Arzneimittelinformationen für Apotheker und Patienten : Analyse der Anforderungen, des Angebots, der Nutzung und der Rolle des Internets

Background: The transformation of pharmacy practice from the focus on drug manufacturing to a patient-centred focus as well as the “informed patient” have influenced the use, the needs and requirements of pharmacists and patients regarding drug information. Important elements of these developments are the information- and communicationtechnologies, especially the Internet and eHealth. High quality, easy accessible drug information is essential when dealing with drugs. Objective: To analyze the current use, needs and wishes regarding drug information by pharmacists and patients. A special focus was on the role of the Internet. The different investigations should help to set the basis for drug information sources tailored to the needs of the pharmacists and contribute to the best possible patient care. Additionally, the basis for appropriate continuing education should be established. Methods: This PhD thesis is structured as a “Paper-Dissertation” which consists of two articles and three original articles. Next to the five articles, there is an introduction, methods, discussion and conclusions. Expert survey: The expert-survey (inspired by the Delphi-Method) with 71 experts was conducted as an e-mail survey. The experts were confronted with two rounds of questions (three open and four question with pre-set responses). They were asked about the possible impact future developments could have on pharmacy practice and on drug information sources and information needs. The answers were summarized anonymously. Use of drug information by community pharmacists: Postal survey to a stratified random sample of 223 community pharmacies from the German speaking part of Switzerland. The 48-item questionnaire consisted of a total of 48 questions addressing the following topics: 1) Use of drug information sources in daily practice. 2) Use of drug information sources to solve specific drug-related problems. 3) Pharmacists’ perspective of the professional future. 4) Infrastructure of the pharmacy. 5) Demographic data. In addition, a telephone-survey to a random sample of 20 nonresponders was performed in order to test for non-response bias. Use of drug information by patients: The survey was performed using a structured interview in which patients visiting nine different community pharmacies were asked questions by pharmacy students trained to apply this tightly structured interview. The interview consisted of a total of 41 questions. Topics addressed included: A.) Patients’ needs for drug information. B.) Specific use of drug information sources to address drug related problems. C) The use of new information technologies. D.) Demographic data. Nonresponders were characterised as well. Pharmacies on the Internet: A) Internet-search to determine the number of Swiss German pharmacies that are present on the Internet. B) To investigate the responses to an e-mail request for advice using a case of intermenstrual bleedings during concomitant intake of St. John’s wort and an oral contraceptive. C.) Internet-based survey to explore the Swiss German pharmacies’ experiences and plans regarding their websites. Focus Group Discussion: The discussion was held among the five members of the project group and was lead by a moderator who addressed the following topics: Drug information / IT / Community pharmacy / Patient. The discussion was tape recorded and later summarized. Results: Expert survey: The community pharmacy has to transform more into an information centre. Individual patient care will be important. The pharmacists need appropriate drug information sources which have to be easily accessible, up to date, trustworthy and address the needs of the patients who demand fast access to information. The pharmacists need to be able to support patients in interpreting the information, they need to be familiar with IT and they need communication skills. Continuing professional development programmes are among the most important tools for pharmacists. Use of drug information by pharmacists: A total of 108 pharmacists (response rate 48%) reported that the official Swiss drug reference book is still the most popular source of drug information. The Internet as a source of drug information is of minor importance, even though 88% of the pharmacies have Internet access. Deficits in drug information were reported for: Paediatrics, phytotherapy, drugs during pregnancy/lactation, therapy guidelines. According to 35% of the pharmacists, the pharmacy has to transform into an information center; 63% do not expect that pharmacists will be increasingly active in the field of diagnostics. Use of drug information by patients: The analysis of 203 (response rate: 62%) interviews revealed that the patients expressed great needs regarding drug information comprising most aspects of drug use. However, 25% of the patients want to be given comprehensive information about drugs by pharmacists only upon their own demand. Pharmacists remain the most preferred source of drug information. 75% are happy with the available information sources; deficits were expressed regarding counselling in pharmacies and the package insert. 49% of the patients use the Internet. 61% of the Internet users retrieve information concerning health topics online. 2% of the Internet users have so far purchased drugs online. Pharmacies on the Internet: By April of 2003, 373 (44%) community pharmacies were present on the Internet. Of the 107 (response rate 58%) pharmacies answering the survey questions, 46% are present on the Internet since 1-2 years, 33% of the websites are part of a pharmacy group’s web portal, 31% of the pharmacies plan to expand their Internet appearance in the future, 40% provide e-commerce-services (non-pharmaceutical products are the most popular). A lot of pharmacists have little knowledge regarding the legal situation of e-commerce with drugs in Switzerland. 84% responded to the e-mail request for advice; 73% were received within 24 hours, 9% ignored the problem and gave no advice. Focus Group Discussion: The participants mentioned, that there is a danger that there could be a gap in the future between the expectations and needs of the patients regarding counselling in pharmacies and the amount of information they get from pharmacists. Pharmacists need drug information that is short and tailored to their needs. Discussion and Conclusions: The use of the available drug information sources has not significantly changed since the last survey (1986) in Switzerland. Pharmacists still primarily use traditional sources of information. Pharmacists seem to lack knowledge about the variety of the available drug information sources. They should be informed in continuing education seminars about the newest available drug information sources and how to use them. Pharmacists need information sources that are specifically tailored to their needs and that are relevant, short and reliable. The Internet needs to be considered as an important source of drug information. The skills on how to retrieve and interpret information for the individual patient situation are essential. To become a contact point for all sorts of health related problems, the community pharmacists need to be able to support patients in interpreting the fast growing amount of information. As patients are very demanding in their needs for drug information, it remains a continuous challenge for the community pharmacists to meet the individual expectations of the patients and to individually target their information services. Even though a large part of the patients know the Internet as a possible source of drug information, it is still rarely (pharmacists do not use it often either) used to retrieve health related information. The widespread access to the Internet in community pharmacies is a good starting point to use the new technology for a trend setting pharmacy practice. The new information technologies will become tools for more efficiency regarding administrative manners, continuing education, communication and exchange of data among health professionals, health insurance companies and drug manufacturers. There is a gap regarding the legal situation of ecommerce with drugs (e-commerce with drugs is generally prohibited) and the offerings (40% of the pharmacies on the Internet offer e-commerce services) and the needs (30% of the patients are not reluctant to order drugs online in the future). Due to the need (according to this study) for high quality websites, a commentated list containing websites for pharmacists was published by the author. Due to more and more individualized therapies, up to date, relevant drug information that fulfills high quality standards will gain importance. Because the instruments used in this study proved to be useful tools, it is possible and necessary to regularly repeat the surveys on the use of drug information by pharmacists and patients in order to constantly improve drug information sources and provide the best patient care possible.