A cohort study of the service-users of online contraception.

BACKGROUND: In January 2017, the first free service providing oral contraceptive pills (OCPs) ordered online and posted home became available in the London boroughs of Lambeth and Southwark - ethnically and socioeconomically diverse areas with high rates of unplanned pregnancy. There are concerns that online services can increase health inequalities; therefore, we aimed to describe service-users according to age, ethnicity and Index of Multiple Deprivation (IMD) quintile of area of residence and to examine the association of these with repeated use. METHODS: We analysed routinely collected data from January 2017 to April 2018 and described service-users using available sociodemographic factors and information on patterns of use. Logistic regression analysis examined factors associated with repeat ordering of OCPs. RESULTS: The service was accessed by 726 individuals; most aged between 20 and 29 years (72.5%); self-identified as being of white ethnic group (58.8%); and residents of the first and second most deprived IMD quintiles (79.2%). Compared with those of white ethnic group, those of black ethnic group were significantly less likely to make repeat orders (adjusted OR 0.53, 95% CI 0.31 to 0.89; p=0.001), as were those of Asian and mixed ethnic groups. CONCLUSIONS: These are the first empirical findings on free, online contraception and suggest that early adopters broadly reflect the population of the local area in terms of ethnic diversity and deprivation as measured by IMD. Ongoing service development should prioritise the identification and removal of barriers which may inhibit repeat use for black and minority ethnic groups.

Telepharmacy Services: Present Status and Future Perspectives: A Review.

Background and Objectives: The term "telepharmacy" indicates a form of pharmaceutical care in which pharmacists and patients are not in the same place and can interact using information and communication technology (ICT) facilities. Telepharmacy has been adopted to provide pharmaceutical services to underserved areas and to address the problem of pharmacist shortage. This paper has reviewed the multi-faceted phenomenon of telepharmacy, summarizing different experiences in the area. Advantages and limitations of telepharmacy are discussed as well. Materials and Methods: A literature analysis was carried out on PubMed, using as entry term "telepharmacy" and including articles on the topic published between 2012 and 2018. Results: The studies reviewed were divided into three categories of pharmacy practice, namely (1) support to clinical services, (2) remote education and handling of "special pharmacies", and (3) prescription and reconciliation of drug therapies. In general, different telepharmacy services were effective and accompanied by a satisfaction of their targets. Conclusions: Nowadays, the shortage of health personnel, and in particular pharmacists, is a challenging issue that the health systems have to face. The use of a new technology such as telepharmacy can represent a possible option to solve these problems. However, there are unsolved limitations (e.g., legal implications) that make greater diffusion of telepharmacy difficult. Stronger data on the effectiveness of this area of pharmacy care, together with a critical evaluation of its limits, can make actors involved aware about the potentialities of it and could contribute to a larger diffusion of telepharmacy services in the interest of communities and citizens.

Consumers Turning to the Internet Pharmacy Market: Cross-Sectional Study on the Frequency and Attitudes of Hungarian Patients Purchasing Medications Online.

BACKGROUND: During the past two decades, the internet has become an accepted way to purchase products and services. Buying medications online are no exception. Besides its benefits, several patient safety risks are linked to the purchase of medicines outside the traditional supply chain. Although thousands of internet pharmacies are accessible on the web, the actual size of the market is unknown. Currently, there is limited data available on the use of internet pharmacies, the number, and attitude of people obtaining medications and other health products from the internet. OBJECTIVE: This study aims to gather information on the frequency and attitudes of patients purchasing medications online in a nationally representative sample of outpatients. Attitudes towards main supply chain channels, perceived benefits, and disadvantages of influencing online medication purchase are evaluated. METHODS: A cross-sectional explorative study using a personally administered survey was conducted in a representative sample of Hungarian outpatients in 2018. RESULTS: A total of 1055 outpatients completed the survey (response rate 77.23%). The mean age was 45 years, and 456 (43.22%) reported having chronic health conditions. The majority (872/1055, 82.65%) of the respondents were aware that medications could be obtained online, but only 44 (4.17%) used the internet for previous medication purchases. Attitudes towards the different pharmaceutical supply chain retail channels showed significant differences (P<.001), respondents accepted retail pharmacy units as the most appropriate source of medications while rejected internet pharmacies. Respondents were asked to evaluate 9 statements regarding the potential benefits and disadvantages about the online medicine purchase, and based on the computed relative attitude rate there is a weak still significant tendency toward rejection (P<.001). Correspondence of demographic factors, internet usage behavior, and prospective online drug purchase attitude was evaluated. Respondents who use the internet more and purchase goods online will be more likely to buy medications online. Furthermore, youth and education will determine the medication purchase behavior. CONCLUSIONS: Many patients will purchase medications on the internet in the future. Currently, there is an increased risk of patients buying products from illegal sites because these dominate the global online pharmacy market. Consequently, improved patient-provider communication and promotion campaigns are needed to inform the public about the safe use of internet pharmacies, as these initiatives can directly prevent patient safety threats.

The recovery of online drug markets following law enforcement and other disruptions.

INTRODUCTION: Online drug markets operating on the 'darknet' ('cryptomarkets') facilitate the trade of illicit substances at an international level. The present study assessed the longitudinal impact on cryptomarket trading of two major disruptions: a large international law enforcement operation, 'Operation Onymous'; and the closure of the largest cryptomarket, Evolution. METHODS: Almost 1150 weekly snapshots of a total of 39 cryptomarkets were collected between October 2013 and November 2015. Data were collapsed by month and the number of unique vendor aliases operating across markets was assessed using interrupted time series regression. RESULTS: Following both Operation Onymous and the closure of Evolution, significant drops of 627 (p=0.014) and 910 vendors (p<0.001) were observed, respectively. However, neither disruption significantly affected the rate at which vendor numbers increased overall. CONCLUSIONS: Operation Onymous and the closure of Evolution were associated with considerable, though temporary, reductions in the number of vendors operating across cryptomarkets. Vendor numbers, however, recovered at a constant rate. While these disruptions likely impacted cryptomarket trading at the time, these markets appear resilient to disruption long-term.

Comunicação, educação e promoção da saúde na internet

Apesar do progresso na produção de medicamentos, técnicas e procedimentos na área de saúde, os resultados são comprometidos por diferenças de contexto e dificuldade de comunicação entre quem cria e manipula essas tecnologias e seus potenciais beneficiários. Para encurtar as distâncias entre ambos, duas iniciativas são utilizadas: a busca de estratégias mais efetivas de comunicação e as atividades de divulgação científica na área da saúde. Na área de comunicação em saúdetemos a crítica ao difusionismo e na divulgação científica o recurso à educação não-formal como alternativa à pura tentativa de transferência de conhecimentos científicos” do “cientista” para o “leigo”. Em ambos os casos se trabalhava com conceitos que identificam informação à “conteúdo” ou “mensagem” e comunicação à sua transmissão do emissor para o receptor através de um canal. O que se pretende agora é pensar a produção e a construção do conhecimento como um processosocial, superando-se a separação entre “emissor” (ativo) e “receptor” (passivo).Ocorre que as tecnologias de inteligência disponíveis partiam de pressupostos quereproduziam essa separação. Os sistemas simples de comunicação, construídos pelas tecnologias de inteligência precedentes, estruturadas no texto, se organizam em um espaço-tempo determinado, o que transforma qualquer variável espaço-temporal diferente em ruído. Isso aprofunda as diferenças entre culturas, tornando inviável sua convivência, pois a homogeneidade do ambiente é uma necessidade. A hierarquia, a estrutura piramidal, a aculturação dos subordinados, as práticas “transmissionistas” e a divisão entre quem “sabe” e quem “não sabe”, entre ativos e passivos não são males ocasionais, mas características inerentes a esse tipo de sistema.