Characteristics of direct-to-consumer platforms offering erectile dysfunction treatment.

Background: Due to the sensitivity and potential embarrassment of discussing erectile dysfunction (ED) in person, men are seeking treatment online. Aims: We sought to compare offerings of direct-to-consumer (DTC) platforms for ED treatment with respect to consultation, pricing, services, and privacy policy. Methods: Google was queried to identify DTC platforms offering ED treatment with the keywords: "telehealth erectile dysfunction," "telemedicine erectile dysfunction," and "online erectile dysfunction." Inclusion criteria were as follows: serving a majority of U.S. states, existing online only, providing both the consultation and prescription for phosphodiesterase type 5 inhibitors, and delivering the prescription to the patient. Results: Fifteen DTC platforms met criteria. Ten provided free consultations; 4 bundled the consultation fee with the first month of the prescription, with 1 of these functioning as a subscription service. Fourteen (93%) relied on online intake forms and 10 (67%) advertised review by the prescriber within 2 business days. Only 4 (27%) platforms explicitly advertised physician-only consults. Direct contact with the prescriber would only occur if needed or if required by state law at 8 (53%) platforms. Purchasing sildenafil and tadalafil was advertised on all platforms. Minimum prices of sildenafil ranged from $0.50 to $35/pill (mean $5.16/pill, median $2.65/pill); tadalafil ranged from $0.50 to $9.80/pill (mean $4.70/pill, median $3.21/pill). In addition to ED therapy, 13 (86%) platforms offered treatment for other men's health issues. All platforms included a website privacy policy, but only 10 (67%) mentioned Health Insurance Portability and Accountability Act compliance, with 2 of these claiming to not be covered entities. Conclusion: Although DTC platforms are transparent with phosphodiesterase type 5 inhibitor medication and subscription pricing information, few offer direct contact with a physician to further discuss issues related to ED after completion of the online intake form. For comprehensive evaluation of ED in Health Insurance Portability and Accountability Act-compliant settings, in-person or telemedicine visits should be arranged with men's physicians.

An Online Investigation Into Direct-to-Consumer Men's Health Clinics: The Who, What, and Where.

OBJECTIVE: To characterize direct-to-consumer (DTC) men's health clinics by reviewing their online content. Increasing numbers of patients are seeking treatment for erectile dysfunction (ED) and hypogonadism from DTC "men's health" clinics. Treatments are often used off-label, with lack of transparency of provider credentials and qualifications. METHODS: We identified DTC Men's Health Clinics in the United States by internet search by state using the terms, "Men's Health Clinic," and "Low T Center." All stand-alone clinics were reviewed. RESULTS: Two hundred and twenty-three clinics were reviewed, with 147 (65.9%) offered ED treatments and 196 (87.9%) offering testosterone replacement, and 120 (53.8%) offering both ED treatment and testosterone replacement. Of those clinics offering ED treatments, 93 (63.3%) advertised shockwave therapy and 84 (57.1%) PRP therapy. There were 56 (38%) who offered shockwave therapy and PRP. ICI was significantly more likely to be offered if there was a urologist on staff (p <.001). Clinic providers represented 20 different medical and alternative medicine specialties. Internal medicine was most common (17.4%), followed by family medicine (11.1%). A nonphysician (nurse practitioner or physician assistant) was listed as the primary provider in 10 clinics (4.5%) and 45 clinics (20.1%) did not list their providers. Urologists were listed as the primary provider in 10.3% of clinics. A naturopathic provider was listed as a staff member in 22 (11.6%) of clinics. CONCLUSION: There is significant heterogeneity and misinformation available to the public regarding men's health. Familiarity with and insight into practice patterns of "men's health" clinics will help provide informed patient care and counseling.

Can Digital Instruments Like the Macula-App Support AMD Therapy? / Können digitale Instrumente wie die Makula-App die AMD-Therapie unterstützen?

BACKGROUND: A long lasting and continuous anti VEGF-therapy represents a gold standard in nAMD treatment to maintain and stabilize vision in the individual patient. Disease Management represents a daily life challenge for patients and relatives and "Real-life" clinical outcomes of patients treated with IVOM therapy are often inferior to results from randomized clinical trials. After their diagnosis, AMD-patients undergo individualized long-term therapeutic approaches. An important success factor is, that this care is patient centered and provided continuously. This study aimed at evaluating, whether digital tools, such as Makula-App 1.0 developed by the AMD-Netz can support AMD patients. PATIENTS AND METHODS: The results of a user survey integrated in the Makula-App 1.0 (n = 110) as well as the results of an additional survey on the topic of "Digital appointment management in IVOM therapy" by ophthalmologists (n = 54) and patients (n = 60) were analysed with respect to use and acceptance of the Makula-App. RESULTS: The survey revealed: 79% of Makula-App user rely on the information presented, 71% perceive the device helpful for their daily life and 80% would recommend the device. 52% of ophthalmologists and 65% of patients regard clear benefits of future digital tools for patient adherence. A digital appointment management function is rated as important by 82% of ophthalmologists. CONCLUSIONS: User perceived Makula-App 1.0 as well as its future development options as beneficial especially for the management of appointment arrangements but also as information tool. Ophthalmologists confirm the importance and usefulness of devices such as Makula-App 1.0 with respect to an optimized management of appointments and an improved patient adherence. These promising results support the future development of a Makula-App 2.0 platform, providing interfaces for an information exchange between patient and treating ophthalmologist.

Is Opioid-free Post-Vasectomy Analgesia a Pain? A Single Surgeon Experience.

OBJECTIVE: To determine the impact of transitioning from opioid to non-opioid analgesia post-vasectomy on unplanned opioid prescriptions and health encounters. METHODS: A retrospective review for patients who underwent vasectomy from October 2018 through December 2019 was performed. Beginning February 1st, 2019, patients were counseled to take scheduled acetaminophen and ibuprofen in lieu of acetaminophen with codeine, with an opioid prescription only provided upon request. Analysis was performed comparing 200 consecutive patients before and after this transition. Baseline patient characteristics, unplanned postoperative encounters for pain within 30 days of vasectomy, and associated narcotic prescriptions were compared between groups. RESULTS: 400 patients were included, consisting of 200 patients pre and 200 patients postintervention. There were no differences in socioeconomic characteristics between groups. No differences between the pre- and postintervention groups were observed in terms of generating telephone calls to clinic (9% vs 11%, P = .5), clinic visits (2.5% vs 2.5%, P = 1), or ED visits (0% vs 1%), P = .5) for the pre and postintervention cohorts, respectively. CONCLUSIONS: Patients that are not prescribed opioids after vasectomy do not generate additional phone calls, clinic, or ED visits compared to those that were routinely prescribed prior to our institutional change. We have permanently discontinued the routine use of opioids for post-vasectomy analgesia. Other physicians performing vasectomy should consider making this change as well.