Ontario Association of Naturopathic Doctors Phase 1: Research & Discovery Presented October 31, 2013...

1

Ontario Association of Naturopathic Doctors

Phase 1: Research & Discovery

Presented October 31, 2013

Version 10, Revised November 25th, 2013

2

Overview

• Introduction• Patient Profile• Awareness Interest• Consideration & Selection

– ND– MD– other CAM providers

• Keeping Patients• Losing Patients • Practice Building

3

Introduction

• This research is part of a multi-phase campaign development process

• Several different methodologies were used to uncover insights – This allows for the opportunity to evaluate issues through multiple

lenses

• The findings from each methodology have been integrated to create a single presentation

• This research will be used to develop a strategic recommendation for OAND campaign development

4

TDC Branding Process Overview

• Research and Discovery (this document) • Strategic Platform (next step)• 360 Vision Development

– Creative idea– Key messaging

• Consumer Testing • Execution of campaign• Soft launch

5

Research Objectives

• The objectives of the research are to identify: – Current attitudes and usage of NDs in Ontario

Typical patient profile

Reasons for using service

Strategies for building patient compliance/loyalty

– Barriers (real and imagined) to growing NDs usage in Ontario– Patient segments/demographics that are potentially underserved by

NDs

6

Research Methods

• Secondary Research– Published articles

Numerous articles reviewed from Canada, USA and Australia.

Articles are referenced on each slide and included in a bibliography in the appendix.

– Online listening Review of social media comments made by ND patients in Ontario on their experiences with naturopathic medicine.

• In-depth Interviews (NDs, Public) – OAND members

24 phone interviews with OAND members representing a range of years of experience and regions of practice. Discussion guide included in the appendix.

– Online Survey (NDs)OAND members invited to participate in an online survey similar to interview. Interview questions included in the appendix. (N=43)

– Ontario PublicRecruited from the TDC AHAA™ (Active, Healthy, Affluent, Aware) online panel. 24 phone interviews with ND users and nonusers representing a range of ages. Discussion guide included in the appendix.

7

Overview

• Patient Profile• Awareness Interest• Consideration/Selection



8

Higher Education

• Users of CAM have higher levels of education (supported by both US and Canadian published data)4-8

• Those with a higher level of education may be more likely to: – Be exposed to nontraditional/CAM practices – Educate themselves about their illnesses and the treatment options

available– Question the authority of conventional practitioners

4. Nguyen, L. et al. (2010). Use of complementary and alternative medicine and self-rated health status: results from a national Survey. J Gen Intern Med. 26(4): 399–4045. Innovative Research Group. (2011). Attitudes toward naturopathic medicine6. Millar, W. (1997) Use of alternative health care practioners by Canadians. Canadian Journal of Public Health. 88(3): 154-1587. Blais, R et al. (1997) How different are users and nonusers of alternative medicine? Canadian Journal of Public Health. 88(3): 159-162 8. Wolsko, P. et al. Insurance coverage, medical conditions, and visits to alternative medicine providers. Arch Intern Med. 162(3): 281-287.

9

More Engaged in Their Health

• US data suggests CAM users are4: – 62% more likely to report their health as ‘Better’ than in the prior year– 9% more likely to rate their health as ‘Excellent’ – More likely to visit a healthcare provider in the last 12 months– More likely to say they are healthier versus previous year

4. Nguyen, L. et al. (2010). Use of complementary and alternative medicine and self-rated health status: results from a national Survey. J Gen Intern Med. 26(4): 399–404

10

Not Necessarily Healthier

• US data suggests CAM users are more likely to4: – Be a drinker of alcohol

25% more likely to self-identify as a heavy drinker

– Be a smoker or ex-smoker– Have visited an emergency room in the last 12 months – Have ‘spent the day in bed’ in the last 12 months – Higher level of anxiety (self-reported)


11

Not Necessarily Using Less Traditional Healthcare Resources• Minority of Ontarians with an ND feel naturopathy has (significantly

or noticeably) reduced:5

– Use of Rx (28%)– Visits to family doctor or GP (25%)– Emergency room visits (19%) – Visits to specialists (18%)

5. Innovative Research Group. (2011). Attitudes toward naturopathic medicine

12

Predominantly Female

• US data and Ontario research suggest men are less likely to go to seek medical care, especially for preventive services11

Leading theory: cultural myths that men are the stronger sex and do not need to be concerned about their health keep men from seeking medical care

“Before the age of 16, the utilization of health care is equal by gender. After age 16, there is a dramatic reduction in health-services utilization by males. Why is there no gender discrepancy before age 18? Mom. Mom takes both boys and girls equally to the doctor. After age 18, boys disappear. The same phenomenon even holds truth for oral care. I don’t think men have healthier teeth than women. It’s something about gender.” Ridwan Shabsigh, President International Society of Men’s Health

11. Astin, J. (1998). Why patients use alternative medicine. JAMA. 279(19): 1548-1553

13

Why So Few Men?

• According to OAND members: – Women tend to be more patient– Men appear to be:

Less in tune with their bodies

Seeking a magic pill

“Men are very problem-solution focused. They’d rather

see a specialist in their problem than a generalist.”

ND, 8 years in practice*

“I find in general men have a less preventative mindset.”


* TDC phone interviews with OAND members. September 2013.

“Men come in with specific issues, they want quicker

resolutions.” ND, 11 years in practice*

14

Patient Profile4,5:

CAM user vs. non-CAM user*

*The CAM group consists of respondents who used any type of CAM in the past 12 months. 4. Nguyen, L. et al. (2010). Use of complementary and alternative medicine and self-rated health status: results from a national Survey. J Gen Intern Med. 26(4): 399–4045. Innovative Research Group. (2011). Attitudes toward naturopathic medicine

Skews (more likely in ND user) Ontario Research

US/ Australian Data

Female ✔ ✔

White/Caucasian ✔ ✔

Income ✔

No Skews (equally likely in ND user) Ontario Research

US/ Australian Data

Health insurance coverage n/a ✔

Hypertension/high blood pressure n/a ✔

BMI/obesity n/a ✔

15

Psychographic Insights**

• Naturopathic medicine users are:– More likely to prioritize mental well-being– More likely to take part in adventure sports/tourism (e.g.: mountain

climbing, backpacking)– Less likely to sacrifice features in order to save money when it comes to

buying products/services– More likely to eat healthy, use alternative medicine, choose natural

products (foods, household cleaners, etc.) – More likely to prefer socially responsible companies/be willing to pay

more for products from socially responsible companies– More likely to volunteer for a non-profit organization

**From AHAA™ user group database, Ontario residents.

16

Patient Profile Summary

• Ontario patient, based on review of all research sources: – Female skew– Higher education– Higher income – More engaged in health, but not necessarily healthier

Willing to spend money on ‘the healthier option’

– Higher levels of anxietySpends more time thinking/worrying about health

– Mindset: ranges from passionate supporters of natural health to those who seek naturopathic medicine as a last resort

17

Overview




18

CAM User Segmentation

• Primary Positioning: Complementary to Traditional Medicine– Those who use alternative care in conjunction with conventional

medicine tend to: Have a holistic philosophy of health

Not have negative attitudes or experiences with conventional care

• Secondary Positioning: Alternative to Traditional Medicine– Individuals who rely primarily on alternative therapies to treat health

problems tend to have a: Distrust of and dissatisfaction with conventional physicians

Desire for control over health

19

CAM User Segmentation

• Primary reason for visiting: Chronic Health Issue(s) – Individuals may seek out alternatives to treat their problems as they

have:Less success in treating their health problems

Symptoms unaccounted for by pathological findings

• Secondary reason for visiting: Prevention – Those who see an ND or use CAM for health maintenance tend to have:

Higher levels of anxiety

20

Public Perception of Naturopathy Largely Accurate• Holistic approach• Natural alternative• Healing people in a natural way• Naturally adding what your body is lacking

“It’s not just writing a prescription.”**

F18-24“They help identify problems, not necessarily solve problems.”**

F18-24

“They are good for ongoing problems.”**

F45-64

**From AHAA™ user group database interviews, Ontario residents.

21

NDs Are Part of a Very Personal Health Journey• Reasons for going to an ND/considering an ND are highly varied

“If I was diagnosed with cancer I’d definitely see an ND first, before chemo

or whatever.” F18-24**

“It’s for not too severe stuff – muscle pains – definitely not cancer.”

F25-34**

“I just like to try the natural route if I can.” F35-44**

“If my doctor told me to take a bunch of drugs, that’s when I might look at exploring

options with an ND.” M35-44**


22

Patients Are Looking for Integrated Care

• Ontario research suggests: – Majority of patients actually prefer their primary care physician to

routinely ask about their personal CAM use1

– The relationship that’s hard to replace is the traditional doctor1

“We’re taking care of them, but they don’t want to sort of ruin that relationship with their family doctor, right? Because it's so hard to get one.” 1

1. Hollenberg, D., Lytle, M. Walji, R. Cooley, K. (2013). Addressing provider shortage in underserviced areas: The role of traditional, complementary and alternative medicine (TCAM) providers in Canadian rural healthcare. European Journal of Integrative Medicine. 5(1): 15-26.

23

High Satisfaction with MD Makes Patients Less Likely to Try ND• MDs with highly satisfied patients seem to be actively engaged in

pursuing natural options and alternatives to drugs • Patients who are satisfied with MDs tend to be less likely to consider

an ND • Dissatisfaction with MD does not necessarily lead to ND trial

“My doctor is just like take this antibiotic and call me in two weeks if

you’re not better.” F18-24**

“My doctor [MD] understands and appreciates that I’d rather go the natural route if I can.” F35-44**

“My doctor [MD] is amazing. I think naturopathy is good, I just don’t

see the need for me to go.” F45-64**


24

Why Patients Visit

• Specific health concern that traditional medicine can’t help– Often coming in as a last resort for concern not resolved by traditional

Med/Rx– Different from 2011 phone survey which identifies “seeking a more

natural approach to health/wellness” as primary reason to visit ND

• Patients who consider NDs as cheaper, less invasive, first option • Patients looking for a more natural, gentle modality• Prevention

“Chronic conditions usually no doctor can fix.” ND=

“…referral from friend, other practitioner or media….start with

issue management and work towards preventative care.” ND=

“If the patient identifies stress, mental/emotional factors as a

contributor to their disease state, they will seek naturopathic care.” ND=

= Responses from OAND online survey. October 2013.

25

Prevention is an Underdeveloped Mindset

• Few patients’ initial visits are prevention focused• Prevention is an effective way to convert them into loyal patients• An adjunctive perspective

“Some are coming for prevention, like their mom got breast cancer and they

want to take steps to reduce their risk.” ND, 1 year in practice.*

“Nobody comes in with ‘prevention’ written on their intake form. Once I deal with what’s bothering them, I

can usually start a conversation about family history and prevention. ”

ND, 11 years in practice.*


“When I see people for the first time in my clinic, they never feel they are in good health. They’re never here to preserve

their good health” ND, 11 years in practice.*

“Once they’re coming in regularly, and seen some results, I can get

them to start thinking about prevention. ”


26

People Need a Reason to Go

• Few go for prevention• The very healthy don’t have a reason to visit

“It’s expensive to go, so I need a reason.” F18-24**

“I have no reason to go. I’m happy with what my doctor

and dermatologist have done for me.” F35-44**

“I’ve never considered it. I was brought up to see a MD and I think I’ll just

continue to see doctors of that profession.” F35-44**


27

Overview




28

Marketing/Outreach

• Few NDs do formal marketing/promotion– NDs with 10+ years experience do almost none

• Tactics that lead to a personal connection are most effective – Tradeshows/fairs– Free consultations– Radio shows/talks, local media exposure

• Google ad words common tactic with younger NDs

29

Finding a Naturopathic Doctor• Word of mouth (WOM) is the strongest practice builder

– Girlfriend to girlfriend– Co-worker to co-worker– Female to male – Like begets like (i.e. fertility patients bring in more fertility patients)

• Referrals from adjacent practices (i.e. chiropractor, acupuncture, etc.) • Men seem more likely to find ND through web search

“I get a few referrals from MDs, not many, but I like to get them—they are

usually good patients.” ND, 15 years in practice.*

“Midwives love us, we get a lot of referrals through that

channel.” ND, 15 years in practice.*

“I ask all of my patients how they found me and there are only 2 answers: online

or word of mouth.” ND=

“I have a successful blog that attracts new patients…most of my patient base has come

from me giving talks.” ND=

= Responses from OAND online survey. October 2013. * TDC phone interviews with OAND members. September 2013.

30

Choosing/Finding

• Methods most often mentioned when finding/choosing an ND – WOM

Friends

Family

MD

– Online reviews/comments– Geography very subjective

Some people are willing to travel long distances, others are not

Online Listening

Worldwide

Canada

Dec Dec Dec Dec Dec

31

DecDec Dec Dec

Source: Google analytics. Accessed October, 2013.

Charts show that ‘naturopath’ search is essentially flat worldwide, but is

slowly trending up in Canada.

32

Online Listening

Worldwide

Canada

Search: Naturopath

Regionally, ‘naturopath’ searches are clustered in Australia and Canada. Within Canada, searches are most intense in BC,

followed by Ontario and Alberta.


33

Online Listening

Naturopathic doctor

NaturopathyNaturopathic medicine

Naturopath


In Canada, ‘naturopath’ is searched for more often than ‘Naturopathic doctor’, or ‘Naturopathic medicine’, and is growing as

a search term.

34

Online Listening

Naturopath

Naturopathic Doctor

‘Naturopath’ is most widely used in B.C. ‘Naturopathic doctor’ is most widely used

in Ontario.


35

Online Listening

Positive comments (technical)- Knowledgeable/intelligent- Effective- Fair prices

“He is knowledgeable, patient, and has always been there for me. He has corrected problems that have been

longstanding for years. ”

“He makes a difference when other doctors give up. Thanks for not turning your head the other way.”

“This man is incredibly smart and intuitive. He is generous and giving and humble.”

“Along with being very knowledgeable in his field, he is kind and extremely easy to talk

to.”

“Seemed very knowledgeable and listened to my concerns. Did not feel

rushed during my appointment – very rare nowadays!”

“I feel very comfortable with [Dr], in part because of her extensive research background with leading institutions like

Sick Kids Hospital.”

“My naturopath is incredibly helpful, finding solutions to problems that doctors ignored…”

Source: Ratemds.com, Yelp.ca comments on Toronto naturopaths. Accessed September 2013.

36

Online Listening

Positive comments (emotional)- Great relationships- Trusting

“He is the first doctor to really listen to my bizarre symptoms and believe in me…we are

figuring this out together. Extremely professional, knowledgeable and kind.”

“As a long time skeptic, [Dr] has done so much good for me. He is a personable guy and actively listens to your concerns.”

“A great physician who actually really cares about his patients

ad provides them with treatment that actually works!”

“I find her to go above and beyond in terms of time and effort and am

most impressed with her vast amount of health knowledge.”

“…excellent naturopathic doctor who has helped me tremendously. Going to this clinic makes you feel like

family rather than a patient.”

“She is just a superb human being…She just genuinely cares about her patients…incredibly compassionate

and extremely professional.”

“I call him whenever I need something, and I trust him with my life. He has helped me with so many health issues

that no doctor could assist me with.”


37

Online Listening

Minimal negative comments• Expensive/driven by money• Not effective/knowledgeable

“3 visits of about 45-60min per visit at $80 for every 15 min. no relief! But assured I would be cured after 10-12

visits. I feel really ripped off!”

“I made a huge mistake when I bought service package ($1450) that included

expensive tests that he doesn’t know how to read. You are better off with Dr. Google.”

“Seems more interested in selling her snake oil treatments that a quacky machine tells her to make. GIANT money making scam”

“…a great sales woman. She does NOT tolerate you seeing related practitioners…SHE

ONLY CARES ABOUT THE MONEY; not you”

“Attempted to treat me with iron supplements on a whim. If I hadn’t stopped

taking them, I would have gotten iron poisoning. Don’t waste your time or money. ”

“This doctor is only concerned with making money. His treatments are band-aid solutions

and he always recommends expensive remedies that never work for me.”


38

Overview




39

Position in the Spectrum of Care

• Most see NDs as complementary/adjunctive to traditional medicine • People appreciate the contradictions/conflicts between MDs and

NDs– Feel that both disciplines have skills and limitations

“I use my MD to get referrals so that they are covered .” F25-34**“I would like to see the ND and the

MD together so that they balance each other out.” F35-44**

“I think they’re [NDs] good at things that aren’t true medical

problems.” F45-64**


40

Differences from Traditional Medicine

• Spend more time with each patient • Focus on holistic health• More gentle modalities • Extra caution around meds • House calls

“A lot of patients are frustrated by the lack of caring from their

MDs.” ND, 8 years in practice*

“People no longer see their doctor as a god, they are more

realistic about their limitations.”



41

Competitive Advantages

• A patient-centered approach“You know, [some patients have] never really had any great explanations” 1

“I spend time with my patients. I think that's maybe something that some of the other healthcare groups don’t do.” 1

• Time spent with the patient also facilitated the other roles of education and focusing on prevention1


42

Negatives about NDs

• Lack of coverage – especially for diagnostics • Overuse of supplements

“It’s $500 for a consultation, way too much.” F18-24**

“It drives me crazy that they instantly go to supplementation

versus trying changes to diet and exercise.” F25-34**

“People say they are good listeners, but I say they are worse because

they need a lot more time to get to the point.” M18-24**

“They gave the same stuff [supplements] to me and my kid,

even though we came for different reasons. It didn’t make sense and didn’t seem like it was needed.”

M18-24**


43

Accurate Idea of ND Approach

• Very positive overall perception to naturopathy – Nearly 100% with AHAATM group, 57% from 2011 phone survey – Public can accurately describe what a naturopathic doctor is and how they

treat/heal– Naturopathic doctors described as:

Using natural sources – not prescribing Rx

Using a natural approach that includes looking at diet and exercise

Having holistic mindset

Looking at the body’s deficiencies

44

Lack of Awareness Regarding ND Training

• Very little awareness of the amount of education NDs possess • Naturopathic medicine seen as a hobby

– Very different from traditional medical practice

“My mom is studying it.” F35-44**

“Oh, my aunt’s a naturopath, she’s read all the books.”

F35-44**


“I take my dog to a naturopath at the Vet.” F35-44**

45

Relationship with MDs

• MDs not a strong barrier to use – Cultural shift to recognizing MDs as no longer having all the answers – Offer little/no guidance on NDs

• Negative MDs can slow down (but not prevent) process (i.e. refuse to share medical records) but few actively prevent patients from going – Most common objection: it’s a waste of time and money

“MDs are usually passive resisters, but it’s not a relationship you want to upset for

the patient.” ND, 11 years in practice.*


46

Relationship with Other CAM Professionals

• Lots of office sharing (one stop shop concept)• Many referrals within CAM • Keeping people within CAM is a strategy to develop patient loyalty • Differentiator from traditional medical practice

47

Rural Ontario CAM Usage

• A lot of rural usage driven by medical doctor shortage, financial resources, transportation and distance to traditional healthcare services1

• Physician shortages are exacerbated by geography1 – 14% of Ontario family physicians and 2.5% of Ontario specialists are

caring for Ontario's rural patient population, which represents approximately 20% of the province


48

Complementary Care From NDs Not On Equal Footing with MDs • CAM providers may become important as “other” types of

healthcare providers who may assist with Canadian rural models of care1

• There is little physician-initiated communication regarding patients’ use of CAM1

“… I certainly am many people's [patients’] only doctor because they [patients] don’t have a medical doctor, so they do all their Paps with me and all their blood tests, regular check-ups and everything else.” 1

“There are some patients of mine that have a hard time getting in to see their doctor, their medical doctor. There are patients that don’t have MDs, so there are times where I may be the only health provider that's doing a physical exam or running blood work.” 1


49

Government Regulatory Changes Have Impact on Attitude for Some • Little change to the positives/users • Positive effect on the neutrals/nonusers

“I’d be scared giving them too much power without regulation.”

F18-24**

“Regulations aren’t as important as hearing from people .”

M45-54**


50

Overview




51

Barriers

• Knowledge • Mindset • Cost of tests/diagnostics• Cost/coverage a limiting factor

“Many patients won’t come back that year once their coverage runs out. But once the new coverage cycle begins they usually come

back.” ND=

“Canadians are reluctant to spend any money on their health so I try to

advertise the value of my services.” ND=

“No insurance coverage so we might only have 1-2 visits.” ND=“There are still a lot of misconceptions

too…I have people telling me that they want to continue to see their MDs as if they fear I would advise them not to!”

ND=

“Cost and fear of repercussion from their family doctor.” ND=

= Responses from OAND online survey. October 2013. * TDC phone interviews with OAND members. September 2013.

52

Keeping Patients • Clinical AND emotional connection needed in first visit

– Make some kind of difference on the very first visit

• Develop a real connection– Outreach should always be conversation starters – ‘A quick win’, an emotional connection or a health insight is key

“If I can get a patient in the door, I have a very good chance of keeping them.” ND=

“About 90% of people I see for a free 15 minute consultation will

book a full appointment.” ND, 11 years in practice.*

“If you can shed some light on the issue they are having, just one or two

sentences, they are sold.” ND, 15 years in practice.*

“Obviously if you make people feel better, they will come back. I also feel that personality goes a long way.” ND=

“Trust and the establishment of a relationship with my patients.” ND=

* TDC phone interviews with OAND members. September 2013. = Responses from OAND online survey. October 2013.

53

Keeping Patients

• Setting expectations• Follow-up• Don’t overprescribe/oversell

natural health products (NHPs)

“If you send them out the door with $400 worth of supplements, you’ll never

see them again.” ND, 11 years in practice.*

“Cost would be the number one challenge…ensuring new patients

know not every visit will be as long and expensive as the first 2 is

important. I also try not to recommend any supplements until the 3rd visit in so their bill isn’t too

high right from the start.” ND=

“When finances are tight, I use primarily body-work and

diet/lifestyle to eliminate/reduce cost of supplements.” ND=

“Follow up is key, as is getting results.” ND=

“Great results, excellent customer service….” ND=

“Making sure to book them in for their next visit when they get to reception is really

important.” ND=


54

Losing Patients

• They feel better– Not converted to a prevention mindset

• Life overwhelms them– Particularly true of new mothers

• They’re deeply entrenched in the traditional medical world (i.e. the very sick)

“Patients disappear because they feel better. They don’t

often call back to say hey I feel great now.”


“…it’s convincing regular patients to move into health maintenance once

they’re out of physical discomfort that I struggle with.” ND=

“Their busy schedule. Lack of commitment to the process.” ND=

“The treatment plan is hard, the therapies are hard, changing lifestyle.” ND=


55

Losing Patients

• They were skeptical in the first place – Do-it-yourselfers, self-prescribers, dabblers/specialist day-trippers– Self-described experts

• Personality clash– ND/patient relationship relies heavily on fit, like a friendship

• Extremely ill – fear of the unknown

“When [older patients] health really starts to fail they tend to go with the familiar

which is most likely orthodox medicine.” ND, 10 years in practice*

“Some people are put off by the tough questions we ask.” ND, 6 years in practice*

“If a patient hasn’t completed everything in their plan they cancel or push back their next

visit…self sabotage?” ND=

“If I lose a patient it’s usually a screening and intake problem.”



56

NHP Detractors

• Focus on exclusive alternative use• “Killed Steve Jobs”

“It is one thing to note the obvious, the added benefits of healthy choices for a body; it is quite another to assert that they can replace scientifically-proven medical treatments to treat diseases already present.” 2

2. Flanagan, T. (2013). The scientific method and why it matters. C2C Journal. 7(1)

57

Overview


– ND– MD– other CAM

• Keeping patients• Losing patients • Practice Building

58

Knowledge Gaps

• Level of education – Trained to treat the same conditions as MDs– Primary care physicians

“Many need to know we are educated and have the

education to treat & diagnose just as MDs.” ND=

“We have a minimum of 8 years of education comparable to MDs.” ND=

“We can help with PRIMARY CARE and do the job of a GP for those who may not

have one… ” ND=


59

Knowledge Gaps

• Substitute for MDs vs. offers something unique from MDs• Most people have coverage for NDs

“It is a superior substitute for the lackluster care given by most

family doctors.” ND=

“We are not an alternative or equivalent to medical doctors. What

we offer is unique…” ND=

“…we are covered by many private insurance plans.” ND=

“We need to be much more confident in our medicine and our value. Too many NDs only

seem to want to do “evidence based medicine”…the current MD model of

evidence based medicine is failing too many people.” ND=

“Evidence based, effective.” ND=


60

Patient Types Where Naturopathy Makes a Real Difference• Complex cases, e.g. “Nobody knows what’s wrong with me.”

– Not helped with traditional medicine

• Ideological opposition to Rx/traditional medicine a minority segment – Most patients also have a primary care MD

• Prevention– Higher level of anxiety in this patient class– Typically a female between 30-50

• General/primary care– Especially in rural communities where access to MDs may be limited

“I see a lot of GI concerns, mental-emotional distress.” ND=

“Most common are digestive issues…mental health (anxiety/depression).” ND=


61

Underserved Categories

• Varies widely, common themes: – Men

Back/MSK, GI

– ChildrenAllergies, Diet, ADD

– Teens Allergies, Derm (acne), Weight, Stress/Anxiety

– ElderlyReduced dependence in Rx, Vitality

Consensus that this group is treated poorly by MDs: they just medicate and send them home

– Diabetes“I’ve got elderly with 12 different medications and you can tell their MD doesn’t really care about their case.”

ND, 1 year in practice.*


“The elderly in Ontario are over medicated. We can help a lot of them cut down on their meds.”


“There’s amazing things we can do for male diseases like cardiovascular

disease, hypertension, back...” ND, 12 years in practice.*

62

Insights

• Very positive associations with naturopathy – Near 100% among subjects (AHAATM group) – 72% of Ontarians have a positive impression of naturopathic medicine5

• Coexistence within greater spectrum of care desired– Problematic second best position for NDs

• From a patient perspective, good MDs are ‘very similar’ to NDs in their approach to care and present a strong barrier to ND use

• Problematic relationship/classification with some other CAM practitioners

• Strong sense of public service among NDs– Saving healthcare system money– Taking on the cases that traditional medicine has abandoned

• ND professionalism is not well understood


63

Next Steps

• R&D:– OAND Internal Review (Oct 21-24)– OAND to TDC Approval to Proceed (Oct 25)

• Strategic Platform:– TDC Working Period (Oct 28-Nov 8)– TDC Presentation (w/o Nov 18)– OAND Internal Review (Nov 25-28)– OAND to TDC Approval to Proceed (Nov 29)

64

APPENDIX

65

References/Bibliography


2. Flanagan, T. (2013). The scientific method and why it matters. C2C Journal. 7(1)

3. Wardle, J. et al. (2013). Current challenges and future directions for naturopathic medicine in Australia: a qualitative examination of perceptions and experiences from grassroots practice. BMC Complementary and Alternative Medicine. 13(15)



6. Millar, W. (1997) Use of alternative health care practioners by Canadians. Canadian Journal of Public Health. 88(3): 154-158

7. Blais, R et al. (1997) How different are users and nonusers of alternative medicine? Canadian Journal of Public Health. 88(3): 159-162

8. Wolsko, P. et al. Insurance coverage, medical conditions, and visits to alternative medicine providers. Arch Intern Med. 162(3): 281-287

9. Richardson, J. (2004). What patients expect from complementary therapy: a qualitative study. American Journal of Public Health. 94(6): 1049-1053

10. Harmon, S., Ward, C. (2007) Complementary and alternative medicine: awareness and attitudes. Academy of Health Care Management.

11. Astin, J. (1998). Why patients use alternative medicine. JAMA. 279(19): 1548-1553

12. Canada. Statistics Canada. Access to a regular medical doctor, 2010

13. Briggs, B. (2012, November 14). Too tough to get sick: why men won‘t go to the doctor. MSNBC News. Retrieved from: http://www.nbcnews.com/

http://www.nbcnews.com/

66

OAND Member Interviews Discussion Guide

Discussion Guide

August 26th, 2013

Draft V01

Objectives

Identify common business challenges Naturopathic Doctors (NDs) face in running a successful practice

Identify ways in with the OAND can help/guide their members

Questions

Who we are, disclosures, etc.

Purpose – how information will be used

Confidentiality

20 minutes in length

Briefly describe your practice

Generalist vs. specialist

Solo/group practice

Years in operation

Typical patient experience in your practice (# of visits, time in office, treatment programs, results)

New patients:

How do new patients learn about naturopathic medicine?

How do new patients select a ND (i.e. you) to visit?

What issues/ailments typically bring in the most new patients?

What else drives new patients? Probe:

Dissatisfaction with traditional medicine

Control over your healthcare/health choices

Relationship with healthcare provider

Cost

Convenience

How likely is a new patient to return for a second visit? Probe:

In-office experience

Solution(s) offered

Compliance issues

Cost/convenience

Returning/regular patients:

What percentage of your patient consults are with returning/regular visits?

What is the gender split (in %)? Probe:

If not 50/50 why?

Do your patients also have a traditional doctor?

Potential patients:

What patient types are you not seeing that ND could be helping?

Why do you think they are not coming in?

Cost – insurance coverage, income ranges

Effort – finding, visiting, program compliance

Trust – proof, detractors, alternatives

OAND Support:

Should OAND be promoting naturopathic medicine awareness?

Promote industry

Partnerships/lobbying

Should OAND be helping clinics find patients?

Key word searches

Find a ND capabilities

Should OAND be helping members build a successful practice?

Help members effectively manage clinic

Lunch n learn

Workshops, etc.

67

OAND Member Online Survey 1 of 2

• Thank you for taking the time to answer a few questions about your patient population and for providing your perspective on the drivers and barriers to seeking naturopathic care. Your responses will be invaluable in developing OAND's marketing strategy with the general public in Ontario. Please press the Start Survey button below to begin.

• *1. Are you currently practicing as a Naturopathic Doctor?(*Required)• Select one.

– Yes– No

• *2. How long have you been/ were you practicing as a Naturopathic Doctor?(*Required) Select one.– Less than 5 years– 5 to 10 years– 11 to 20 years– More than 20 years

• *3. Is/ was your practice located in a small town/rural, suburban or urban area?(*Required) Select all that apply.– Small town/ Rural– Suburban– Urban

• *4. Please enter the first 3 digits of the postal code for your practice in the box below.(*Required)• 5. How would you describe your patient population? Are all your patients very similar, do they fall into distinct subgroups, or are they

all very different? Please describe any defining characteristics of your patient population (i.e.: age, gender, education, attitude, life experiences, health status)

• 6. What situations typically drive new patients to seek naturopathic care with you? Please describe any health issues, health goals, experiences, etc. that commonly bring new patients to your practice.

68

OAND Member Online Survey 2 of 2

• 7. In your experience, how do your new patients first learn about naturopathic medicine? • 8. How do new patients go about selecting you as their naturopathic doctor? e.g.: ND referrals, yellow pages, walk-ins, friend

referrals • 9. What are some of the barriers to seeking naturopathic care for some of your potential patients? Please describe any successful

strategies that you have implemented to overcome these barriers. • 10. What are some of the drivers of return/ regular visits? • 11. What are some of the challenges in getting new patients to return or to become regular patients? Please describe any

successful strategies that you have implemented to overcome these barriers. • 12. In your opinion, what does the general public need to know about naturopathic medicine that they do not currently know in order

to be motivated to take action and seek an ND? • 13. Do you have any other comments/information to share?

69

AHAATM (Ontario Public) Discussion Guide 1of 2 Draft for OAND/AHAATM Discussion Guide

Sept 12, 2013

INTRO

How and why data being used

20 min length

Recorded

Confidentiality

$25 honorarium

HEALTH STATUS

Describe your current health

Anything you would describe as a chronic pain/discomfort/illness?

In a typical 12 months how many trips do you make to a healthcare provider?

What are general the reasons for each?

Include NDs, ERs

***based on AHAATM profile, verify on phone which section from the below three to use with subject***

CARE PROVIDERS (MD ONLY)

What reasons prompt you to visit your MD?

Who do you actually see in the office?

Are they helpful?

Do they listen to you?

Do you feel they devote enough time to you?

How do you feel after a typical visit?

Probe for feelings of satisfaction, anxiety, etc.

If you had an extremely unsatisfactory experience with you MD, what would you do?

CARE PROVIDERS (ND ONLY)

What reasons prompt you to visit your ND?

Who do you actually see in the office?

Are they helpful?

Do they listen to you?

Do you feel they devote enough time to you?

How do you feel after a typical visit?


If you had an extremely unsatisfactory experience with you ND, what would you do?

CARE PROVIDERS (MD & ND)

Who do you consider your primary care provider?

How do you decide when to go to each one?

Do they interact well i.e. share information?

Do they both listen well?

Do they both spend enough time with you each visit?

How do you feel after a typical visit with each?


If you had an extremely unsatisfactory experience with your ND or MD, what would you do?

70

AHAATM (Ontario Public) Discussion Guide2 of 2 ND KNOWLEDGE (FOR EVERYONE)

How would you describe the practice of naturopathy?

How do you think they are different from a MD?

What types if illnesses/issues do you think they are most effective in resolving?

What types if illnesses/issues do you think they are least effective in resolving?

Are they covered by your health insurance?

Are they expensive?

Is it hard to find a good one?

ND ATTITUDE (FOR ND NONUSERS)

Have you ever considered visiting a ND?

Why/why not?

What would it take to get you to visit one?

Probe:

Personal recommendation

Recommendation from MD

Specific issues

Cost/coverage change

Government regulations

Scientific proof

ND ATTITUDE (FOR ND USERS)

Do you see yourself visiting your ND more or less in the future?

Why/why not?

Does government regulation/endorsement of NDs change your perception of them, how?

Do you ever recommend your NDs to friends/family?

Under what circumstances?

What do you say?

What do they say?

What’s the best thing about NDs?

What’s the worst thing about NDs?

Ontario Association of Naturopathic Doctors Phase 1: Research & Discovery Presented October 31, 2013...

Documents

Transcript of Ontario Association of Naturopathic Doctors Phase 1: Research & Discovery Presented October 31, 2013...