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.

Caracterización del servicio de venta online de medicamentos en las farmacias catalanas durante el periodo 2015-2019 / Characterization of the online sale service of medicines in the catalan pharmacies during the period 2015-2019

INTRODUCCIÓN: En julio de 2015, entró en vigor la normativa de venta a distancia de medicamentos de no prescripción a través de las páginas webs de las oficinas de farmacia, una nueva forma de dispensación y atención farmacéutica. OBJETIVOS: Conocer cuál ha sido el grado de implantación del servicio en las farmacias comunitarias de Cataluña, después de 5 años de inicio de la actividad. MÉTODOS: Estudio descriptivo de las páginas web activas de las farmacias de Cataluña durante el periodo 2015-2019, a partir de la revisión periódica y sistemática de dichas páginas web realizadas por el Departament de Salut. RESULTADOS: En 5 años, un 3,77% de las farmacias comunitarias catalanas disponen de página web activa de venta de medicamentos de no prescripción, porcentaje superior a la media española (2,03%). El año 2015 fue el que registró un mayor número de inicios de actividad, mientras que 2018 y 2019 fueron los que registraron menos inicios de actividad. Asimismo, en 2019 se registró el mayor número de suspensión de páginas web. En relación a las bajas, el 41,67% fueron a petición de la propia farmacia y el resto por resolución administrativa debido a un mantenimiento deficiente. CONCLUSIONES: El servicio de venta online de medicamentos de no prescripción a través de páginas web desde la farmacia comunitaria no ha conseguido una buena implantación desde su entrada en vigor. La tendencia actual es un descenso progresivo de la cobertura del servicio por no aportar un valor añadido, ni a la población ni al farmacéutico

OBJECTIVES: To find out what the degree of implementation of the service has been in community pharmacies in Catalonia, after 5 years of operation. METHODS: It was carried out a descriptive study about the evolution of the number of active web pages of pharmacies in Catalonia during the 2015-2019 period, based on the activity communications made by pharmacies and the systematic review of the web pages made by the Department of Health. RESULTS: After 5 years, 3.77% of the community pharmacies in Catalonia have an active website for the online sale of non-prescription drugs, a higher percentage than the Spanish average (2.03%). 2015 was the year with the highest number of activity starts, while 2018 and 2019 were the years with the least activity starts. In addition, in 2019 it was recorded the largest number of web pages suspensions. In relation to the casualties, 41.67% were at the request of the pharmacy itself and the rest by administrative resolution due to poor maintenance. CONCLUSIONS: The distance selling service of non-prescription drugs through websites from the community pharmacy has not achieved a good implementation since its entry into force and the current trend is a progressive decrease in service coverage for not providing a benefit, neither to the population, nor to the professional pharmaceutical service

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.

The practice of OTC counseling by community pharmacists in Parana, Brazil / La práctica del asesoramiento en OTC por farmacéuticos comunitarios de Paraná, Brasil

Background: In order to provide appropriate advice to the patient at the time of dispensing and over-the-counter (OTC) medication counseling, community pharmacists need access to current and reliable information about medicines. Brazilian pharmacists have assumed new functions such as prescribing medication, in a dependent model, based in protocols. Objective: To examine the practice of community pharmacists in a Brazilian State, focusing on OTC recommendation. Method: A cross-sectional survey of community pharmacists in a state of Brazil was conducted from October 2013 to January 2014, with data collection through a pre-piloted self-administered anonymous survey via Survey Monkey® platform. Following ethical approval, the online instrument was sent to 8,885 pharmacists registered in Parana State, Brazil, focusing on professionals working in community pharmacies. The questionnaire assessed the community pharmacy setting, the search for information, the knowledge of the evidencebased practice, the important factors to consider when recommending an OTC medicine, and the pharmacist prescribing. Responses were imported into SPSS® (version 22.0) for analysis. Nonparametric tests were used to assess the association between responses and demographic information with a significance level less than 5% (p<0.05). Results: Of the pharmacists, 97.4% dispensed medications and counseled patients for a median of six hours per day. Product's efficacy (97%) and adverse effects (62.3%) were the most important factors taken into account when counseling a nonprescription medicine. Few pharmacists knew the meaning of terms related to evidence-based health. Most respondents agreed that pharmacists have the necessary training to prescribe. Conclusion: Over-the-counter medication counseling is a daily practice among Brazilian pharmacists. Learning needs exist for community pharmacists in relation to evidence-based practice. Thus, sources of information with good evidence could be used daily by community pharmacists, especially as regards nonprescription medication counseling (AU)

Antecedentes: Para proporcionar asesoramiento adecuado al paciente en la dispensación de medicamentos over-the-counter (OTC), los farmacéuticos comunitarios necesitan acceso a información actual y fiable sobre medicamentos. Los farmacéuticos brasileños han asumido nuevas funciones, tales como la prescripción de la medicación, en un modelo independiente basado en protocolos. Objetivo: Examinar la práctica de los farmacéuticos comunitarios en un estado de Brasil, centrándose en las recomendaciones de OTC. Métodos: Se realizó un estudio transversal de farmacéuticos comunitarios en un estado de Brasil entre octubre 2013 y enero 2014, con recogida de datos mediante un cuestionario auto-administrado, pre-pilotado y anónimo en una plataforma Survey Monkey®. Después de la aprobación ética, se envió el instrumento online a 8.885 farmacéuticos registrados en el estado de Paraná (Brasil), centrándose en los profesionales que trabajan en farmacia comunitaria. El cuestionario evaluaba el establecimiento de la farmacia comunitaria, la busca de información, el conocimiento de las prácticas basadas en la evidencia, los factores importantes a considerar cuando se recomienda un medicamento OTC, y la prescripción del farmacéutico. Las respuestas se importaron a SPSS® (versión 22.0) para su análisis. Se usaron pruebas no paramétricas para evaluar la asociación entre respuestas y la información demográfica con un nivel de significancia de menos del 5% (p<0,05). Resultados: El 97,4% de los farmacéuticos dispensaba medicamentos y aconsejaba a pacientes durante una mediana de seis horas por día. Los factores más importantes a tener en cuenta cuando se aconsejaba un medicamento sin receta eran la eficacia del producto (97%) y los efectos adversos (62,3%). Pocos farmacéuticos conocían el significado de los términos relacionados con la práctica basada en la evidencia. La mayoría de los respondentes estaban de acuerdo con que los farmacéuticos tienen la formación necesaria para prescribir medicamentos. Conclusión: El asesoramiento en medicamentos overthe- counter es una práctica diaria entre los farmacéuticos brasileños. Existen necesidades formativas de los farmacéuticos comunitarios en relación a la práctica basada en la evidencia. Así, los farmacéuticos comunitarios podrían usar a diario las fuentes de información con buena evidencia, especialmente relativas al asesoramiento de medicación sin receta (AU)

La Farmacia española y el comercio electrónico / Electronic Commerce and Spanish Pharmacies

Objetivo: Analizar el comercio electrónico de las farmacias online españolas, teniendo en cuenta la normativa legal de la venta por Internet de medicamentos. Material y métodos: Selección de las diez farmacias que venden en Internet mejor posicionadas de forma natural en el motor de búsqueda Google y utilización de las mejores herramientas online gratuitas para el análisis de cada uno de los sitios web de las farmacias seleccionadas. Resultados y conclusiones: Las farmacias objeto del estudio presentan un nivel de SEO elevado, al igual que de seguridad, usabilidad y visibilidad, con diseños y arquitecturas web muy similares, mostrando carencias en la accesibilidad y adaptación de sus diseños web al comercio electrónico móvil (AU)

Aims: electronic commerce of selected Spanish pharmacies is analized taking into account the legal aspects of the Internet sales of medicines. Material and methods: selection of ten top natural ranked pharmacies that sell in Internet better positioned naturally in Internet search engine Google and use of the best free online tools for the analysis of each of the web sites selected pharmacies. Results and conclusions: The pharmacies under study exhibit a high level of SEO, security, usability and visibility, with very similar designs and web architectures but show gaps in accessibility and adaptation of web design for mobile commerce (AU)

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.