Surfing, self-medicating and safety: buying non-prescription and complementary medicines via the internet

OBJECTIVE

To examine whether the sale of medicines via the internet supports their safe and appropriate use.

DESIGN

e-Pharmacy websites were identified using key words and a metasearch engine and the quality of information published on these websites was surveyed using the DISCERN tool. A case scenario and internet pharmacy practice standards were also used to evaluate the quality of care delivered.

SETTING AND PARTICIPANTS

Between July and September 2001 104 websites were surveyed and 27 sent either Sudafed (pseudoephedrine HCl), St John's wort products, or both to a residential address in Melbourne, Australia.

MAIN OUTCOME MEASURES

Quality of health information (DISCERN ratings), information exchanged between e-pharmacy staff and consumers, and product and delivery costs.

RESULTS

Of 104 e-pharmacies from at least 13 different countries, 63 websites provided some health information but overall the quality of the information was poor. Only three website operators provided adequate advice to consumers to avoid a potential drug interaction. The costs for a daily dose of pseudoephedrine HCl (240 mg) ranged from 0.81 Australian dollars to 3.04 Australian dollars, and delivery costs from 3.28 Australian dollars to 62.70 Australian dollars.

CONCLUSION

Consumers who self-select medicines from websites have insufficient access to information and advice at the point of ordering and on delivery to make informed decisions about their safe and appropriate use.

Specialized medical search-engines are no better than general search-engines in sourcing consumer information about androgen deficiency

BACKGROUND

The Internet provides consumers with access to online health information; however, identifying relevant and valid information can be problematic. Our objectives were firstly to investigate the efficiency of search-engines, and then to assess the quality of online information pertaining to androgen deficiency in the ageing male (ADAM).

METHODS

Keyword searches were performed on nine search-engines (four general and five medical) to identify website information regarding ADAM. Search-engine efficiency was compared by percentage of relevant websites obtained via each search-engine. The quality of information published on each website was assessed using the DISCERN rating tool.

RESULTS

Of 4927 websites searched, 47 (1.44%) and 10 (0.60%) relevant websites were identified by general and medical search-engines respectively. The overall quality of online information on ADAM was poor. The quality of websites retrieved using medical search-engines did not differ significantly from those retrieved by general search-engines.

CONCLUSION

Despite the poor quality of online information relating to ADAM, it is evident that medical search-engines are no better than general search-engines in sourcing consumer information relevant to ADAM.

Quality of global e-pharmacies: can we safeguard consumers?

OBJECTIVE

E-pharmacies are web sites selling prescription-only medicines and other products including non-prescription and complementary medicines to consumers via the internet. This study aims to evaluate the quality of global e-pharmacies, discuss whether e-pharmacies support the safe and appropriate use of medicines, and consider how we can protect consumers in the future.

METHODS

A survey of public information published on global e-pharmacy web sites was conducted between July and September 2001. We used a meta-search engine, Copernic, and the search terms of 'online' or 'internet', and 'pharmacy', 'pharmacies' and 'medicines' to identify a sampling frame of global e-pharmacies. We surveyed all web sites in the sampling frame except those under construction or only offering electronic refills, members-only and non-English web sites. Survey data included country of origin, range of medicines sold, prescription requirements, availability of online medical consultations and pharmacists' advice, quality accreditation seals, policies and advertisements.

RESULTS

E-pharmacies operated in at least 13 countries; however, the country of origin could not be identified for 22 web sites. Twenty web sites (19%) appeared to supply prescription-only medicines with no prescription required. Only 12% of e-pharmacies displayed quality accreditation seals. We observed information published on e-pharmacy web sites that potentially undermines the safe and appropriate use of medicines.

CONCLUSION

Safeguarding consumers and ensuring the quality of web sites that sell medicines across state and national boundaries is both complex and difficult. Strategies to improve the quality of e-pharmacies include independent third-party regulation of providers, evaluation and enforcement of sanctions in cases of dissemination of fraudulent or harmful information and practices, self-regulation and consumer education. The development of internet regulatory technologies themselves and the resolution of jurisdictional issues offer future solutions but international co-operation is vital.

Smoking cessation and the Internet: a qualitative method examining online consumer behavior

BACKGROUND

Smoking is a major preventable cause of disease and disability around the world. Smoking cessation support-including information, discussion groups, cognitive behavioral treatment, and self-help materials-can be delivered via the Internet. There is limited information about the reasons and methods consumers access smoking cessation information on the Internet.

OBJECTIVES

This study aims to determine the feasibility of a method to examine the online behavior of consumers seeking smoking cessation resources. In particular, we sought to identify the reasons and methods consumers use to access and assess the quality of these resources.

METHODS

Thirteen participants were recruited via the state-based Quit smoking cessation campaign, operated by the Victorian Cancer Council, in December 2001. Online behavior was evaluated using semi-structured interviews and Internet simulations where participants sought smoking cessation information and addressed set-case scenarios. Online interaction was tracked through pervasive logging with specialist software.

RESULTS

Thirteen semi-structured interviews and 4 Internet simulations were conducted in January 2002. Participants sought online smoking cessation resources for reasons of convenience, timeliness, and anonymity-and because their current information needs were unmet. They employed simple search strategies and could not always find information in an efficient manner. Participants employed several different strategies to assess the quality of online health resources.

CONCLUSIONS

Consumer online behavior can be studied using a combination of survey, observation, and online surveillance. However, further qualitative and observational research is required to harness the full potential of the Internet to deliver public health resources.

Prevalence of South Australia's online health seekers

OBJECTIVE

To determine the proportion of South Australians accessing online health care information, predictive characteristics of online health seekers, nature of the information sought and consumer behaviour.

METHODS

A probability-based survey of 3,027 South Australians, aged 15 years and older, as part of the Spring 2000 South Australian Health Omnibus.

RESULTS

Internet access decreases with age, while the prevalence of online health seekers is constant (26% to 28%) among people aged between 15 and 54 years. Predictive characteristics of online health seekers include gender, age, education and income. Most commonly sought information is the cause or description of disease (60%). Consumers use online health information as a second opinion (19%), discuss it with their doctor or pharmacist (16%), or change their health care management (11%).

CONCLUSIONS

The Australian prevalence of online health seekers is likely to be slightly higher than 21%.

IMPLICATIONS

The Intemet can deliver preventative and clinical health information to a critical mass of Australians, but poorer and older Australians may be unable to access it.

Do Internet interventions for consumers cause more harm than good? A systematic review

OBJECTIVE

To systematically review the effect of consumer use of online health information on decision-making, attitudes, knowledge, satisfaction and health outcomes and utilization.

SEARCH STRATEGY

Electronic databases searched included the Cochrane Controlled Trials Register, MEDLINE, PREMEDLINE (to 14 March 2001), CINAHL, Australian Medical Index, Health and Society, National Institutes of Health Clinical Trials Database and CenterWatch.

INCLUSION CRITERIA

All post-1995 comparative studies (including controlled studies, before and after studies, and interrupted time series analyses) of Internet users vs. non-Internet users and other communications mediums, and Internet characteristics such as e-mail vs. other communication mediums, were included. Outcomes included consumer decision-making, attitudes, knowledge, satisfaction and measurable changes in health status or health utilization.

DATA EXTRACTION AND SYNTHESIS

One reviewer screened all papers then two reviewers independently assessed studies against the selection criteria and any discrepancies were resolved by discussion with a third reviewer. No attempt was made to combine the data for further statistical analysis.

MAIN RESULTS

We identified 10 comparative studies. Studies evaluated the effectiveness of using the Internet to deliver a smoking cessation programme, cardiac and nutrition educational programmes, behavioural interventions for headache and weight loss, and pharmacy and augmentative services. All studies showed some positive effects on health outcomes, although the methodological quality of many studies was poor.

CONCLUSIONS

Despite widespread consumer Internet use to obtain health-care information, there is almost a complete lack of evidence of any effects this may have on health outcomes.

'Pharmacist only' medicines

While there is a global trend to switch medicines from prescription to non-prescription status, Australia has created a unique schedule of 'pharmacist only medicines' (POM). Such medicines may provide consumers with greater choice and control of health care decisions. However, the impact of these actions has not been evaluated. Public health concerns including the appropriate use of medicines, awareness and equity of access to POM, and access to information on POM are discussed using antifungal vaginal products as an example. The National Medicines Policy advocates a partnership approach to achieve improved health outcomes by the quality use of medicines, however currently no data on POM are available. Recommendations include changes to legislation, public health data collection and the provision of quality information including pharmaceutical and non-pharmaceutical interventions.