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FAQs section one

Section 1: Implementing the 1-2-3 Approach to Provider Outreach

This section covers questions your team may have about planning for and implementing your provider outreach initiative. Ask your team to review these FAQs as part of their training. These FAQs are designed to complement and expand upon information and tools in the marketing guide.

Why reach out to primary care practices about chronic disease self-management education and physical activity interventions?

Evidence from clinical trials and program evaluations demonstrates that self-management education and physical activity interventions are effective for reducing the symptoms of arthritis and other chronic diseases and improving quality of life. Based on research sponsored by the Centers for Disease Control and Prevention (CDC) and other reputable organizations—including Stanford University, the University of Washington, and the Arthritis Foundation—the CDC Arthritis Program has identified a number of interventions shown to help relieve symptoms, improve joint range of motion, and increase participants’ confidence in managing their health. CDC has allocated a portion of its state arthritis program funding to make these interventions available in communities across the country. Because chronic disease can be difficult to manage, health care providers and their patients are eager for additional treatment options. Although most providers are not aware that self-management education and physical activity interventions are offered locally, research with providers shows that they want to learn more, preferably via in-person visits by knowledgeable professionals. Reaching out to providers is important because their recommendations are powerful motivators for patients. because their recommendations are powerful motivators for patients.
Enrollment in these CDC-supported interventions has been low. Using the academic detailing model, a proven model adapted from the pharmaceutical industry, you can develop an educational outreach program for local primary care providers (PCPs) to encourage them to recommend self-management education and physical activity interventions to their patients with chronic disease.

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What is the academic detailing model?

Pharmaceutical companies typically use face-to-face outreach with health care providers to market their products. This marketing strategy—called “pharmaceutical detailing” and conducted by sales representatives—has proven successful in influencing providers’ prescribing habits and increasing sales of a company’s products. Universities and other non-commercial organizations have adapted this strategy as a way to reach out to providers with information for managing a variety of health conditions. Evaluations of these “academic detailing” approaches show that they have an impact on the recommendations providers make to their patients, particularly for chronic, difficult-to-manage conditions like obesity, diabetes, and arthritis. Your marketing team will use the detailing model to promote chronic disease self-management education and physical activity classes to primary care providers (PCPs) in your community.

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Is there anything we can do ahead of time to make providers more receptive to outreach visits?

The first contact you have with a practice is likely to be the initial phone call to introduce the goals of your outreach efforts and schedule an outreach visit. However, by building on existing relationships with local providers, you can get the word out about the interventions you are promoting and prepare practices for eventual contact with your marketers. While you are establishing and training your team and gathering information on primary care practices, start by contacting providers with whom you have established relationships and informing them of your efforts. You can also use the resources of state and local partner organizations to target “influencers”—providers who have well-established reputations in the local medical community and could influence the behavior of other providers. Whether leveraging existing relationships or reaching out to influencers, ask these providers if they are willing to publicize their support for chronic disease intervention programs and to recommend other interested colleagues. Starting with providers you or your colleagues know will give your team the chance to hone your marketing approach with a more receptive audience.
You may also consider talking to local class instructors. Ask them to encourage class participants to spread the word about the programs to their doctors.

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How can we succeed in marketing interventions when no one on our staff has any marketing experience?

The marketing guide and outreach materials are designed to help you and your team develop a successful provider outreach program regardless of your level of marketing experience. Extensive experience with marketing or community outreach isn’t necessary. All you need to do is recruit team members who are knowledgeable and enthusiastic about promoting the interventions, have good active listening skills, are flexible and adaptable in one-on-one interactions, and can project confidence when talking with providers and office staff. The marketing guide will help your marketers use the simple 1-2-3 Approach to engaging primary care practices.
Training is one of the keys to success. You should thoroughly review the marketing guide and role play with other staff members before taking the outreach to the field. Employing a tiered or phased approach by starting with providers who are familiar or have expressed particular interest in self-management education or physical activity programs can help members of your team become comfortable with the marketing approach and refine their techniques for making initial contact with practices and conducting outreach visits.

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We have a small team and limited time to devote to developing a provider outreach program. How can we be successful with the resources we have?

The strategies described in this marketing guide are simple, straightforward, and designed for busy organizations with competing priorities. To help manage available staff and resources, consider having junior staff, interns, or volunteers conduct the initial research to identify local primary care practices to target. Leverage available resources from partner organizations wherever possible, and try using a tiered or phased approach to both training and engaging providers.
This marketing guide includes several tools and templates (e.g., spreadsheets, checklists) to help you organize, document, and track your outreach efforts. Templates such as the Marketing and Promotion Plan and Evaluation Summary Report are designed to be comprehensive but easy to complete. Detailed instructions are provided for customizing outreach materials, and technical assistance is available.

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How long will it take to train our team?

Training time will vary depending on your team’s skills and previous experience. In general, most teams will need about a month to become familiar with the interventions and to practice enough role-play sessions that they are comfortable approaching practices. Consider training in phases as marketers move through the steps in the outreach process. For example, while some members of your team are gathering information about practices to target, others can begin training for the initial contact. As first contacts are made, move to training for the outreach visit. Schedule continuing training/education sessions throughout the year for all staff and offer remedial training as necessary.

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What training techniques work best?

To accommodate different learning styles, use a combination of instructive, interactive, and self-study sessions to train your marketing staff. Give each person a copy of the marketing guide sections related to the tasks they’ll be doing, and walk them through the materials and their tasks step-by-step. The key to effective provider outreach training is rehearsal: for staff who will be in direct contact with PCPs, ensure that your training schedule allows ample opportunity for role-play with colleagues. Role-playing exercises will enable them to practice a variety of scenarios they may encounter during phone and in-person contacts. Use the scripts and training video to guide role-playing exercises. Invite providers from within your program or from other local organizations or agencies to observe and give feedback to staff during role-play sessions.

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How do we find out about competing programs in our community?

Conduct an environmental scan to determine whether there are similar programs being promoted within the community for arthritis or other chronic health conditions like diabetes, obesity, or heart disease. Inform other colleagues and partners about your efforts, and ask them if they have similar activities under way. Check the Web sites of local health care organizations and facilities (e.g., hospital-based outpatient and wellness clinics) and social service agencies (e.g., the local YMCA) for information about programs available to the community. Review local newspapers, community bulletins, or blogs for announcements about new programs or classes. Stay abreast of similar classes being offered in the community by signing up to receive mail or electronic newsletters and updates from local organizations.

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Are there any incentives I can offer providers to encourage them to recommend the interventions to their patients?

Providers will schedule outreach visits because the information you bring is valuable for them and for their patients. However, bringing a small gift item may help break the ice and show a consideration that staff will appreciate and remember. These items could include candy or other food item, or giveaways like pens with your organization’s logo.
A powerful motivator for providers is patient feedback. Use the information gathered from the How Did You Hear? questions you’ve asked class instructors to distribute to estimate the number of successful recommendations the provider has made. Include this information on the follow-up post cards you send to providers to show them that their efforts are producing tangible results, and to encourage them to continue recommending the interventions to their patients. For additional impact, consider including patient testimonials in your follow-up materials. Survey data suggest that testimonials are highly influential and may reinforce provider behavior.

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How do I know which practices are making recommendations?

Before your local classes begin, make sure that instructors have copies of the How Did You Hear? form - [DOC - 45KB] (or have added your questions to their existing registration forms). Ask them to distribute the forms to participants during the first visit. After you’ve collected the completed forms, record the answers on the How Did You Hear? Data Entry Spreadsheet - [XLS - 120KB] or other self-designed tracking tool. The answers to these questions capture the names of the providers or practices who recommended an intervention. You can use this information to track the effectiveness of your outreach efforts and to give feedback to providers.

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How long will it take to make contact with all of the local primary care practices?

It will take at least 6 months to establish relationships with a practice. The timeline will vary depending on your team’s resources, staffing, and the number of practices you are targeting. Some activities—such as training, making initial contact, and conducting the first outreach visits—may be done simultaneously, while others—such as follow-up—will be ongoing. Use the first 1–2 months to identify and train your marketing staff and to target practices for outreach. During Month 2, you should begin making initial contact with practices. Give yourself 2-3 months to get an outreach visit scheduled. You’ll want to time your efforts so that you have met with most of the targeted providers before the first class is scheduled to begin.

Remember that follow-up doesn’t end with a postcard. Your long-term goal is to establish ongoing relationships with providers and to continue reinforcing the value of the interventions and provider recommendations through periodic contact by mail, phone, and in-person visits.

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How many attempts should I make at contacting the practice?

By following the information in the marketing guide, you should be able to make at least initial contact with a staff member at the practice. However, if after 3 attempts you are unable to speak with the designated primary contact at the practice, consider alternate options:

  • Some busy practices prefer drop-in visits. Prepare your outreach materials and make an unscheduled visit. It’s best to arrive first thing in the morning, just before the lunch hour, or towards the end of the day—periods when the patient volume is likely to be lower and staff may have a few minutes to meet with you.
  • Use your existing relationships with other local providers or influencers to make inroads with the unresponsive practice. Informal reminders from respected colleagues about your outreach efforts may prompt providers to contact you or make them more receptive to further phone calls and mailers from you.
  • Mail a packet of information to the practice, addressed to the primary contact (if known). Include your business card and a short note introducing yourself. There is a downside to mailing materials before making contact with a practice: research shows that unsolicited materials may not be read by providers and staff. If you have not heard from the practice within 1–2 weeks, call again. If the staff has had a chance to review the materials, they may be more receptive to your calls.

If practices do not respond to alternate contact strategies after approximately 2 months, end your efforts until you begin outreach work again for the next cycle of intervention classes.

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What should I do if the practice declines an outreach visit?

Practices are likely to be interested in learning more about the interventions once they’ve had the opportunity to hear your initial pitch. However, some practices may be skeptical at first, and may decline your offer to schedule an outreach visit. If this happens, try the following:

  • Ask the staff member you have contacted why the practice is declining a visit. They may be concerned about having the time available to meet with you. They may be skeptical about the effectiveness of the interventions, or they may feel that their patients won’t be interested. The scripts provided in this marketing guide provide you with responses for each of these scenarios. Use them to address the practice’s concerns.
  • The practice may be concerned that you are selling a product or other services. Reiterate your affiliation and partnership with the CDC and remind the practice that your goal is to promote healthier behaviors in people with arthritis and other chronic health conditions.
  • Offer to mail or drop off outreach materials for the provider and staff to review. Call back or drop by again 1–2 weeks later and see if the practice is more receptive to scheduling a formal visit.

If these strategies don’t work, end your efforts with the practice. You may try contacting them again once you begin outreach for the next season’s classes. In the meantime, you might ask their colleagues or local influencers to put in a good word with the practice about the interventions and your outreach work.

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What if the marketer has to reschedule an outreach visit due to health, weather, or other emergency?

The marketer or another team member should call the practice as soon as he or she knows that the visit needs to be rescheduled. Set a new date and time that is convenient for the practice. Offer to meet during off-hours—e.g., early morning before the first patient is scheduled, after the last appointment of the day, or during lunch time. If the visit needs to be rescheduled more than 1 week later, offer to mail or drop off materials in advance.

An alternate strategy is to see if another intervention marketer on your team is available to meet with the practice as originally scheduled. If so, make sure to give the practice the option of meeting with a different person or rescheduling with the original marketer.

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What should I do if the provider cuts an outreach visit short?

When trying to schedule time with busy providers, you’re bound to encounter unexpected situations. Refer to the visit script - [PDF - 567KB] and training video to practice a variety of scenarios. Although the guide suggests planning for a 5-minute visit, you may find that you only have 1–2 minutes of the provider’s time in the hallway between office visits. When this happens, don’t get flustered. During the time you have with the provider, stay focused on the core messages (“the three Cs”—cost, convenience, and credibility—and effectiveness) as you practiced during your training role-play sessions. Leave your business card and outreach materials with the receptionist or office manager. Try to schedule a follow-up visit or phone call as soon as possible to answer questions and reinforce information already provided.

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How often should I follow up with the practice? Should I schedule additional in-person visits?

To reinforce the messages conveyed during your outreach visit, aim to make approximately 3 contacts during the first two months post-visit. Choose follow-up techniques that require minimal levels of effort. For example, place a call to the office approximately 2 weeks after a visit to see if there are any follow-up questions. You can also use the camera-ready artwork files provided with this marketing guide to create postcards to which you can add a personalized message, class announcements or reminders, and patient enrollment information or testimonials. Mail these postcards to your primary contact at each practice. As new research findings are published on the interventions you are promoting, attach copies of journal articles to the post cards. Be available for follow-up by phone or e-mail as needed.

Consider conducting in-person visits at least once a year as continuing education and to maintain a relationship with the practice. Schedule these visits to coincide with a new season of intervention classes.

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What supplies will my program need to purchase in order to reproduce outreach materials?

The materials are designed so that they can be reproduced using standard office equipment and supplies. For best results, have the materials printed by a vendor (e.g., local printer or FedEx Office store). If you are printing from your desktop, have the following supplies on hand:

  • 8½” x 11” laser paper (24 lb. and 32 lb.)
  • 8½” x 11” card stock (65 lb.)
  • 11” x 17” laser paper (24 lb. or 32 lb.)
  • 8½” x 11” standard Avery labels (Avery 8255)
  • 9” x 12” two-pocket folders with business card slit; available from vendors such as Paper Direct, Office Depot, and Staples.

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What are the estimated costs of these supplies, and will our CDC grant cover them?

Costs will vary by location and vendor. Color laser paper is generally priced at $10–$20 for a 500-sheet ream; laser gloss paper may run up to $30 or $40. The Avery labels typically cost around $40 for 100 labels. Card stock costs $12–$15 for 250 sheets. Most two-pocket folders run $1–$4 each.

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Is special software required to customize and reproduce marketing materials?

No. Electronic files of all customizable templates are saved in Microsoft Word, Excel, or PowerPoint, and compatible with Microsoft Office 2007 and earlier versions. Fillable PDFs are compatible with the Adobe Acrobat family; you can customize them with only Adobe Reader. All materials are available for download from the CDC Web site at http://www.cdc.gov/arthritis/interventions/marketing-support/1-2-3-approach.

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Why do we need to prepare different fact sheets for providers and patients?

Both the provider and patient materials cover information on the interventions (e.g., course descriptions, goals, benefits) and emphasize “the three Cs” (cost, convenience, and credibility). However, their content addresses the particular concerns of each audience, as reported in research conducted to prepare for this outreach approach. The fact sheets developed for providers discuss in more detail the scientific evidence supporting the use of the interventions, focusing on their credibility and effectiveness. These materials are written for medical professionals and require a familiarity with clinical and research terminology. They present the interventions as additional treatment tools for healthier and more satisfied patients. The patient brochure and class schedules are written in conversational, plain language (approximately an eighth grade reading level) and are appropriate for a broader audience. They address some of the barriers to and concerns patients have about signing up for self-management education and physical activity programs. They emphasize the goal of increased autonomy to convince patients they can be active partners in managing their own health.

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How many copies of the outreach materials should we provide to each practice?

To each outreach visit, bring the following:

  • 1 copy of the provider overview fact sheet for each PCP or staff member
  • 1 copy of each provider intervention fact sheet for each PCP or staff member
  • 1 copy of each evidence summary (if available) for each PCP or staff member
  • 50-100 copies of the patient brochure
  • 50-100 copies of each class schedule
  • 1-3 posters

Always leave at least one provider packet. During the visit, ask the provider or other staff member how many posters and patient fact sheets they would like you to leave behind. The number will depend on the volume of patients the practice sees and the space it has available to display materials. Assure the staff that you will resupply materials as needed; they can call you when their stock is running low, or you will send or bring new materials as part of your regular follow-up.

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What should I do if the practice tells me that they don’t want or don’t have the capacity to display patient materials or posters?

You can suggest that the practice keep these on file with other patient informational materials to hand out as needed. You can also offer ideas for displaying posters. If the waiting room and exam room walls are full, suggest hanging a poster in the patient bathroom, near the laboratory, or in the hallway.

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Are the patient materials available in other languages?

Yes, the patient brochure is available in Spanish as ¡Hágase cargo! Tomando Control de su Salud! - [PDF - 542KB]. Class schedules for three Spanish language programs are available in both English and Spanish.

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How often will we need to update outreach materials?

Update the patient and provider materials whenever class offerings, schedules, locations, or local contact information changes. At minimum, the fact sheets will need to be updated each spring and fall to reflect the new season’s class schedules.

Remember to provide updated copies of the materials to your local practices. Depending on your outreach follow-up plan, you can mail the updated copies, drop them off in person, or bring them as part of another scheduled outreach visit. Consider marketer availability, postal fees, your proximity to the practice, and your relationship with the provider when deciding how best to disseminate the updated information. Restocking is an opportunity for another conversation with the provider and for building a relationship with the practice, so marketers are encouraged to deliver the updated materials in person as resources allow. If mailing the materials is the most efficient option, try to follow up with an in-person visit at the provider’s convenience. When mailing materials to a practice, remember to address the package to the name and title of your primary contact (e.g., Sarah Smith—Office Manager).

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What should I do if I have technical questions about customizing or reproducing outreach materials (i.e., fact sheets, posters, follow-up post cards)?
If you have questions about the toolkit or need technical assistance with the materials, contact arthritisprogram@cdc.gov.

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