Advice and products on the internet - how can pharmacists compete?
Professor Bill Felkey (associate professor, Auburn university, United States)
told participants that the third largest use of the internet had become the
seeking of medical and pharmaceutical advice by consumers. Patients who approached
pharmacists with a sheaf of paper printouts downloaded from the internet were
no longer rarities.
In addition, consumer purchasing on the internet was growing and it was imperative
that every pharmacist established a web presence and promoted this to patients.
So, if an individual moved house and looked on the web for his or her nearest
pharmacy, pharmacists needed to be sure that it was their pharmacy that appeared
as a result of the search rather than that of a competitor.
Three things were required for a web site — a domain name (which in the
US cost about $70), web space or hosting services (which currently cost about
$8 a month) and a program (which could scan documents in HTML format).
Three stages
A web page could be planned in three stages of increasing sophistication, and
the easiest way to get started at first was to display information about the
pharmacy itself, including its location, contact details and services offered;
in other words a welcome page, which encouraged the patient to use that pharmacy.
The second stage was to provide links on the web page to other health care information.
Pharmacists were often concerned about “losing” patients at this stage,
when patients pursued more and more sites unrelated to the pharmacy.
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Bill Felkey: “brick and mortar” or “click
and mortar”?
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However, the webmaster could be asked to design the pharmacy site in such a
way that windows displaying linked web pages were always smaller than the full
computer screen, leaving room for the pharmacy’s name and logo to show
at the side.
The web site could be taken to a third stage of development, where patients
could obtain information on health management and therapeutic outcomes for their
condition. Eventually, patients would be in touch not only with the pharmacist
but also with other patients, so building a virtual community larger than the
geographical locality.
Computer literacy was essential for development and management of the web site,
although a webmaster could be employed initially to set up the site. However,
when established, the web site had to be managed continuously. For example,
the pharmacist needed to find out how many people were using the site, which
links they used and which ones they did not. The web page could then be altered
in accordance with patients’ likes and dislikes.
With the projection that more than 10 per cent of sales would soon be made on
the internet, pharmacists needed to consider e-commerce. The opportunities would
be enormous. For example, the pharmacy site could be linked to a wholesaler’s
warehouse, which would have in stock hundreds of thousands of products, all
of which could be marketed and sold to the patient from the individual pharmacist’s
site. Thus, the patient could order wheelchairs and other items which a small
pharmacy might not have the room for, but the order would still come through
the pharmacy.
This approach would prove popular with patients, maybe not at first as many
people preferred dealing with a person rather than a screen. But the facility
to order items, say, in the middle of the night if an individual was having
trouble getting to sleep, would be increasingly appreciated.
There were already several different internet business models in the pharmaceutical
world — from drugstore.com, which was essentially a bricks and mortar pharmacy,
to cornerdrugstore.com, where the web page was used for marketing and selling
only.
Different models suited different pharmacists, and there was now a narrow window
of opportunity for pharmacies to change from a “brick and mortar”
operation to a “click and mortar” operation.
Opportunities for pharmacist and physician collaboration
According to Dr BeRtrand Anz (medical practitioner, Opelika, Alabama, United
States), the internet provided the infrastructure and opportunity for increased
collaboration between pharmacists and physicians. And increased collaboration
was necessary to ensure that both professionals kept control of their own destinies.
Increasingly, third party payers, such as health management organisations (HMOs),
advertised themselves as deliverers of health care, whereas the truth of the
matter was that their main activity was to collect dollars and pay out as little
for patient care as they could get away with. It was health care professionals,
including physicians and pharmacists, who provided real health care for patients,
and patient care could be further enhanced by doctor and pharmacists working
together.
Unique
Moreover, the internet allowed the pharmacist to provide the physician with
unique and valuable information. The pharmacist had a “vast expertise”
on the appropriate use of drugs.
The concept of the doctor-pharmacist partnership on the internet could work
as follows. The patient visited the doctor and the doctor selected a drug from
a pull-down menu. The prescription would then be transmitted by infrared technology
online to the pharmacy, where it would be reviewed for safety and effectiveness.
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Bertrand Anz: benefits of collaboration obvious?
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The situation in the US was that patients could consult several different doctors
so the pharmacist was in a good position to check for duplicate prescriptions.
The potential for adverse drug reactions and interactions could also be assessed,
usually by the computer database, and any relevant information could be transmitted
back to the doctor by the computer with no cost in pharmacist time. The pharmacist
could then begin to fill the prescription or contact the doctor about any other
problems. The technology was already available for this type of process, and
all that was needed was to encourage pharmacists and doctors to collaborate
on the internet in this way.
A survey in Alabama had looked at the way in which physicians made use of pharmacists’
expertise and their attitudes towards working with pharmacists. The survey,
which was in the form of a questionnaire and elicited a 70 per cent response
rate, asked doctors to rate on a scale of one to five how much they felt pharmacists
helped them by contacting the doctor about various issues. The issues that generated
high scores (ie, those where doctors felt most benefit from being contacted
by a pharmacist) included duplicate prescriptions (score 4.9), adverse drug
reactions (score 4.7), potential drug interactions (score 4.6), compliance problems
(score 4.4) and doses that were too high (score 4.4). Doctors also felt that
pharmacists were qualified to make generic substitutions (score 3.6), but were
less comfortable with pharmacists making therapeutic substitutions within a
given drug class (score 2.7).
Physicians in the survey were enthusiastic about electronically transmitting
prescriptions to the pharmacist, and this, together with the physicians’
high regard for the pharmacist’s drug knowledge (survey score 4.4), seemed
to open the window for the two professions to collaborate on the internet. However,
physicians would need encouragement to use the internet in their practices,
because use in that setting was currently low.
Longer term benefits
Although various issues such as data protection and patient confidentiality
needed to be addressed, the benefits of such collaboration were obvious in that
prescriptions could be screened against the patient’s medication record
held at the pharmacy and the potential for adverse reactions and drug interactions
could be assessed. Longer term benefits lay in closer co-operation between doctors
and pharmacists and the fact that pharmacists could investigate drug utilisation
patterns and educate doctors on areas where prescribing could be improved.
Protecting the consumer — avoiding errors
The need to protect consumers was being increasingly recognised, Professor
Bill Felkey (associate professor, Auburn university, United States) told participants.
In the United States, medication errors had a high media profile, and the way
to address these errors was through systematic pharmaceutical care. To achieve
this required a good documentation procedure, he said.
The public also required protecting from poor quality health information, of
which there was a great deal on the web. But there were now various web sites
which acted as quality filters, evaluating health information on the internet.
Examples included the Health on the Net (HON) Foundation, the Six Senses Review
and Quackwatch. Illegal prescribing on the net and illegal drug importation
were also problem areas, and it was hoped that the regulatory agencies could
sort these out.
New errors
However, a new class of errors would come from the electronic systems themselves.
Thus a palm-top computer could be used to access a drug selection programme,
but with an eighth of an inch difference on the screen between two drugs, it
was easy to click on the wrong one. Database updates and software glitches with
the potential for bugs and viruses could also contribute to mistakes. Speech
recognition software could confuse similar sounding words.
Pharmacists needed to learn how to use new technology properly and get the best
out of it. Among other things, this meant using firewall protection to ensure
that patient data could not be accessed by anyone else, and being careful to
apply evidence-based principles in use of the internet. Pharmweb, a specialised
web site for pharmacists, was expanding its site to provide a system whereby
only peer-reviewed papers would be retrieved during a search, Professor Felkey
told the audience.