John Branston

There have been numerous reports in the pharmaceutical and international press concerning the high rate of adoption of mobile devices amongst physicians. A survey conducted earlier this year by Manhattan Research showed that physician use of tablets for professional purposes nearly doubled last year, with 62% of doctors now using the technology. A report by Jackson and Coker released late last year stated that four out of five practicing physicians in the US use smartphones, computer tablets, and other mobile devices during the course of their workday.

But despite advances in data collection techniques and technology over the years, pharmaceutical market researchers have not successfully developed techniques to capture immediate detailed, qualitative insights into prescription rationale at the patient level, particularly where these prescription decisions are made by hospital specialists. This is a problem that I believe mobile research is destined to overcome, because of the ‘go-anywhere’ functionality afforded by smartphone technology and because of the popularity of smartphones, specifically amongst physicians.

It is a theory that I recently tested by working with pharmaceutical company Merck Serono. The organisation was seeking approval of its existing oncology drug Erbitux (currently licensed in colorectal and head-and-neck cancers) to be prescribed to patients suffering from non-small cell lung cancer (NSCLC).  Mobile research offered a means of collecting rich, detailed information directly at the point of prescription, when the physician had just seen a patient and had made the decision about the best course of treatment for the patient. This level of insight had not really been possible before in the medical environment, so it offered exciting potential.

The findings of the study were presented at the 2012 EphMRA Conference in Paris and the presentation won the Jack Hayhurst award for best paper. We called this study the “Rx Rationale” approach and as well as an App for non-small-cell lung cancer we have also since created a similar study for Chronic Obstructive Pulmonary Disease (COPD).

The applications in each case were programmed as a means to collect prescription rationale for key products, using an on-screen questionnaire with tick-boxes to collect clinical patient descriptors, as well as requiring audio recording of the respondent’s spoken prescription rationale for a new treatment decision among a key set of modern (mainly targeted) therapies. The resulting data and the audio recordings were available immediately in real time via an admin panel on the database. In addition to allowing the ongoing monitoring of responses, this also supported the creation of full, traditional outputs, which were offered at the end of the fieldwork period.

As you might imagine, although the questionnaire was very short, this combination of patient descriptors and spoken word answers delivered rich insights in real-time. Not only were all the required aspects covered, but the audio often told another part of the story, with tone of voice communicating the respondent’s disappointment at not being able to provide significant overall survival benefits, or their hope for a good response in patients for whom a new treatment seemed tailored to offer good prospects. It is no exaggeration to say that this is the first time that market researchers have got this close to these crucial product selection decisions.

The App enabled us to collect rich qualitative insights at a quantitative level. Secondly, with our focus on the “treatment rationale at Point of Prescription”, we were able to identify considerations not collected in full via other methodologies such as more specific information on treatment goals and patient characteristics. These were of better quality because we captured them at the moment they were in the physician’s mind. As these key issues significantly affect decision-making, we can learn more about these decisions when analyzing the verbal in-depth feedback from physicians captured in this way.

Whilst undertaken this study, I have had the chance to consider the main advantages of mobile and App-based research techniques in pharmaceutical research, which I would like to outline here:

Mobile research is engaging
One of the key aspects of mobile phone Apps is that they are great media for engaging people. Everywhere you go these days it is impossible to ignore the fact that people want to engage with their phone or tablet device; that is because the interaction is engaging,  rewarding and often provides some form of instant gratification in the form of intercommunication. In our Rx Rationale study, respondents said they really enjoyed participating in the research and using the App. Given the adoption rate by physicians of smartphone technology, clearly mobile research is a way of leveraging this existing interest.

Mobile research is targeted
Another benefit of mobile research is the ability to have screener-based control of who the research targets – similar to most forms of qualitative research – but with a greater geographical reach. You might think, for example, about how mobile research can target prescribers of a specific product, or treaters of a specific disease – perhaps a rare disease. In the latter case, the research can be set up so that data is captured immediately on those rare occasions when a patient presents, rather than relying on periodical reporting, which may not support clear recollection of the patient interaction.

It lets you go anywhere
As its name suggests, mobile research can be conducted wherever mobile devices go. This is almost anywhere and certainly includes the clinical environment, where physicians are already making extensive use of Apps for reference purposes. So, for the first time, it is now possible to record physicians’ thoughts and actions in the moment in which these are formed and executed. The Rx Rationale study used this functionality to record the patient-specific rationale for individual prescription decisions among a narrowly-defined set of treatments. This is just one scenario, but helps illustrate the important insights we can derive using this technology.

It allows for rich forms of data collection
Mobile devices are inherently good at making the input of data easy, with touch-screen technology facilitating responses to closed and numeric questions. But the real advantages come when you begin to build on the devices’ capabilities to record audio and video material. When a physician explains a treatment decision verbally and in detail at the moment that decision has been made, it is arguably a level of quality of insight that we have not previously been able to achieve.

It’s immediate
To add to the benefits already mentioned, mobile devices are set up to send data and the sending of data can be programmed as an immediate subsequent step once data is collected. Depending on what you’re trying to do, it can be possible to use either the cellular data network or wi-fi to transmit data immediately or very soon after it is captured.

Databases and admin panels can then be set up to collate this data and make it available in real time, including the possibility to play back what the respondent has recorded in either audio or video form; this can then be translated, coded and analysed as necessary.

It can be carried out in emerging markets
You might think that mobile research is confined to the richer, western nations but in fact, penetration in emerging markets is even higher in Asia, with the Chinese market for smartphones now overtaking the US market (Canalys). It’s possible that mobile research will be adopted faster in emerging markets, where even the poorest populations own a mobile phone, than in the West where internet research via computer is the norm.

The more I think about the technical capabilities offered by mobile devices and their presence in situations of key interest to us as market researchers, the more possibilities can be seen for their potential use, either as stand-alone studies, or to augment traditional research and increase its insight or scope.

In the pharmaceutical industry, mobile research could be used for:

  • Continuous Medical Event (CME) Evaluation: Doctors are required to attend Continuous Medical Events (organised by pharma companies) to keep up-to-date with current medical best practice. If a CME event suggested a specific path of behaviour to a set of physicians, the ongoing use of App-based feedback could be used to monitor how well the CME was working in subsequent clinical practice
  • Testing devices: Mobile research could be used with good effect when testing the use of specific tools or hand-held devices used by doctors or patients, in order to monitor the frequency or correct usage procedure
  • Conference research: HCPs regularly attend medical conferences covering specific therapy areas. Delegates could be invited to participate in a mobile research study to give instant feedback on the quality of the papers, or the booths, or other aspects, with audio or even video material to enhance the insights
  • Post-launch campaign testing: Specific physicians could be targeted to monitor, record, photograph and feedback on all marketing or promotional activity to which they are exposed in a specific therapy area.
  • Evaluating health-based Apps: There are now thousands of healthcare Apps, some created by pharmaceutical companies, which have been devised to support patients with their healthcare and physicians to treat papers. Mobile research Apps could be used to evaluate how effective these Apps are at engaging with stakeholders and help give guidance for improvement.

I can see multiple benefits from using mobile research. The benefit of immediacy is key. It only takes a few moments of contemplation to realise how many different opportunities for new, and better research, can be opened up by this simple concept of immediate access to the physician or patient experience. Above all, there are significant opportunities for this engaging,  ‘go-anywhere’ technology to truly take us into situations and – as a result – to target very specific information we have not been able to access in quite the same way in the past.

John Branston is a Director at The Research Partnership

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