Clinical Nurse Educators: Driving Diagnosis, Prescribing, and Adherence Pete Megronigle, VP, Head of Health Management Solutions, ­Quintiles Faced by a broad array of challenges — from healthcare reforms to evolving practice dynamics — physicians have little time to spend with patients, and still less for biopharma sales representatives. This time pressure can limit a healthcare practitioner’s awareness of the latest advances and techniques, and their ability to fully support and educate patients, particularly those with complex or chronic treatment protocols. Further, one-third to one-half of patients with long-term conditions fail to take their medications as prescribed, regardless of the severity of their condition. Against this backdrop, innovative solutions are needed. Clinical Nurse Educators (CNEs) – also known as clinical educators, nurse advisors, patient advocates, or coaches — are highly trained individuals who provide educational outreach to both healthcare providers (HCPs) and patients, optimizing diagnoses, prescribing rates, and patient adherence. For physicians and staff, CNEs can provide disease and therapy-specific information. For patients, CNEs can offer treatment information, ongoing therapy support, educational seminars, and a way to connect with other people living with the same condition. CNE programs represent a powerful differentiator for both physicians and patients. Many therapeutic categories can benefit from the intervention of CNEs, including chronic conditions such as diabetes, asthma, multiple sclerosis, oncology, and immune disorders, as well as rare diseases and challenging-to-diagnose conditions. The results can be dramatic with decreases in the percentage of asthma patients not previously prescribed controller medications from 40% to nearly 18%. An added benefit is the extraordinary effect on patient satisfaction, which often improves by 40% or more. Central to the success of CNEs is their high level of expertise and disease-specific knowledge, which helps ensure access to prescribers, practice staff, and patients, using educational outreach to improve diagnosis and prescribing rates. Time spent by CNEs with patients and advocacy groups can also positively impact subsequent prescription refills and therapy adherence (Figure 4). Office relationships built during CNEs’ educational outreach — during sessions that can last 30 to 45 minutes compared with the couple of minutes typically allocated to sales representatives — may improve access to HCPs for sales representatives as well (Figure 2). CNE programs may be branded, with the goal of supporting a particular product, or non-branded, with the aim of increasing the size of the overall market through awareness and advocacy. Both types of programs can improve access to no-see and difficult-to-see practices, increase patient adherence, boost disease awareness, use peer-to-peer knowledge, and experience to create a selling opportunity, and generate goodwill for the sponsoring company. Case Study: Dialysis/Nephrology A recent project involved using 26 CNEs across the United States to support a dialysis/nephrology program. The goals were to improve the adoption of a branded product, support nephrology clinics through clinical interactions, and maintain then grow market share. The results were impressive: for clinics that were called on by both CNEs and sales representatives, the market share rose from zero to a peak of almost 35% (Figure 3). What is a Clinical Nurse Educator? A CNE is a credentialed healthcare provider such as a nurse with a minimum of two years of experience of managing patients with a specific chronic disease. Focusing on the needs of the practice, CNEs provide comprehensive education on disease management tools, and assist in implementing these learnings in the practice. This creates behavior change within the practice, allowing a biopharmaceutical company to overcome hurdles and challenges that may be slowing brand adoption or market expansion. This approach also complements the sales representative, who is trained to sell product features and benefits to encourage utilization of a brand and to increase sales and market share (Figure 1). Note: Quintiles has deployed 80 teams and 1,800 clinical educators covering more than20 therapeutic areas in the United States and 300 teams comprising 2,300 clinical nurse educators globally. “In the current healthcare environment, the value of adhering to a regimen ­designed to improve outcomes and quality of life is at a premium. Clinical nurse educators can add significant value for healthcare practitioners and patients alike. We have no shortage of critical drugs, but we can certainly ­enhance the level of understanding and support on multiple levels to deliver ­better outcomes for physicians, patients and biopharma providers." Challenges Many chronic diseases affecting Americans may not be managed appropriately – going undiagnosed or being sub-optimally treated Practitioners’ time with patients is limited and staff may not be properly trained or may not have adequate skills to educate patients Patient self-management is vital to proper adherence. Patients need to better understand their disease and the risks of non-treatment Reps can be perceived as being biased when they educate HCPs on disease and patient management CNE Solution CNEs are typically disease-state certified with a ­minimum of 2-3 years of specific hands-on ­patient experience CNEs typically get more HCP and staff access and deliver trainings to enhance understanding of the disease and therapy CNEs provide staff with educational techniques and can work directly with patients and ­advocates CNEs deliver branded & nonbranded programs ­focused on improving oucomes Benefits Remove disease barriers and practice ­management challenges to improve patient identification and treatment standards Improved understanding of the disease and therapy, along with patient education skills leads to better patient care Improved patient and understanding of disease state and treatment leads to improved ­adherence Physicians appreciate disease-trained, ­­ patient-centric, treatment-oriented resources Quintiles is the world’s leading provider of biopharmaceutical services. With a network of more than 27,000 professionals working in more than 80 countries, we have helped develop or commercialize all of the top 50 best selling drugs on the market. { For more information, visit quintiles.com

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