LYRICA® (pregabalin) eLearning System Introduction to the Patient Care Process® Pfizer Inc CONFIDENTIAL — EDUCATIONAL AND TRAINING MATERIALS. DO NOT DETAIL OR DISTRIBUTE TO ANY THIRD PARTIES. Copyright © 2009 Pfizer Inc, with respect to proprietary product- and marketspecific information. Copyright © 2009 Whole Systems, with respect to all instructional design and formats. All rights reserved. Printed in the U.S.A. (7/09) No part of this work may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without permission in writing from the publisher. TN130X09 CONFIDENTIAL — EDUCATIONAL AND TRAINING MATERIALS. DO NOT DETAIL OR DISTRIBUTE TO ANY THIRD PARTIES. Introduction to the Patient Care Process® The information contained in this training module is for your educational purposes only. This training piece is designed to provide you with information you need on the product, the disease, and the competitive environment. It is not to be used in detailing or distributed to any third parties. The Patient Care Process® describes the iterative cycle that healthcare professionals (HCPs) follow to diagnose, treat, and manage patients (see the figure below). This cycle applies to all patients — new patients making their first visit to the HCP as well as patients who are currently being treated. The Patient Care Process® provides a framework for understanding what matters to physicians at each step in the process. The HCP Perspective is in the middle, because it is the basis for understanding the differences in how each physician applies the Patient Care Process®. A brief definition of each step follows. Patient Presentation — The patient must describe some symptoms (eg, burning in the chest), while other symptoms can be observed by the HCP (eg, a rash or swelling). As a result, this step may be very straightforward, or it can be very challenging. ® The Patient Care Process Hypotheses — As soon as experienced HCPs observe or hear about a symptom, they start to form hypotheses that are then tested and refined through the subsequent steps of the Patient Care Process®. These hypotheses are formed using a combination of qualitative and quantitative data from the HCP’s personal experience, interaction with peers, clinical studies, journal publications, and/or guidelines established by a local or national organization. History and Physical Examination — After hypotheses are formed, the HCP begins to test and refine them. At this point, most of the data being gathered is qualitative. If the HCP has formed multiple hypotheses, he or she uses this step to rule out as many hypotheses as possible (a differential diagnosis) before conducting more quantitative tests. This step may involve asking more in-depth questions about the patient’s family history, previous experience, and symptoms; in addition, affected body systems are identified and, wherever possible, physically examined. Introduction to the Patient Care Process® CONFIDENTIAL — EDUCATIONAL AND TRAINING MATERIALS. DO NOT DETAIL OR DISTRIBUTE TO ANY THIRD PARTIES. 1 Diagnostic Tests — The primary purpose of ordering tests is to gather quantitative, standardized evidence that will help rule out, confirm, or validate a hypothesis. HCPs typically order tests based on accepted guidelines regarding which tests should be ordered given a particular set of symptoms. If several hypotheses are still valid after the history and physical examination step, multiple tests may be ordered to rule out some of the suspected conditions and suggest others. Interpret Results — Test results give the HCP quantitative data on which to base the diagnosis. Accepted values, abnormal values, abnormal findings, or findings that outline the stages of disease progression all provide evidence to raise the HCP’s level of certainty in making a diagnostic decision. Often, test results are inconclusive or unhelpful; in this case, the HCP may return to the history and physical examination step or make a diagnosis based on his or her clinical experience or on the advice of other HCPs. Diagnosis — When the HCP’s level of certainty is high enough, based on his or her clinical experience, patient information, test results, and peer advice, he or she makes a diagnosis. The level of certainty required will vary depending on the specialty, the particular HCP, and the patient’s condition. Therapeutic Intervention — Therapy selection may be a qualitative or quantitative decision, depending on the disease, the HCP’s level of certainty, and the HCP’s diagnostic “style.” For some conditions, protocols and other types of guidelines have been developed to suggest the best treatment approaches. Some therapy choices are made based on these protocols or guidelines, but the physician often makes a choice based on his or her judgment, the patient type, and patient values. Evaluate Outcomes — Once a therapy selection is made, the criteria for evaluating its success should be delineated. These criteria include factors such as length of time to get the desired response, degree of impact on the symptom, presence and severity of side effects, the patient’s quality of life, comparative expense, and patient compliance, as well as the product’s safety. Introduction to the Patient Care Process® CONFIDENTIAL — EDUCATIONAL AND TRAINING MATERIALS. DO NOT DETAIL OR DISTRIBUTE TO ANY THIRD PARTIES. 2 Four patient cases will be presented throughout the modules to help reinforce the learning material by allowing the representative to assume the role of the physician as well as understand the perspective of the patient and other HCPs for each case: Rodney, a 66-Year-Old Man with Type 2 Diabetes and DPN Jennifer, a 68-Year-Old Woman with PHN Amy, a 41-Year-Old Woman with Fibromyalgia Mark, a 41-Year-Old Man with Epilepsy At appropriate points in the modules, case segments corresponding to the different phases of the Patient Care Process®, from Patient Presentation to Evaluate Outcomes, will be presented. For each segment, the representative will have the opportunity to answer questions about the cases based on material recently presented in the modules. Introduction to the Patient Care Process® CONFIDENTIAL — EDUCATIONAL AND TRAINING MATERIALS. DO NOT DETAIL OR DISTRIBUTE TO ANY THIRD PARTIES. 3