Doctor-Patient Global Communication Performance Insights from the Worldwide Independent Network (WIN ) of Market Research Fall, 2011 1
Contents 1. Background & Research 2. Context and Methodology 4. Key Findings 6 4. Communication Assessment Tool 7 5. Medication Usage 10 2
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.
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 2011. Sample: The total size of the sample is 1 577 cases representative of 1 98 990 516 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
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 100 79548 Quota Sampling National 56000 18+ Gender, Age Aug. 12-25.09 Australia Colmar Brunton Online 910 20000 000 Stratified National 18200 000 18+ Gender, Age, Region Aug. 4-10.25 Gender, Age, Austria Gallup Austria Face to Face 52 8400000 Random quota sampling National 700000 14+ Region,Employment, Jun. 20 -Aug. 4.25 Income Bosnia Mareco Index Bosnia CATI 750 850000 Multistage random sample National 2950000 15+ No Jul. 19 - Aug. 5.58 Brazil Ibope Inteligencia Face to Face 1410 190000 000 Probabilistic National 141248 576 16+ Gender Age, Employment Aug. 11-15 2.61 Bulgaria BBSS Face to Face 6 700000 Random National 6500000 Gender, Age, Region, Type 18+ Jul. 28-Aug,04 of settlement.90 Canada Leger Marketing Online 1004 79 900 Random National 24750 000 18+ Gender, Age, Region, language Aug. 8-15.09 Chile IBOPE Inteligencia Chile CATI 47 15116 45 Random Urban 5408150 18-60 Gender, Age, Location Aug. 19- Sep. 5 4.51 China WisdomAsia Online 400 100000 000 Random Sampling with online Panel (Shanghai, Beijing and Guangzhou) Urban 51520 000 15+ No Aug. 11-17 4.90 Colombia CNC (Centro Nacional de Consultoria) CATI 612 44 000 000 Two-stage design applied simple random sampling Urban 1 826 60 18-65 No Aug. 2-29.96 Czech Gender, Age, Region, Size of Mareco Ltd. Face to Face 1000 10224 626 Random route sampling National 89250 18+ Republic Community Aug. 4-15.10 Denmark DMA Research Online 510 5600000 Random National 4200000 18+ No Aug. 12-15 4.4 Finland Taloustutkimus Oy Online 522 5 85000 Random Nationl 4577250 15+ Gender, Age, Region Aug. 12-19 4.29 France BVA Online 999 65000 000 Quota Method National 50 700000 18+ Gender, Age, Region, Occupation Aug. 1-4.10 Germany Produkt+Markt Online 1006 81800 000 Random National 56500 000 18-70 Gender, Age, Region Jul. 25-Aug. 2.09 Greece Centrum S.A CATI 00 10,961,758 Statified Urban 6,51,506 18-74 Region Jul. 18-Aug. 5.66 Hong Kong Consumer Search CATI 800 7100000 Random quota sampling National 61000 15+ Gender, Age Jul. 0-Aug. 19.46 Iceland Capacent Online 717 20000 Random from our Web-panel National 24747 16+ Gender, Age, Region Aug. 10-18.66 India DataPrompt CATI 80 121019 422 Random Urban 96600 000 18+ No Jul. 2-Aug. 19.46 Ireland Red C Research CATI 89 4580000 Random digital dial including both Gender, Age, Social class National 20814 18+ landline and mobile numbers and Regio. Aug. 8-10.8 Italy Doxa CATI 882 6000 000 Random National 50000 000 Gender, Age, Region, Size of 18+ Community, Occupation Jul. 21-24.0 Japan NRC (Nippon Research Center ) Online 1000 126,475,664 Random National 99,604,610 18-79 No Aug. 11-15.10 Kenya Infinite Insight Face to Face 100 8610 097 Random National 26254 865 18+ No Jul. 0-Aug. 8.09 Lebanon Reach CATI 1000 75916 Random National 2781760 18+ No Aug. 1-0 4.8 Luthuania UAB RAIT Face to Face 70 200000 Random Probilty Routine National 2625400 15-74 Gender, Age, Education Aug. 1-18.10 Macedonia BRIMA Face to Face 820 2052722 Multi stage stratified random probability National 1689265 15+ Gender, Age, Region size, Nationality Sept. 1-7.42 Pakistan Gallup Pakistan Face to Face 1752 18742 721 Stratified Probability Sampling National 88000 000 Gender, Age, Region, Type 18+ of settlement Aug. 7-1.70 Palestine PCPO Face to Face 992 4170000 Random National 1876500 18+ No Jul. 20-Aug. 15 2.4 Peru Datum Face to Face 918 27 412 157 probabilistic, multistage stratified allocation Urban 16 085 85 18-69 Gender, Region Aug. 5-8.11 Poland Mareco Face to Face 05 8200 000 Stratified random Urban 5100000 15-65 No Jul. 28-Aug. 2.2 Romania TNS CSOP Face to Face 750 2141 298 Stratified Probability Sampling National 18190 00 18+ Gender, Age, Region Jul. 24-Aug. 1 5.61 Russia Romir Online 1180 14000 000 Random Urban 69000 000 18-44 Gender, Age, Region Aug. 5-9.58 Saudi Arabia PARC CATI 1155 27000 000 Random Urban 1000 000 15+ No Jul. 19 - Aug. 24 2.85 South Africa TRS (Topline Research Solutions) Face to Face 400 4920 000 Random (Johannesburg, Durban, Capetown ) Urban 819 800 18+ Gender, Age, Region Jul. 29-Aug. 10 2.88 Korea Gallup Korea Online 500 4977 145 Random Soft Quota National 4059 211 18+ Gender, Age Aug. 9-18 4.90 Sweden CMA Research Online 1049 9446812 Statified National 7250000 15-75 No Aug. 9-1.0 Swizterland Isopublic Face to Face 4 787014 Random-quota National 605014 15-74 Gender, Age, Region Sept. 21-Oct. 5.29 Tunisia EMRHOD CATI 600 9910872 Stratified (governorates are strata) National 7226 18+ No Aug. 22-27 4.00 USA TRiG Online 1002 122 044 Random National 24265 000 18+ Gender, Age, Region, Race Aug. 8-12.10 5
. 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
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) 2011 2010 25 2 24 0 24 2 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 22 29 22 0 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 22 29 22 0 21 27 19 25 Encouraged me to ask questions 18 2 Total 22 29 *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 2010. 7
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: http://www.stfm.org/fmhub/fm2010/september/ 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 2010. Communication AssessmentTool(CAT) Country 2011 2010 Ireland 66 NA Armenia 66 NA Chile 59 NA Macedonia 56 NA Bosnia 51 NA Australia 49 NA USA 48 52 Lebanon 48 40 Saudi Arabia 45 51 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 24-25 Brazil 2 0 Lithuania 2 NA Russia 2-22 Tunisia 22 NA Korea 22 15 Austria 21 40 Denmark 21 NA Italy 21 11 Czech Rep. 20 NA Romania 20 NA Finland 19 NA India 16-17 Kenya 15 NA Palestine 14 NA Hong Kong 1 NA Poland 11 NA China 11 4 Japan 10-11 Peru 6 NA Pakistan 5 7 Total 22 29
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 42 8 1 2 21 16 22 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.
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 80 68 6 62 58 57 57 55 5 5 52 52 50 50 50 49 48 48 48 47 47 47 46 44 4 41 40 9 9 8 8 7 7 5 5 2 1 26 24 9 4 6 70 67 4 72 68 58 84 7 91 70 75 79 64 75 44 55 76 77 78 85 72 41 78 50 68 61 4 41 74 58 7 68 65 50 5 44 60 57 Of those on prescribed medicaton, taken medication according to doctor's direction Most of the time 55 54 21 0 28 2 2 25 7 2 6 15 18 18 2 18 26 42 20 19 1 10 19 4 14 27 2 4 18 47 16 20 24 7 21 42 18 4 19 1 Only some of the time/rarely 10 8 8 5 1 17 9 14 7 6 29 2 9 4 8 14 8 2 8 6 8 11 10 20 25 1 7 29 22 20 12