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)

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


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


AIMS

“Toprovidenationallyrepresentative estimate for:

  • health-relateduseof the internet,

  • levelof trust in health information sources,

  • and preferencesforcancer information.”


RESULTS

  • Internet:

    • 63.0% internet users

  • e-health

    • 63.7% searchedforhealth information


TRUST IN INFIRMATION SOURCES

Regressione logistica per valutare l’associazione con le variabili sociodemografiche


CANCER:intentiontovs effectivebehavior


Internet Users in the European Union


AIMSThe [email protected] Project

to investigate

the public healthimplications

of the spread internet


BACKGROUND

INFORMATION

DEMAND

CITIZENS / PATIENTS

HEALTH SERVICES

DEMAND

PROFESSIONAL

UPDATING

DOCTORS

ADVERTISMENT

HEALTH

ORGANIZATION

MARKETING


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


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

  • Pilotstudy: 33 OPs

  • First Survey: 118 OPs

    • AnalisisofOPs

    • Economicanalysis

    • Online questionnairesanalysis

  • Secondsurvey: 175 FO

    • Analysisof the persuasionstrategies


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


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?


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


P=0.000

PHYSICAL ADDRESS

66 OP (38%) displayed their physiscal address


PHYSICAL ADDRESS / DOMAIN

56 %Address=Domain

Canada

UnitedStates

Central America

Europe

Address

Domain

Address=Domain

Oceania

Asia

IndianOcean

Australia


96 % India

DECLARED DELIVERY LOCATION

NO

58%

(69)

YES

42%

(49)


AVAILABLE DRUGS


Sildenafil

Fluoxetina

Tramadolo

Amitriptilina

SIDE EFFECTS DECLARED

(Sildenafil, fluoxetine, tramadol and amitryptiline)

NO SIDE EFFECTS DECLARED


SIDE EFFECTS DECLARED

(Sildenafil, fluoxetine, tramadol and amitryptiline)


P=0.000

QUALITY MARKERS


SELLING ARGUMENTS

*

*

*

*

*

*


SELLING ARGUMENTS

  • 1. Better from us:

    • Economical reasons

    • Privacy issues

    • No prescription

  • 2. Don’t worry:

    • Service quality

    • Drug quality

    • It is legal


Want to give a try?


Examples(www.mycanadapharmacy.info)


Sales and induced demand


Free offer of not required drugs


Confiscation policy


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


Questionnariesanalysis(57 websites) – ANAMNESIS ISSUES


Pre-filled in70% (40)


Questionnariesanalysis(57 websites) – DOCTOR INVOLVMENT

53%

19%

63%

21%

57

Numero dei siti web


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


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

  • 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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