Self-care is on the rise. More consumers are finding it difficult to obtain the type of health care services they used to receive from their "family doc" and are assuming more responsibility for their health care. Some are turning to alternative medicinal techniques. Others are self-treating with a wide variety of natural and herbal remedies. Many continue to self-medicate with OTCs before they seek medical care. And there are those who are intrigued with the information in DTC ads and seek medical advice.

Why do consumers have such a high interest in self-care? And why does patient compliance appear to be much higher in self-care than in prescribed care? Is it because the consumer is in control of the decision-making process in self-care?

One aspect of self-care clearly sets it apart from prescribed care. In self-care, the consumer decides which treatment, if any, to use. In contrast, the physician usually makes the decision to use a prescription medication. Patients are rarely involved in the decision-making process. They are simply "told" to follow the instructions. Questions such as "Why is this medicine the best for me?", "What are the risks?", and "What are the side effects?" typically go unasked and unanswered. Yet consumers need answers to these questions if physicians expect them to change their lives and take any prescription drug.

We know the decisions patients make are the reasons for the high rate of noncompliance with prescription drugs. Of the 10 percent of initial prescriptions that are never filled, the majority go unfilled because patients are unconvinced that they need the medication. The same is true of the 30 percent of prescriptions never refilled. Unless patients are convinced that they need the prescribed medication, they probably will not take it. But if patients are involved in the decision-making process, the likelihood that they will take the medication increases.

When Consumers Decide
With nonprescription medicines, consumers are actively involved in the selection process. We see the ads on TV and in magazines. We compare the cost of one product against another. We read the package labels. We might ask our doctor or pharmacist for more information. But in the final analysis, we weigh the risks against the benefits and make the final decision.

What effect does that have on patient compliance? Consumers seem more likely to follow the OTC product instructions than to follow directions for prescription medications. One of the few studies ever done in this area found that patient compliance approached 100 percent when consumers self-treated with the OTC of their choice! That is in sharp contrast to the widely published 50 percent noncompliance rate with prescription drugs.

If patient compliance is higher with OTC medications, is it because patients are in control of the decision process? If so, could DTC ads that were developed as the first component of a total patient education package improve patient compliance with prescription medications? I believe the answer is a resounding "Yes."

Imagine the impact on patient compliance–and a product's success–if DTC ads became the effective first link in a completely integrated patient-education program. As people make the transition between the role of consumers reading a DTC ad to patients prescribed a medication, there would be continuity in all the information materials patients received–whether through direct-mail programs and media ads or from health professionals.

Consumers would benefit from having the information reinforced through the content and design at each step of the patient-education process. The advantages to the pharmaceutical company would be severalfold: increased brand-name recognition, increased brand loyalty, increased comprehension of the information, and increased patient compliance.

The key is to integrate the consumer's decision-making power during the DTC program into the entire patient-education program for the medication. Marketers must coordinate each program to progressively provide consumers with the information needed at each stage of the decision-making process.

DTC Scorecard
So what do consumers think of today's DTC ads? In a recent national telephone survey of 1,200 adults, Prevention magazine found that nearly 74 percent of consumers believe DTC ads help them become more involved in their health care. Unfortunately, only 21 percent believes DTC advertising is "very clear." Many do not believe the ads provide all the information necessary to make appropriate decisions, and nearly three-quarters (72 percent) do not understand clearly the information presented in the DTC ads. This may be part of the reason that more than half (55 percent) of those responding had no change in confidence in prescription medications after seeing the ad, and 20 percent were less confident. Only 25 percent felt more confident after reading the ad.

Despite of the lack of clarity in the information, DTC ads seem to have some impact on increasing consumer awareness about the need to follow their prescriptions correctly. The survey did not measure patient compliance, but it did report that 27 percent of those surveyed said the DTC ad made them more likely to take their medicine, and 25 percent said the DTC ads reminded them to have their prescriptions filled. Imagine how much greater this impact could be if people could understand the information contained in the ads.

Prime Time
Patient compliance is at the heart of every product's success. DTC programs could become effective stepping stones to increasing patient compliance with prescription medications.

A DTC program is an ideal place to begin the patient education process because it targets people while they are still in the "self-care decision-making stage." During this stage, consumers are seeking information to help them make wise decisions. If the consumer decides to make an appointment with a physician, every person wants to ask: "Do I really need this medicine?" Presently, 10 to 20 percent of all patients decide in the doctor's office that they are not going to get the prescription filled because they are unconvinced they need the medication. That is a prime opportunity for pharmaceutical companies to help physicians encourage patients to take more responsibility for their self-care–including prescription drug treatments.

The message is becoming clearer:

Consumers must first be convinced that they need the treatment in question. Consumers must be able to understand the information in the DTC ad. The content and design of the DTC program must complement the patient-counseling efforts of health professionals.

After all is said and done, consumers will still decide whether to take a herbal remedy, use an alternative treatment, purchase an OTC product, or make an appointment with their physicians to discuss a medication in a DTC ad. The DTC ads that are professional and educational will be the winners in the end.

Dr. Dorothy L. Smith is a consumer education expert and president of Consumer Health Information Corporation. The full-service company specializes in patient labeling, program development, and strategic planning for DTC campaigns.

Do you have a DTC question? E-mail it to dlsmith@consumer-health.com or call (703)734-0650.

Published in Pharmaceutical Executive, September 1998. Copyrighted material; All rights reserved.