Introduction

E-pharmacies are websites selling prescription-only medicines and other products including non-prescription and complementary medicines. Consumers can self-select medicines that are often delivered across national and state boundaries, without face-to-face interaction with a health professional. This is the first large-scale study to evaluate the quality of care and information published on global e-pharmacy websites.

Aims and Objectives

We studied whether websites selling medicines to consumers via the Internet supported their safe and appropriate use, by:

• determining the nature of medicines sold via the Internet;
• describing the structural and process characteristics of websites supplying medicines online;
• evaluating the quality of health information published on websites selling medicines;
• examining the provision of advice and exchange of information between e-pharmacy staff and consumers.

We will discuss approaches to safeguarding consumers who buy medicines online, and the potential for e-pharmacy market growth and subsequent impact on the pharmacy profession.

Methods

E-pharmacies were identified using a meta-search engine and the terms 'internet' or 'online' and 'pharmacy', 'pharmacies' and 'medicines'. Quality of information and services provided by e-pharmacies were evaluated using the DISCERN tool and structural indicators, between July and September 2001. As a consumer, pseudoephedrine HCl (30-120mg) and or St John's Wort (100mg+) products were purchased from e-pharmacies using a standard case scenario. Data included the, information exchanged between provider and consumer, product costs, delivery times methods and costs, and customs inspections.

Results

Of the 104 global e-pharmacies, 67% delivered internationally, 42% provided pharmacist's advice, 21% had an unidentified country of origin, 20% advertised prescription-only medicines, 19% sold prescription medicines without a prescription and 12% offered online prescribing. Overall the quality of medicines information was poor or absent. Only 10% of sites rated 4 or 5 on the DISCERN scale of 1 to 5 (1=not useful, 5=useful). Of the 104 e-pharmacies, 27 delivered pseudoephedrine HCl and or St John's Wort to an Australian residential address. Only five e-pharmacies collected relevant patient information, furthermore only three offered advice about a potentially serious drug interaction.

Conclusion

Consumers who buy medicines online risk inadvertent medication misadventures due to the variable services and lack of quality information provided by many e-pharmacies. Consumers are not safeguarded from fraudulent and misleading websites due jurisdictional issues and regulations that lag the development of Internet technologies. Despite these safety concerns and the opposition of some pharmacists, the potential growth of e-pharmacies is likely in the current sociological, political, and economic environment. This potential growth presents opportunities for pharmacists seeking to expand cognitive pharmacy services but will threaten those pharmacists focussed solely on the supply of medicines.