Marketing Community-Based Programs to Primary Care Practices: Results of a Pilot Test of the 1-2-3 Approach to Provider Outreach

Background:

The CDC estimates 50 million adults in the United States have some form of doctor-diagnosed arthritis—a figure expected to increase to one-quarter of adults in 20 years. Evidence indicates evidence-based chronic disease self-management education and physical activity classes can reduce disease symptoms, improve patients’ well-being and increase self-confidence.  Despite their effectiveness, participation in these classes remains low. One potential strategy to increase participation is to have healthcare providers recommend these classes to their patients with arthritis. Patients value advice from their doctors, and physicians are powerful influencers for behavior change.  Formative research conducted with primary care providers (PCPs) suggest they are open to recommending locally-available, evidence-based non-pharmacological interventions.

Program background: CDC developed an outreach strategy to increase participation in local evidence-based chronic disease self-management education and physical activity interventions using PCPs as the promotional channel. This 1-2-3 Approach to Provider Outreach strategy aims to raise provider awareness about locally available classes and encourage them to recommend these classes to patients. Central to this approach is a personal outreach visit with the provider during which the marketer makes a “pitch” for the interventions, highlighting the messages PCPs reported to be of highest concern (the “three Cs” of cost, credibility, and convenience).  Supporting materials to implement the strategy included a turnkey marketing toolkit that included a how-to guide, training tools (e.g., video, scripts), customizable fact sheets for providers and their patients, and tracking and evaluation tools. We conducted a pilot study to assess the strategy. 

Evaluation Methods and Results:

• Pilot study was conducted in six locations across the U.S. from June 2010 through April 2011. Five sites participated as supplements to the cooperative agreements for their state health departments’ CDC-funded Arthritis Programs.
• Sites received marketing toolkits, and accompanying materials 
• Sites had flexibility in implementation 
• Sites tracked outreach activities, provider contacts, and patient referrals

Conclusions: 

Findings provide preliminary support for the 1-2-3 Approach as an effective strategy. There was a total 54 reported recommendations from targeted practices across all sites. Though modest, these findings suggest the 1-2-3 Approachhas the potential to impact attendance at local classes over time. The flexibility and ease of the strategy make it well suited for state programs and partners to disseminate information about their programs more widely.  The approach is labor-intensive and requires building strong relationships with partner organizations and the local medical community. Laying the groundwork for conducting these visits and following up regularly to reinforce messages can occupy the majority of activities for the marketing team. Though this takes time, it has the added benefit of increasing the visibility of state and local health programs.

Implications for research and/or practice:

Findings also indicated that PCPs responded better to messages and materials emphasizing the broad applicability of self-management education and physical activity interventions for a range of chronic conditions rather than arthritis only. Therefore the initial pitch should focus on a general message, positioning arthritis as a comorbidity for which these interventions can have particular benefit.