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 Internhe@lth Project: the Public Health implications of the spread of Internet” Grazia Orizio Lugano, 9 March 2010
Trust and Sources of Health Information The impact of internet and its implications for health care providers l l Arch Intern Med, 2005 Authors Affiliations: United States l l l CDC Geroge Mason University (VA) Universty of North Carolina Harvard University (MASS) 6369 interviews 2
AIMS “To provide nationally representative estimate for: l health-related use of the internet, l level of trust in health information sources, l and preferences for cancer information. ” 3
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RESULTS l Internet: l 63. 0% internet users l e-health l 63. 7% searched for health information 6
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TRUST IN INFIRMATION SOURCES Regressione logistica per valutare l’associazione con le variabili sociodemografiche 8
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CANCER: intention to vs effective behavior 10
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Internet Users in the European Union
AIMS The internhe@lth Project to investigate the public health implications of the spread internet 14
BACKGROUND INFORMATION DEMAND CITIZENS / PATIENTS DOCTORS HEALTH SERVICES DEMAND PROFESSIONAL UPDATING ADVERTISMENT HEALTH ORGANIZATION MARKETING
DOCTORS Drugs Diagnostic Test Medical consultations CITIZENS Internet usage and perception Portals for Doctors Clinical Management Social Networking Health Education WEB Health Marketing HEALTH ORGANIZATIONS
The Internhe@lth: Study Design Pilot study 2007 33 OPs 2009 Drugs analysis Online pharmacies (OPs) monitorage for 2 years 1° step 2007 118 OPs 2008 Economical analisys (100 OPs) 20082009 2008 Questionnaries analysis 57 OPs 2008 31 sites Diagnostic tests websites analysis (2008 -2009) Hospitals websites analysis (2008 -2009) Local Health Authorities websites analysis (2009)
ONLINE PHARMACIES Pilot study: 33 OPs First Survey: 118 OPs 1. 2. 3. Analisis of OPs Economic analysis Online questionnaires analysis Second survey: 175 FO 3. 1. Analysis of the persuasion strategies 18
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BACKGROUND e-health › › Information / knowledge Access to: › › › medical devices diagnostic tests (i. e. , genetic tests) treatment -> drugs WHO: context of counterfeit medicines, defined as “a global public health crisis” FDA: “serious public health risk” Direct to Consumer Advertising › › YES: Patient empowerment NO: It generates demand of medical services
AIMS To investigate offering and advertising of Prescription Only Drugs on the internet l l Trasversal study to obtain an image of online pharmacies characteristics Selling strategies analysis How is consumer’s trust built in the ”protected market” of drugs ? Which kind of guaranties are present to prevent the risks of self-medication?
METHODS WEBSITES SELECTION l l www. google. it Inclusion criteria: l Direct selling sites l By 3 clicks from google l Almost English language l Each site considered only once INTERNET SITES CODING Content analysis › Formal categories › Address declaration › Domain registration › Delivery declared location › Language › Communication channels › Content categories Selling Aspects Selling Arguments Medicines available Disclaimers
PRESCRIPTION REQUIREMENTS
PHYSICAL ADDRESS 66 OP (38%) displayed their physiscal address P=0. 000
PHYSICAL ADDRESS / DOMAIN Address Domain Canada United States Address=Domain Central America 56 %Address=Domain Europe Asia Indian Oceania Australia
DECLARED DELIVERY LOCATION 96 % India NO 58% (69) YES 42% (49)
AVAILABLE DRUGS
SIDE EFFECTS DECLARED (Sildenafil, fluoxetine, tramadol and amitryptiline) Sildenafil Tramadolo NO SIDE EFFECTS DECLARED Fluoxetina Amitriptilina
SIDE EFFECTS DECLARED (Sildenafil, fluoxetine, tramadol and amitryptiline)
QUALITY MARKERS P=0. 000
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
Examples testimonials 42 OPs (36%) (www. rx-giant. com)
Questionnaries analysis (57 websites) – ANAMNESIS ISSUES
Pre-filled in 70% (40)
Questionnaries analysis (57 websites) – DOCTOR INVOLVMENT 53% 19% 63% 21% 57 Numero dei siti web
CONCLUSIONS • • Access to health services Drugs like the other commodities • • • Empowered of empoored? • • l Gap between the information got and the information should be received to make informed health decisions Effects on patient-doctor communication? Legal implications • • Advertisement in an argumentative fashion Selling arguments play on aspects far away from the intrinsic characteristics of the drug Which rules should apply? Drugs quality issues
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
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CONCLUSIONS l l l 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. 49
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