Prilosec & Physical Therapy

One of Larry’s top two favorite reads in 2005 was “The One Thing You Need to Know” by Marcus Buckingham. I just finished reading it and found it to be one of mine as well. Whether you are interested in leadership, management, or merely sustaining individual success, you will find this book invaluable (as well as the “one thing” in each of these areas, plus much more). 

One example given is how Prilosec, a drug for treating acid reflux disease, became the highest selling drug in the world (4 billion a year) from a miserable start in the cellar (only ~200K per year). How did the bright young executive who was given the task of resuscitating the sale of this drug (that was otherwise about to be jettisoned) do it (and how does it relate to physical therapy)?

Well, she began by talking to her customers, the Docs who prescribe it, or in this case were opting not to. What she found was that they didn’t think they needed to prescribe it as a first-line intervention. Their practice pattern was to prescribe H2 antagonists (Pepcid, Zantac, Tagamet) and only when these patients didn’t respond (a minority) did they prescribe Prilosec. The second step was to do some homework about her product and she found the following: 1) While H2 antagonists relieved symptoms, unlike Prilosec they failed to cure the condition; 2) There was a particular type of patient who would never respond to H2 agonists and after a 6 – 18 month trial would be on Prilosec anyway.

The turn-around marketing strategy consisted of the following line: “What if I could define for you a certain kind of patient who will never benefit from the other drugs, who will only ever be rendered symptom-free by Prilosec. Would you be willing, to prescribe Prilosec immediately, rather than using it as a drug of last resort?” 

So how does the Prilosec example relate to physical therapy (PT)? 1) I often hear (and repeatedly say) that physicians in many cases should prescribe PT and patients would experience greater benefit, but instead they often take a wait-and-see approach (actually, that exact wording is in at least 1 practice guideline). Here are some things I have heard our “customers”….referring providers….say: “I haven’t found PT to be that effective”; “most patients get better with time anyway”; “I don’t want to burden you guys, so I give them some meds and then if they don’t get better I send them your way”; or “sure, I will starting sending folks your way (NOT…..many times they just want you (considered yet another sales rep) out the door as quick as possible). Of course, this situation is only made worse by some PTs who milk referrals for as many visits as possible using ineffective interventions with minimal evidence (or so I have heard…obviously not any readers of this blog). 

OK, so what is our item 2) here, the action item? Let’s start by providing our referring providers with high-quality evidence of the efficacy of physical therapy intervention for some of the most common conditions we treat, like mechanical low back and neck pain, hip and knee osteoarthritis, and shoulder impingement to name a few. Wouldn’t this be a welcomed approach instead of dropping off some brownies and who-knows what else and begging for referrals? The second thing we can really press home are validated as well as emerging clinical prediction rules or profiles of patients who have a high probability of doing well with physical therapy intervention (here are just a couple of examples: acute LBP; chronic LBP; P-F syndrome). In other words, tell them the “One Thing” about what the folks you can help look like (ie. their clinical presentation)…..and put it in writing for them!

As the saying goes, “the proof is in the pudding”. We at EIM have found this approach to be well received by not only referring providers, but other therapists, case managers, insurance companies, and many others as well. One of our goals for 2006 is to further develop and refine evidence-based education and marketing tools to help therapists experience the reality of item number 2 above….the action item…. 

Who knows, if we take this “one thing” approach to marketing  and educating our referral sources, maybe collectively the entire system will have a Prilosec experience: git rid of the gas, acid, and excess irritation so that at least one part of the health care system runs right and feels better.

 

Rob

Comments

[Dale Avers]

Rob, I heartily support this "marketing" concept to advocate for PT First. As PTs we don't do enough of this and yet we have so much to offer. In addition to marketing to referral sources, I advocate to consumer groups about the value of exercise, especially as one gets older. Invariably after the sessions, my husband (an excellent therapist in his own right) and I entertain a long line of individual questions and remarks about PT. It is amazing how many individuals have had ineffective experiences with PT. To convince them to try again, I recite the evidence and encourage them to give PT another try. The problem is there are so many PTs not practicing with evidence . My hope is that the TDPT will change this state of affairs.

On another note, I've been made aware of an advocacy group called Try PT First!
http://www.tryptfirst.com/about.html

I think this campaign slogan combined with your thoughts of using evidence and clinical prediction rules is a real winner. Let's advocate for quality PT FIRST!