Strategic quantitative patient chart studies are designed to rigorously explore the interaction between prescriber and patient. Specifically, these studies typically address two specific objectives:

• Quantify the treatment process—from presentation to prescription
  Commonly, market researchers are asked, "What drives patients getting a prescription?" or "What are the gaps we can fill in the prescription process?" Strategic patient chart studies can answer these questions by quantifying the typical path a patient flows through to get a prescription. The data can be sub-analyzed to identify the process for a patient to get a change to the prescription, such as a switch in medication or adjective therapy.
• Understanding this flow allows researchers to profile patients based on the critical steps in the process. For example, if determining severity is identified as an important step in the prescription process, then the research can be designed to profile patients based on their severity. This will identify how physicians distinguish between mild, moderate, and severe presentations.
• Once the steps in a patient flow are identified, researchers can quantify the gaps in the process. For example, if diagnosis is a critical node, then the researcher can determine what percent of patients receive a diagnosis. Furthermore, those patients who have not been diagnosed can be profiled. The results can be used to help a brand team determine which marketing and education efforts should be prioritized and what the content of those efforts should be.

• Identify the drivers of brand choice
  If physicians are instructed to pull charts based on their recent initiation of a specific brand, then researchers can examine significant differences between patients initiated on one brand versus another. This helps determine whether the brand selection process is driven primarily by test results, symptoms, demographics, or other consideration.

This approach is recommended for brand teams needing to determine why its market share is flat or the brand is not getting the volume of switch patients it expected when entering the market.

G & S Research commonly recommends this type of study in combination with a simple attribute battery or message recall exercise. This two-pronged approach allows researchers to identify discrepancies between physicians' perceptions and behavior. For example, in one therapeutic market, physician respondents rated a brand lower on safety than they did its competitors. The patient chart study, however, revealed that the patients' risk status for the safety issue was not a driver for prescription choice of the brand. In this situation, perceptions did not translate into behavior.

Common Methodology:
For strategic quantitative patient chart studies, the most critical step is to determine the criteria for charts that a physician will pull. If the objective is to quantify the treatment process, then criteria would typically center on patients who have recently complained of specific symptoms. If, however, the objective is to identify the drivers of brand choice, physicians should be instructed to pull charts for patients who were recently initiated on specific brands. The criteria need to be easy and clear to ensure that physicians pull the appropriate chart to address the research objectives.

Our recommended approach is to invite physicians to call a toll-free number if they are interested in participating in the strategic quantitative patient chart study. When they call the number, a live person walks the physician through screener questions to find out what charts (s)he has available. Qualified physicians are assigned to pull specific charts for the study.

Typically, the referenced visit will have happened within the past two weeks, and all patient charts will represent the most recent patient to visit the office who meets the pre-determined criteria. We feel that the conversation with a live person is critical to ensuring that physicians pull the correct chart(s) and understand that patient names or identifying information will not be collected.

A study "prep" sheet is then faxed or e-mailed to participating physicians to make sure that the right charts are being referenced. This sheet generally contains a website address, user name, and password to access an online survey. Physicians then take the actual survey on a password-protected website. Using their unique password, physicians can log in and out of a study as needed for interruptions or to access more patient information.

Deliverables:
Depending on the objectives of a particular study, the deliverables for a strategic quantitative patient chart study can address multiple issues. Commonly, research studies of this nature result in several reports that each address specific business decisions.

This slide is an example of a patient flow model that runs from patient presentation to prescription initiation. The colored bar across the top identifies the most important nodes in the process. The boxes under each node quantify the percent of patients that apply to each option. Reading this slide from left to right, the most common flow from presentation to prescription initiation is revealed.

This slide is an example of a driver of choice analysis. The yellow boxes represent a driver for using a specific brand, and the gray boxes represent a barrier to using a specific brand.

Application of Findings:
Findings from strategic quantitative patient chart studies are used to develop sound business strategy related to a brand. As a result, researchers are commonly asked to track their progress using patient charts.