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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

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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
slide3
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

aims the intern he@lth project
AIMSThe [email protected] Project

to investigate

the public healthimplications

of the spread internet

slide15

BACKGROUND

INFORMATION

DEMAND

CITIZENS / PATIENTS

HEALTH SERVICES

DEMAND

PROFESSIONAL

UPDATING

DOCTORS

ADVERTISMENT

HEALTH

ORGANIZATION

MARKETING

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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

slide17

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
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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
slide26

P=0.000

PHYSICAL ADDRESS

66 OP (38%) displayed their physiscal address

slide27

PHYSICAL ADDRESS / DOMAIN

56 %Address=Domain

Canada

UnitedStates

Central America

Europe

Address

Domain

Address=Domain

Oceania

Asia

IndianOcean

Australia

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96 % India

DECLARED DELIVERY LOCATION

NO

58%

(69)

YES

42%

(49)

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Sildenafil

Fluoxetina

Tramadolo

Amitriptilina

SIDE EFFECTS DECLARED

(Sildenafil, fluoxetine, tramadol and amitryptiline)

NO SIDE EFFECTS DECLARED

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SIDE EFFECTS DECLARED

(Sildenafil, fluoxetine, tramadol and amitryptiline)

slide32

P=0.000

QUALITY MARKERS

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SELLING ARGUMENTS

  • 1. Better from us:
    • Economical reasons
    • Privacy issues
    • No prescription
  • 2. Don’t worry:
    • Service quality
    • Drug quality
    • It is legal
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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

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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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