The promotion of clinicians under DRG: from focusing on prescription rights to focusing on diagnostic rights

Before DRG was introduced, our prescription drug marketing focused more on the prescription rights of clinicians, and with the introduction of DRG, especially the establishment of standard procedures for the disease group, we need to move the focus forward to the diagnostic rights, because the DRG disease group once the main diagnosis, coupled with secondary diagnosis, identified the grouping, followed by And with the implementation of the clinical path (package) of the upper disease group naturally determined the drug treatment program of the disease group, equivalent to we should move the focus of prescription drug marketing forward, from the focus on the final prescription right to pay attention to the right to diagnosis when admitted to hospital, in fact, the right to diagnosis is the largest power and the most invisible power in clinical power.For example, the diagnosis of NCP, according to the "New Coronavirus Infection Pneumonia Treatment Program (Trial 5th Edition)" on February 13 in Hubei suddenly increased by 14,480 cases, including 13,332 clinically diagnosed cases, because we redefined clinically diagnosed cases. When we see a doctor to diagnose pneumonia, the pathogens we can get are 230 per cent, and the remaining 70 or 80 per cent depend on clinical diagnosis. From the point of view of clinical thinking and clinical pathway of clinicians, increasing the diagnosis of clinical cases is beneficial to clinicians to make one more judgment on the disease. Previously, cases were confirmed mainly by nucleic acids. In fact, by the standards of our clinical diagnosis, there is a large number of suspected cases. In clinical work, clinicians mainly from these aspects of comprehensive diagnosis: First, if the patient in Hubei or Wuhan area, it is certainly already epidemiological history; For example, our common streptococcus pneumoniae, in fact, can get a positive proportion and culture ratio of 20 to 30 percent, most of them rely on clinicians to the next clinical diagnosis of clinical cases. In general, a clinician's clinical diagnosis is critical!Let's start by reviewing the three core mental patterns in which clinicians form prescriptions: prescription reflexes, titration patterns, and adoption cycles.Prescription Reflexes: A link between a patient's specific signs and symptoms and the doctor's comprehensive consideration, including the choice of a drug for a disease at the beginning of treatment and later in the course of treatment, which begins as early as the doctor is in medical school, until some external influence changes these habits, which is the prescription condition reflex effect. To change this conditioned reflex, we need to influence the process of doctor awareness and association. The first is to uncover how doctors class classes patients, and secondly, we need to understand what the doctor's comprehensive consideration of this symptom is before we can change it.Titring thinking: is a broad concept that applies to different products or product line. The basic thought process is to start with a product that has no baggage (e.g. side effects, no drug-to-drug interactions, etc.) to see if it is effective and the efficacy is low. Then increase the amount of medication until the therapeutic effect is achieved. The whole process is called a therapeutic pathway or sometimes a treatment. For example, start with 5mg, then increase to 10mg; start with amoxicillin, then switch to stronger antibiotics; start with diuretics, then turn to stronger antihyperperpressure drugs; start with familiar medications, and then try new treatments. From low efficacy, low side effects, to high efficacy, high side effects, until the discovery of relatively effective, moderate side effects.Adoption cycle: Clinicians make prescription choices in stages, the treatment adoption cycle is divided into seven stages: unrecognized, non-treatment, recommended to experts, consult experts, treat some patients, treat most patients, support. For different treatment adoption cycles, we have different prescription rights promotion strategies for clinicians.1, can not identify the stage: the focus is "inform", to help doctors correctly identify the type of patient, exclude patients who do not apply. Promotional strategies: publicity of the dangers and severity of diseases, physician education - focusing on specific symptoms and indicators (consensus, guidelines, special seminars, city meetings), continuing education (CME), patient education, questionnaires, selection of foreign literature, means of testing, diagnosis, treatment or gadgets, etc.2. Non-treatment phase: focus on "professional helper" to help doctors accurately grasp the way to deal with problems and side effects, reduce risk to make the transition easier (this stage of people like children learn to walk stage, it is important not to let him fall). Promotion strategy: to provide routine diagnosis or expert consensus, so that they understand the treatment plan, case sharing, etc.3, recommended to experts (referral): the focus is "careful support", improve doctor confidence, eliminate inappropriate patients to simplify treatment options, reduce the risk of change (the most important stage of prescription changes, simple safety doctors will change). Promotion strategy: provide sample trial, use clinical observation, select the most suitable patient type, encourage them to try to apply to patients, often follow up, discuss efficacy, product flyer explanation and so on.4, consult with experts (consultation): the focus is on "heart-stopping pills", find out which factors make doctors feel uncomfortable, take measures to reduce risk. Promotion strategy: consultation, lectures and lectures from appropriate department experts, enhanced daily visits and follow-up, visits by regional managers and product managers, and timely handling of customer responses (so that customers can find you at any time).5, treatment of some patients: focus on "expanded adaptive, differentiated services", confirm the cause if the reason is a competitive factor, then determine how the doctor is currently: a define the patient type b arrangement treatment plan (looking for "blue sea"). Promotional Strategies: Third-Party Investigation: Understanding the Classification of Existing Patients by Doctors: Those in Use, Those Not Used; Da (Documentation) and Targeted Visits to a Class of Available Patients, Targeted Meetings, Typical Case Discussions, Salons, Associations; Clinical Case Collections, Essay Collections, Articles Published; Patient Education Materials (Reducing Prescription Trouble); Active Meetings (Using the Influence of Key Academic Leaders) and Sales Activities (e.g., Story Sales);6. Treat most patients: focus on "hedges", increase doctors' confidence in treatment, keep doctors feeling good about medicines, make doctors' work easier and reduce the risk of treatment to zero, and increase the risk of doctors changing prescriptions. Promotion strategy: ask doctors to do patient education, clinical observation, case analysis, further education programs, domestic, international conferences, etc.7, advocacy: the focus is on "building partnerships", coaching and preparing them to join the "speaker" program, in line with the personal values of doctors. Promotion strategy: in-hospital: inpatients, doctors, departments of communication, invitation to lecture, patient education, visits to lower-level hospitals, consultations, round table exchanges, lessons learned, published articles, leading special topics (new selling points) clinical trials or published articles, added value services: cooperation with the media, hotline, etc.From 1st to 5th to 5th to treatment adoption, from 4th to 7th to competitive positioning, the treatment adoption phase focuses on selling treatment options: by helping doctors identify and treat more patients, you can significantly improve your sales performance without relying on competitive means. The competitive positioning phase is primarily about selling products, and you can expand the types of patients that apply through changes in specific treatments, thereby increasing sales and competitive advantage. What we're trying to do is try to position our products in the treatment adoption phase, not the competitive phase, because it takes the least effort and the least competition. That is, find our blue sea without rushing into the Red Sea.We know that a doctor's clinical consultation is divided into six steps: consultation, examination and diagnosis, treatment options, brand selection, dosage, compliance. The full impact of drG implementation is one of the three core links: treatment option selection, brand selection, dosage, these three links due to the optimization of the path of the disease group, the establishment of the standard disposal procedures of the disease group (relevant content can be seen in the article: DRGs under the standard treatment procedures and clinical path optimization), a single clinical doctor prescription rights of the impact limit gradually smaller, we should move forward our focus, pay more attention to the patient's visit and diagnosis link! What are the items included in the examination and treatment, and what is the role? What checks are made, what results will be made, and when will results be made?In the patient's visit and examination diagnosis, the key points are how to divide the sub-groups: age, sex, diagnosis, type of disease, severity of the disease, complications, treatment methods, etc. How doctors classes patients, you can learn by asking questions such as how doctors identify diseases, the main categories of patients that doctors classes in practice, the criteria used by doctors to define these patient types (to see if a patient meets a certain category), and the various factors that doctors use to divide patient types include: complications/mergers, whether patients are taking other drugs, age, gender, body area (BSA), lifestyle, whether they have health insurance/the ability to pay for medical care. The division of patient types, combined with major diagnoses, secondary diagnoses, whether there are complications/mergers, determines the grouping of patients, and finally determines the standard of payment of patients and follow-up treatment options.For example, a 55-year-old female patient with high blood pressure, systolic pressure >180MMHG, diastolic pressure>100MMHG, has no other underlying symptoms of the disease, and doctors may use a combined treatment, prescription CCIB and diuretics. If the treatment doesn't work well, he may switch to another treatment: CCIB-ARB or triple therapy, CCIB-ARB-diuretic.We must fully consider the impact of diagnostic and related examination options on product treatment options, and the impact of diagnosis and related examination options on payment standards is divided by diagnosis and treatment: surgical treatment or non-surgical treatment? To combine the positioning of enterprise products. To build a competitive advantage, we need to make the characteristics of our products, or the patient categories defined by our products, more favorable prescription reflexes for our products. For the mental model of prescription reflexes, the strategy we chose was: 1, to recognize new types of disease from the prescription adaptations we already have, and to move into the new DRG segment; maspin, for example, had a lot of appeals when it first came on the market (older patients, chronic lung diseases or other underlying diseases, 2 hospitalizations> in the last 90D、... and later developed a score sheet to define the type of patient with moderate to severe infection. The propaganda is: the best choice for the initial experience treatment of moderate to severe infection.2, to create a new patient type, into the new DRG sub-group; for example, the first publicity point of the medica in its entry into the market is middle-aged and elderly women osteoporosis patients, the result of the market response is not good, some doctors proposed that the drug in the treatment of osteoporosis caused by bone pain has a good effect, so proposed a new patient type (bone caused by osteoporosis), has been successful.3, redefine an existing patient type, convert different DRG sub-groups, re-develop a treatment pathway, newpieces once market positioning: anti-inflammatory pain relief of course newtablets; rapid anti-heat analgesia, fast lasting, safe and effective; anti-inflammatory pain treatment classic drugs, 35 years of clinical safety and effective verification. The author helps redesign the market positioning: the first with selective suppression of COX-2 anti-heat analgesic compound preparation, gastrointestinal high-risk patients of choice; The market principle that also embodies here is to create a new area where you may become the "first". Being number one is better than doing better. If you can't be the first to enter a category, create a category and make yourself number one.In addition to focusing on a clinician's diagnostic rights, we should also pay attention to the multidisciplinary integration of diagnostic rights, that is, the issue of MDT. We know that at present, with the segmentation of disciplines, diagnostic rights are more and more dispersed, once encountered involving multidisciplinary responsible cases, the need for MDT consultation, so in the process of focusing on the diagnosis of a disease group, to pay attention to MDT diagnosis involved in a variety of disciplines, including: all relevant clinical departments, the relevant medical and technical departments (testing, ultrasound, pathology, imaging, intervention), clinical medicine, medical department (MDT) to lead and manage the new Instead of losing both at the tactical level, it's better to go beyond competition on a strategic level! DRG fully implemented, put our focus forward, from prescription rights to diagnostic rights, to carry out more clinical promotion work, enabling diagnosis, in order to truly achieve beyond competition! (Medical representative)