Section of Hygiene, Epidemiology and Public Health – University of Brescia (Italy)
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Section of hygiene epidemiology and public health university of brescia italy

Section of Hygiene, Epidemiology and Public Health – University of Brescia (Italy)

Institute of Communication and Care – University of Lugano (Switzerland)Research Centre on “Quality and Technology Assessment, Governance and Communication Strategies in Health Systems” – University of Brescia (Italy)

“The [email protected] Project:

the Public Health implications

of the spread of Internet”

GraziaOrizio

Lugano, 9 March 2010


Section of hygiene epidemiology and public health university of brescia italy

Trust and SourcesofHealth Information

The impact of internet and itsimplicationsforhealth care providers

  • ArchInternMed, 2005

  • AuthorsAffiliations: UnitedStates

    • CDC

    • GerogeMasonUniversity (VA)

    • Universtyof North Carolina

    • Harvard University (MASS)

  • 6369 interviews


Section of hygiene epidemiology and public health university of brescia italy

AIMS

“Toprovidenationallyrepresentative estimate for:

  • health-relateduseof the internet,

  • levelof trust in health information sources,

  • and preferencesforcancer information.”


Results

RESULTS

  • Internet:

    • 63.0% internet users

  • e-health

    • 63.7% searchedforhealth information


Trust in infirmation sources

TRUST IN INFIRMATION SOURCES

Regressione logistica per valutare l’associazione con le variabili sociodemografiche


Cancer intention to vs effective behavior

CANCER:intentiontovs effectivebehavior


Section of hygiene epidemiology and public health university of brescia italy

Internet Users in the European Union


Aims the intern he@lth project

AIMSThe [email protected] Project

to investigate

the public healthimplications

of the spread internet


Section of hygiene epidemiology and public health university of brescia italy

BACKGROUND

INFORMATION

DEMAND

CITIZENS / PATIENTS

HEALTH SERVICES

DEMAND

PROFESSIONAL

UPDATING

DOCTORS

ADVERTISMENT

HEALTH

ORGANIZATION

MARKETING


Section of hygiene epidemiology and public health university of brescia italy

DOCTORS

WEB

Drugs

Diagnostic Test

Medical consultations

Clinical Management

Social Networking

Health Education

Internet usage and perception

Portals for Doctors

Health Marketing

CITIZENS

HEALTH

ORGANIZATIONS


Section of hygiene epidemiology and public health university of brescia italy

The [email protected]:

Study Design

2009

Drugsanalysis

Pilotstudy

Online pharmacies (OPs) monitoragefor 2 years

1° step 2° step

2007

33 OPs

2007

118 OPs

2008 Economicalanalisys (100 OPs)

2008-2009

2008

Questionnariesanalysis 57 OPs

2008

31 sites

Diagnostictestswebsitesanalysis (2008-2009)

Hospitalswebsitesanalysis

(2008-2009)

LocalHealthAuthoritieswebsitesanalysis (2009)


Online pharmacies

ONLINE PHARMACIES

  • Pilotstudy: 33 OPs

  • First Survey: 118 OPs

    • AnalisisofOPs

    • Economicanalysis

    • Online questionnairesanalysis

  • Secondsurvey: 175 FO

    • Analysisof the persuasionstrategies


Background

BACKGROUND

  • e-health

    • Information / knowledge

    • Access to:

      • medicaldevices

      • diagnostictests (i.e., genetictests)

      • treatment -> drugs

    • WHO: context of counterfeit medicines, defined as “a global public health crisis”

    • FDA: “seriouspublic health risk”

  • Directto Consumer Advertising

    • YES: Patientempowerment

    • NO: Itgeneratesdemandofmedicalservices


Section of hygiene epidemiology and public health university of brescia italy

AIMS

To investigate offering and advertising ofPrescriptionOnlyDrugs on the internet

  • Trasversalstudytoobtainanimageof online pharmaciescharacteristics

  • Sellingstrategiesanalysis

  • Howis consumer’s trust built in the ”protected market” ofdrugs ?

  • Whichkindofguaranties are presenttoprevent the risksofself-medication?


Methods

INTERNET SITES CODING

  • Contentanalysis

    • Formal categories

      • Address declaration

      • Domain registration

      • Delivery declared location

      • Language

      • Communication channels

  • Content categories

    • Selling Aspects

    • Selling Arguments

    • Medicines available

    • Disclaimers

METHODS

WEBSITES SELECTION

  • www.google.it

  • Inclusion criteria:

    • Direct selling sites

    • By 3 clicks from google

    • Almost English language

    • Each site considered only once


Prescription requirements

PRESCRIPTION REQUIREMENTS


Section of hygiene epidemiology and public health university of brescia italy

P=0.000

PHYSICAL ADDRESS

66 OP (38%) displayed their physiscal address


Section of hygiene epidemiology and public health university of brescia italy

PHYSICAL ADDRESS / DOMAIN

56 %Address=Domain

Canada

UnitedStates

Central America

Europe

Address

Domain

Address=Domain

Oceania

Asia

IndianOcean

Australia


Section of hygiene epidemiology and public health university of brescia italy

96 % India

DECLARED DELIVERY LOCATION

NO

58%

(69)

YES

42%

(49)


Section of hygiene epidemiology and public health university of brescia italy

AVAILABLE DRUGS


Section of hygiene epidemiology and public health university of brescia italy

Sildenafil

Fluoxetina

Tramadolo

Amitriptilina

SIDE EFFECTS DECLARED

(Sildenafil, fluoxetine, tramadol and amitryptiline)

NO SIDE EFFECTS DECLARED


Section of hygiene epidemiology and public health university of brescia italy

SIDE EFFECTS DECLARED

(Sildenafil, fluoxetine, tramadol and amitryptiline)


Section of hygiene epidemiology and public health university of brescia italy

P=0.000

QUALITY MARKERS


Section of hygiene epidemiology and public health university of brescia italy

SELLING ARGUMENTS

*

*

*

*

*

*


Section of hygiene epidemiology and public health university of brescia italy

SELLING ARGUMENTS

  • 1. Better from us:

    • Economical reasons

    • Privacy issues

    • No prescription

  • 2. Don’t worry:

    • Service quality

    • Drug quality

    • It is legal


Section of hygiene epidemiology and public health university of brescia italy

Want to give a try?


Examples www mycanadapharmacy info

Examples(www.mycanadapharmacy.info)


Section of hygiene epidemiology and public health university of brescia italy

Sales and induced demand


Section of hygiene epidemiology and public health university of brescia italy

Free offer of not required drugs


Section of hygiene epidemiology and public health university of brescia italy

Confiscation policy


Examples testimonials 42 ops 36 www rx giant com

Examplestestimonials42 OPs (36%)(www.rx-giant.com)


Questionnaries analysis 57 websites anamnesis issues

Questionnariesanalysis(57 websites) – ANAMNESIS ISSUES


Pre filled in 70 40

Pre-filled in70% (40)


Questionnaries analysis 57 websites doctor involvment

Questionnariesanalysis(57 websites) – DOCTOR INVOLVMENT

53%

19%

63%

21%

57

Numero dei siti web


Section of hygiene epidemiology and public health university of brescia italy

Access tohealthservices

Drugslike the othercommodities

Advertisement in anargumentative fashion

Sellingarguments play on aspects far awayfrom the intrinsiccharacteristicsof the drug

Empoweredofempoored?

Gap between the information got and the information shouldbereceivedtomakeinformedhealthdecisions

Effects on patient-doctorcommunication?

Legalimplications

Whichrulesshouldapply?

Drugsqualityissues

CONCLUSIONS


Section of hygiene epidemiology and public health university of brescia italy

Which strategies to face the issue?

There is no shared international regulation so far

A law enforcement appproach is costly and few effective

Health education seems to be the winning plan

CONCLUSIONS


Conclusions

CONCLUSIONS

  • The prescription has a value on the market. A consumer who wants to buy a drug without prescription has to pay a higher price.

  • The unit cost of the active principle decreases with quantity; this may be due to decreasing marginal cost, but it may also suggest a strong demand inducement effect

  • Active principles that do not originate from the US/Europe/Canada, because the drug is shipped from elsewhere, cost less. The shipping origin may be related to the quality of the drug sold.


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