that received the rating of excellent most frequently. Discussed next steps, including any follow-up plans Gave me as much information as I wanted Let me talk without interruptions 22 1 Key Finding: A quarter or less of citizens rate their doctor as excellent in all of the categories. Showed interest in my ideas about my health Spent the right amount of time with me Checked to be sure I understood everything Involved me in decisions as much as I wanted Encouraged me to ask questions 18 2 Total *Global totals represent the averages of the top boxes scores in every surveyed country **In 2010, 2 countries participated in the survey. IN 2011, 9 countries participated in the survey of which only 15 were recurrences from

8 5. CAT (Communication Assessment Tool) Q. Thinking of your most recent visit, please rate the doctor s communication with you. Communication Assessment Tool (CAT) The Communication Assessment Tool (CAT), developed by Makoul et al, assesses patient perceptions of physicians interpersonal and communication skills. TheCATisa15-itemsurveythatiseasily administered in a paper-and-pencil format, via the phone or Internet. The CAT asks respondents to rate different dimensions of the communication and interpersonal skills of the physician using a 5-point rating scale (1=poor, 2=fair, =good, 4=very good, 5=excellent). Makoul et al found that scoring the CAT based on the proportion of items rated as excellent was more meaningful than summarizing the scores using means. Their psychometric analysis of response scales indicated that a rating of excellent was akin to yes, while even very good was closer to no than yes. Data for the present study were analyzed using the sum of the items scored as excellent divided by the number of items answered.* *Source: Linda567.pdf(2010) 8 Overall,theCATscoreinthe9surveyed countriesisatalowof22. ThecountrywiththehighestCATscoreis Ireland with a score of 66. On the other hand, Pakistan continues to record a low CAT score with the lowest this year at 5 (Pakistanscoreda7in2010). Of the countries that participated in the survey for the past two years, Austria s CAT score most decreased(-19) while Italy (+10), Lebanon (+8), Korea (+7), China (+7) most increased. Key Finding: On average, citizens throughout the world give their doctor a low CAT score. **In 2010, 2 countries participated in the survey. IN 2011, 9 countries participated in the survey of which only 15 were recurrences from Communication AssessmentTool(CAT) Country Ireland 66 NA Armenia 66 NA Chile 59 NA Macedonia 56 NA Bosnia 51 NA Australia 49 NA USA Lebanon Saudi Arabia Canada 4 47 Sweden 7 NA Germany 6 NA France 5 9 Switzerland NA Greece 2 NA Colombia 28 NA Iceland 27 0 South Africa 25 NA Bulgaria Brazil 2 0 Lithuania 2 NA Russia 2-22 Tunisia 22 NA Korea Austria Denmark 21 NA Italy Czech Rep. 20 NA Romania 20 NA Finland 19 NA India Kenya 15 NA Palestine 14 NA Hong Kong 1 NA Poland 11 NA China 11 4 Japan Peru 6 NA Pakistan 5 7 Total 22 29

9 5. Global Communication Assessment Tool (CAT) Summary Summer 2010 Doctor-Patient Relationship around the world High CAT scores Citizens in Armenia, Australia, Bosnia, Canada, Chile, Columbia, France, Germany, Greece, Ireland, Lebanon, Macedonia, Saudi Arabia, Sweden, Switzerland, and the USA are very satisfied with their communication with their doctors with CAT scores above average. Key Finding: Middle East Americas Western Europe Eastern Europe Africa Asia Total Average CAT scores Respondents in Austria, Brazil, Bulgaria, Czech republic, Denmark, Finland, Iceland, Italy, Korea, Lithuania, Romania, Russia, South Africa and Tunisia have average CAT scores. Low CAT scores Citizens in China, Hong Kong, India Japan, Kenya, Pakistan, Palestine, Peru, Poland and are the least satisfies with their doctor with below average CAT scores. 9 *The data for this graph is based on questions presented on slides 12. For the definitions of CAT (communication Assessment Tool) please refer to slide 12.

10 6. Medication Usage Q. Do you currently have a medication that was prescribed by the doctor with whom you most recently met? Q. How often would you say you have taken this prescription medication exactly according to the doctor s direction? 9 of individuals currently have a medication that was prescribed by a doctor. Just over half (57) of respondents take the medication exactly according to the doctor s directions and another 1 take the medication according to the doctor s direction most of the time. While Bulgarians are most likely to take prescription medication exactly according to direction (91), citizens of Peru and Czech Republic are the least likely to do so with 29 who answered that they only some of the time or rarely take the medication according to direction. Key Finding: Just over half (57) of citizens on prescribed medication take it exactly according to the doctor s directions. 10 China Korea USA Australia Palestine Canada Austria South Africa Bosnia France Bulgaria Colombia Romania Denmark Germany Sweden Czech Rep. Japan Italy Poland Ireland Macedonia Lithuania Hong Kong Brazil Tunisia Switzerland Iceland Armenia Pakistan Lebanon Saudi Arabia Finland Greece Chile Russia Peru India Kenya Total Yes All the time Of those on prescribed medicaton, taken medication according to doctor's direction Most of the time Only some of the time/rarely