Quality of medication information available on retail pharmacy Web sites

Pharmacists' Perceptions of the Benefits and Challenges of Electronic Product Information System Implementation in Hong Kong: Mixed-Method Study

Background

With the advancement of technology, more countries are now adopting the use of electronic product information (ePI), which refer to an electronic version of physical product inserts in a semistructured format optimized for electronic manipulation. The successful implementation of ePI has led to advantages and convenience to patients, health care professionals, and pharmaceutical companies in many regions and countries. In the Hong Kong Special Administrative Region (SAR), there is currently no citywide implementation of ePI. The SAR exhibits conditions that would favor the implementation of an ePI system, as well as existing barriers hindering its implementation. However, no study has been performed to examine the specific situation in Hong Kong.

Objective

The objective of this study is to explore working pharmacists’ overall perception of ePI and to identify potential challenges to the implementation of an ePI system in Hong Kong.

Methods

This mixed-method study involved a structured survey and interview with practicing pharmacists in Hong Kong. Pharmacists were eligible if they were licensed to practice in Hong Kong, and currently working locally in any pharmacy-related sectors and institutions. Respondents completed a survey to indicate their level of agreement with statements regarding the potential advantages of ePI over paper PI. A structured interview was conducted to gather respondents’ perceived advantages of ePI over paper PI in different aspects, such as professionalism, usability, presentation, and environment, as well as challenges of citywide ePI implementation in Hong Kong. Thematic analysis was adopted to analyze the qualitative data. Grounded theory was used to generate themes and identify specific outcomes.

Results

A total of 16 pharmacists were recruited, comprising 4 community pharmacists, 5 hospital pharmacists, and 7 industrial pharmacists. All of them used electronic platforms at least once per month on average. Respondents identified many flaws in physical package inserts that can potentially be mitigated using ePI. The speed with which drug information can be retrieved and the degree to which the drug information can be readily updated and disseminated were considered the greatest strengths of ePI. The clarity with which ePI present drug information to patients was considered as the weakest aspect of ePI. Many respondents highlighted concerns about the security risks and high cost associated with system maintenance and that certain subpopulations may not be sufficiently computer literate to navigate the ePI system. Respondents also voiced many concerns about the implementation and maintenance of a local ePI system.

Conclusions

We conclude that an ePI system is generally supported by pharmacists but concerns about implementation process and maintenance of the system has been raised. The perceived benefits of ePI gathered from this study, as well as collective evidence from other countries with mature ePI systems, confirm that more efforts should be made to promote optimized development and implementation of an ePI system in Hong Kong.

Online drug information platform for the public in Hong Kong-Review of local drug information use and needs

INTRODUCTION

In view of the popularity of Internet usage in Hong Kong, an interactive web-based drug information platform entitled "Ask My Pharmacist - Online University Led drug Enquiry Platform" (AMPOULE) was launched in 2009 to better serve the needs of drug information in Hong Kong. This paper aimed to evaluate the utility of AMPOULE in improving drug-related knowledge among the public and to reassess the needs of the general public in Hong Kong.

METHODS

All enquiries sent via AMPOULE were reviewed. Demographic data, nature of questions and types of drug class covered were analyzed. The workload of pharmacists was examined with respect to the preparation time needed for the enquiry, the lag days to reply and also the timing of enquiry recipient.

RESULTS

2122 enquiries were received from 2009 to 2017. Most enquirers were from Hong Kong (56.6%) and female gender (49.2%). 13% of the concerned subjects were aged over 61-year-old. The most frequent types of questions and medications covered were "Drug Ingredients and Indications" (28.0%) and Adverse Drug Reactions (26.8%) and "Cardiovascular Medication" (21.9%) respectively but these varied in different age groups or enquirer groups. The median time for preparation was 40.0 min (IQR: 25-65 min) while the median time lag was found to be 2.5 days (IQR: 1.0-5.0 days). The number of enquiries received was evenly distributed throughout the day except during 1:00 am to 9:00 am and 7:00 pm to 8:00 pm.

CONCLUSION

AMPOULE has demonstrated that an online platform providing patient-oriented drug information service through the Internet is promising and further promotion is warranted. Current data suggested that the need of different age groups and enquirer groups are different and should therefore be individualized.

Online information seeking by patients with bipolar disorder: results from an international multisite survey

Background

Information seeking is an important coping mechanism for dealing with chronic illness. Despite a growing number of mental health websites, there is little understanding of how patients with bipolar disorder use the Internet to seek information.

Methods

A 39 question, paper-based, anonymous survey, translated into 12 languages, was completed by 1222 patients in 17 countries as a convenience sample between March 2014 and January 2016. All patients had a diagnosis of bipolar disorder from a psychiatrist. Data were analyzed using descriptive statistics and generalized estimating equations to account for correlated data.

Results

976 (81 % of 1212 valid responses) of the patients used the Internet, and of these 750 (77 %) looked for information on bipolar disorder. When looking online for information, 89 % used a computer rather than a smartphone, and 79 % started with a general search engine. The primary reasons for searching were drug side effects (51 %), to learn anonymously (43 %), and for help coping (39 %). About 1/3 rated their search skills as expert, and 2/3 as basic or intermediate. 59 % preferred a website on mental illness and 33 % preferred Wikipedia. Only 20 % read or participated in online support groups. Most patients (62 %) searched a couple times a year. Online information seeking helped about 2/3 to cope (41 % of the entire sample). About 2/3 did not discuss Internet findings with their doctor.

Conclusion

Online information seeking helps many patients to cope although alternative information sources remain important. Most patients do not discuss Internet findings with their doctor, and concern remains about the quality of online information especially related to prescription drugs. Patients may not rate search skills accurately, and may not understand limitations of online privacy. More patient education about online information searching is needed and physicians should recommend a few high quality websites.

Electronic supplementary material

The online version of this article (doi:10.1186/s40345-016-0058-0) contains supplementary material, which is available to authorized users.

Evaluation of Web-Based Consumer Medication Information: Content and Usability of 4 Australian Websites

Background

Medication is the most common intervention in health care, and written medication information can affect consumers’ medication-related behavior. Research has shown that a large proportion of Australians search for medication information on the Internet.

Objective

To evaluate the medication information content, based on consumer medication information needs, and usability of 4 Australian health websites: Better Health Channel, myDr, healthdirect, and NPS MedicineWise .

Methods

To assess website content, the most common consumer medication information needs were identified using (1) medication queries to the healthdirect helpline (a telephone helpline available across most of Australia) and (2) the most frequently used medications in Australia. The most frequently used medications were extracted from Australian government statistics on use of subsidized medicines in the community and the National Census of Medicines Use. Each website was assessed to determine whether it covered or partially covered information and advice about these medications. To assess website usability, 16 consumers participated in user testing wherein they were required to locate 2 pieces of medication information on each website. Brief semistructured interviews were also conducted with participants to gauge their opinions of the websites.

Results

Information on prescription medication was more comprehensively covered on all websites (3 of 4 websites covered 100% of information) than nonprescription medication (websites covered 0%-67% of information). Most websites relied on consumer medicines information leaflets to convey prescription medication information to consumers. Information about prescription medication classes was less comprehensive, with no website providing all information examined about antibiotics and antidepressants. Participants (n=16) were able to locate medication information on websites in most cases (accuracy ranged from 84% to 91%). However, a number of usability issues relating to website navigation and information display were identified. For example, websites not allowing combinations of search terms to be entered in search boxes and continuous blocks of text without subheadings.

Conclusions

Of the 4 Australian health information websites tested, none provided consumers with comprehensive medication information on both prescription and nonprescription medications in a user-friendly way. Using data on consumer information needs and user testing to guide medication information content and website design is a useful approach to inform consumer website development.

Extending FDA guidance to include consumer medication information (CMI) delivery on mobile devices

This paper describes the current state of consumer-focused mobile health application use and the current U.S. Food and Drug Administration (FDA) guidance on the distribution of consumer medication information (CMI), and discusses recommendations and considerations for the FDA to expand CMI guidance to include CMI in mobile applications. Smartphone-based health interventions have been linked to increased medication adherence and improved health outcomes. Trends in smartphone ownership present opportunities to more effectively communicate and disseminate medication information; however, current FDA guidance for CMI does not outline how to effectively communicate CMI on a mobile platform, particularly in regards to user-centered design and information sourcing. As evidence supporting the potential effectiveness of mobile communication in health care continues to increase, CMI developers, regulating entities, and researchers should take note. Although mobile-based CMI offers an innovative mechanism to deliver medication information, caution should be exercised. Specifically, considerations for developing mobile CMI include consumers' digital literacy, user experience (e.g., usability), and the quality and accuracy of new widely used sources of information (e.g., crowd-sourced reviews and ratings). Recommended changes to FDA guidance for CMI include altering the language about scientific accuracy to address more novel methods of information gathering (e.g., anecdotal experiences and Google Consumer Surveys) and including guidance for usability testing of mobile health applications.

Drug Information Activity and Nonprescription Requests Over the Malaysian Counter

Providing drug information has become one of the essential job functions of a community pharmacist. To ensure the availability of up-to-date information, pharmacists should have access to reliable drug information. The current study was an effort to explore the use of drug information resources at a community pharmacy in Penang Island, Malaysia. This study also explores nonprescription requests, with a special emphasis on pharmacists' agreement to dispense medicines without a prescription. A cross-sectional study was performed among the community pharmacists practicing in 3 populous areas of Penang Island. Face-to-face interviews were conducted using a 24-item questionnaire. The response rate was 67.3%. Online drug information, compared with other resources, was preferred by a majority of pharmacists (n = 19, 51.4%). Of the pharmacists, 28 (75.7%) mentioned that patients often make a nonprescription drug request for anti-inflammatory agents, painkillers, and medicines for cough and flu. In about 59.5% of the cases, pharmacists dispensed the requested medicine without question. Most of the pharmacists stated they have dispensed painkillers, creams and ointments, antifungals, body tonics, and inhalers without prescription.

Pharmacy students' opinions of direct-to-consumer advertising: a pilot study at one university

BACKGROUND

Direct-to-consumer advertisement (DTCA) of prescription medications has become an important informational source for health care consumers. As future health care professionals on the front line of potential communication and dispensing of products emerging from DTCA, it is important to elicit the attitudes of student-pharmacists.

OBJECTIVES

This study aims to (1) evaluate the validity of the DTCA attitudinal questionnaire using Rasch rating scale analysis and (2) investigate the attitudes of pharmacy students toward DTCA and determine whether these attitudes were associated with years of pharmacy education and demographic characteristics.

METHODS

This investigation used a cross-sectional print-based questionnaire to evaluate the attitudes of pharmacy students toward DTCA of prescription medications. The 16-item questionnaire included items addressing the attitudes of pharmacy students toward DTCA with respect to patients' knowledge of medications, pharmacists' interaction with patients, and overall consumer judgment of medical prescriptions. Analyses included Rasch analysis and a multiple linear regression.

RESULTS

A total of 243 students submitted usable questionnaires (85% response rate). Item response categories were collapsed from 5 categories to 3, and 4 items were removed to achieve acceptable Rasch model fit. Pharmacy students demonstrated little difficulty in agreeing with the statements suggesting that DTCA helps patients take a more active role in health care and had the most difficulty in agreeing with items suggesting that DTCA may lead to inappropriate prescribing to satisfy patient requests. Students' overall support for DTCA was the only variable that predicted the questionnaire score (P<.001).

CONCLUSIONS

In conclusion, the Rasch analysis evaluated the psychometric properties of the instrument and identified the necessity to adapt the questionnaire from previous iterations to adequately fit the student population. Future research should examine factors that contribute to the variance in attitudes toward DTCA among a larger and more heterogeneous population.

Drug information resources at community pharmacies in Amman, Jordan

Objectives

The aim of this study was to investigate the drug information resources available in community pharmacies in Amman, Jordan.

Methods

A total of 156 private community (retail) pharmacies in different parts of Amman, the capital of Jordan, were recruited by personal contact. Pharmacists at the sample pharmacies completed a self-administered questionnaire that consisted of two sections. The first section elicited the drug information resources available in their pharmacies. The second section presented five mock medicines information scenarios and asked respondents to identify the most suitable information resource to be used from a given list. Answers then were coded and entered into SPSS for Windows for statistical analysis.

Key findings

All pharmacies had at least one reference book, but most were outdated. The Monthly Index of Medical Specialties (MIMS) was the most commonly found (n =101; 64.7%), and 40.4% (n = 63) had internet access. Only 19.2% (n = 30) of the respondents reported getting medicines information directly from pharmaceutical companies, usually through pharmaceutical representatives. Most pharmacists could identify appropriate information resources for drug dosing and side effects but did not fare well for medicine identification, drug interactions and primary research evidence.

Conclusions

The quality of drug information resources in private community pharmacies in Amman is far from optimal. This will affect the quality of information provided to patients and prescribers and have an adverse effect on the role that pharmacists can play in the health system in Jordan.

Email medication counseling services provided by Finnish community pharmacies

BACKGROUND

The importance of email as a mode of communication between medication users and pharmacists is likely to increase. However, little is known about the email medication counseling practices of community pharmacies.

OBJECTIVE

To determine the prevalence of email medication counseling services in Finland and to assess the accuracy and comprehensiveness of responses by pharmacies providing the opportunity for email medication counseling to inquiries related to use of antidepressants.

METHODS

An inventory was made of all Finnish community pharmacies that provided the opportunity for email medication counseling. Data related to the accuracy and comprehensiveness of responses were collected, using a virtual pseudo-customer method with 3 scenarios related to common concerns of patients on antidepressants. Two inquiries were emailed to each pharmacy that provided the opportunity for email medication counseling in January and February 2005. The responses were content analyzed by 2 researchers, using a prestructured scoring system.

RESULTS

Almost one-third (30%, n = 182) of Finnish community pharmacies maintained a working Web site, and 94% of those provided the opportunity for email medication counseling. An online "ask-the-pharmacist" service was offered by 13% (n = 23) of the pharmacies with a Web site. Pharmacies responded to 54% of the email inquiries sent by the virtual pseudo-customers. The response rate and the content score ratio between mean and maximum scores varied among the scenarios. The content score ratio was highest for the scenarios concerning the adverse effects of fluoxetine (0.53, n = 55) and interactions with mirtazapine (0.52, n = 63) and lowest for the scenario related to sexual dysfunction and weight gain associated with citalopram (0.38, n = 52).

CONCLUSIONS

Community pharmacies are potential providers of email medication counseling services. However, more attention should be directed to responding to consumer inquiries and to the content of these responses.

Suitability and readability of consumer medical information accompanying prescription medication samples

OBJECTIVE

To examine readability and formatting characteristics of consumer medication information (CMI) accompanying prescription medication samples.

METHODS

We collected the most commonly used prescription medication samples (n=100) from four out-patient clinics at a large teaching hospital in the Southeastern US. Seventeen percent of samples were not pills/tablets and of such diverse nature (e.g., injections, drops, and creams) that there were not enough in any category to draw conclusions. Therefore, our analyses were limited to 83pill/tablet samples, belonging to 11 drug classes (e.g., cardiovascular, and psychiatric). We noted if CMI was present, and if so we assessed it for how instructions were presented, reading level, text size, format/layout, and comprehensibility.

RESULTS

No CMI was present in 39 (46.9%) samples. In 19 (22.9%), CMI was contained in a package insert and in 25 (30.2%) it was printed on the medication package. Average reading difficulty of CMI was at the 10th grade level (range=6-15) using the Fry formula, and text point size was small (mean 9.9+/-2.2 on package inserts and 9.4+/-2.6 when printed on packages).

CONCLUSIONS

Almost half of samples did not include any type of CMI. For those that had CMI, it was often written at a reading difficulty level higher than the average reading skills of American adults, and the format of most CMI was not optimal for comprehensibility. It is likely that many patients do not understand the instructions accompanying medication samples they receive from clinicians.

PRACTICE IMPLICATIONS

Clinicians should be cognizant of the shortcomings of CMI accompanying medication samples and thereby, distribute them to patients with caution. Manufacturers too should consider revising CMI to comply with low-literacy guidelines.