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Since the introduction of the Internet, there has been a revolution in the way that products are marketed and sold to consumers. Pharmaceutical goods are no exception, and online pharmacies or Internet pharmacies have arisen in response. Online pharmacies are businesses which sell medicines including those which require a prescription, on the Internet. It is estimated that 1 in 6 US consumers have bought pharmaceutical drugs online.
Online sales of drugs have grown rapidly, often driven by the lower price point of online pharmacies. It cannot be doubted, however, that a high degree of integrity is required to maintain health standards and fulfil the ethical responsibility to provide optimal care for patients.
Legally, online pharmacies must be licensed in any region where consumers may make a purchase, although the exact regulations vary according to the country or state of practice. Additionally, the physical premises of online pharmacies selling to some countries, such as the United States, must be based in the country to which the sales takes place.
The involvement of a doctor for a consultation with the patient is usually required for all licensed online pharmacies to dispense a prescribed drug. Therefore, an online form of patient-reported symptoms is insufficient in most countries.
Studies have revealed that even prescription drugs are available online without a prescription. Why would users shift to this non-traditional way of supplying their legitimate need for a prescription drug, away from the approved system of a doctor’s office visit, obtaining a prescription and getting it filled at the community pharmacy? In many cases, the process of obtaining and filling a prescription was seen as more expensive and cumbersome than buying the same drug online. The medical system was seen as less responsive to the patient’s needs in the sense of not providing sufficient doses of the required medication. Anonymity was another consideration.
There is no doubt that online pharmacies can be of great benefit for patients in some instances. This is particularly so for individuals who live in rural or remote areas, or for those who may have difficulty in gaining access to a traditional community pharmacy. Online pharmacies can also increase convenience of purchase of medicines, and have an economic benefit for many consumers, regardless of location.
However, online pharmacies are not without their own risks. Of particular concern is the high incidence of counterfeit or sub-optimal quality pharmaceutical goods sold online, when compared to a community pharmacy. In most cases, patients are unable to recognize differences in the appearance of drugs until they feel the effects after the administration of the dose. Packaging or labeling may be misleading or inappropriate. Additionally, the pharmacist-patient interaction is usually less focused or non-existent in an online environment, which could potentially result in misinformed patients and increased likelihood of medication errors. A study has even shown a higher risk of adverse effects when prescription painkillers were purchased without prescription online, as compared to traditional routes of purchase via prescription at a physician’s office. This phenomenon has been postulated to be the effect of unsupervised dosages, the interactions with other medications and the inappropriate conditions of use of these drugs.
The provision of advice to patients about health and the safe dosage, administration, side-effects and interactions of the medications they ask for, whether over-the-counter or on prescription, is one of the central roles of a pharmacist. It is important that this is not compromised with the implementation of the online pharmacy business model.
The way in which advice is offered can vary between different pharmacies. Although most online pharmacies include a written consumer medicine information (CMI) leaflet, it is feared that in practice many patients may not take the time to comprehend the important information in it. Thus a CMI may suffice in some cases, but online pharmacies may need to make additional contact by phone, particularly for complicated cases that are more likely to be associated with potential issues.
Similar to any other business, the success of an online pharmacy hinges on the satisfaction of the patients who make use of their services, because this alone can ensure the ongoing viability of the business. There are several facets that are most essential to provide a positive customer experience:
It is possible for these areas to be handled optimally by an online pharmacy if appropriate care is taken to address the needs of the patients to the same degree, and to maintain the quality of care, that has traditionally been offered by community pharmacists. When customers are satisfied with the service, they will be more likely to seek further care; if they have a negative experience, the success of the online pharmacy is limited.