Original ResearchQuality of medication information available on retail pharmacy Web sites
Introduction
Drug sales on the Internet are one of the fastest growing markets in health care today, projected to increase from $3.2 billion to an estimated $13.8 billion by 2007.1 Although it is difficult to accurately estimate the exact number of online pharmacies, current research suggests that more than 1000 online pharmacies are in operation and that this number continues to grow.2 The popularity and growth of online pharmacies may be attributed to convenience factors such as the ability to order medications without leaving home, the ability to easily compare prices, and privacy advantages afforded by the Internet.3
The increasing popularity of online pharmacies creates the need for accurate, useful, and understandable consumer medication information (CMI). Although the quality of medication information dispensed in brick and mortar pharmacies has been reported to be suboptimal,4, 5, 6 inaccuracies or omissions in CMI available at brick and mortar pharmacies may be overcome by face-to-face interaction with pharmacy staff. In contrast, in an online pharmacy, real-time interaction with pharmacy staff is either nonexistent or minimal.7 Therefore, the quality of CMI offered by online pharmacies may be even more important than that of CMI available in brick and mortar pharmacies.
In 1995 the FDA proposed a new patient education program to help patients better understand their medications.8 It was proposed that by 2006, 95% of patients would receive medication information that fulfilled a minimal standard for quality. To be considered acceptable by the agency, under this plan, the “information given to patients must be scientifically accurate, unbiased, specific, complete, understandable, up-to-date, and useful.” However, recent studies show that this minimal standard of quality has not yet been met.4, 6, 9, 10, 11 Both content and presentation of CMI are deemed important.
The quality of online CMI has been studied by a variety of investigators. For example, researchers evaluating 30 commonly prescribed drugs on 4 Web sites (MedicineNet, RxList, Drug InfoNet, and thriveonline) found a 2% inaccuracy rate across the Web sites.12 A review of Web pages offering information about the medication sildenafil found that two thirds of these Web pages were identified as low quality.13 Additionally, some online pharmacy information available today is incomplete, inaccurate, misrepresented, and potentially harmful.3, 14 Internet information sources also have sponsors or advertisements that detract from the unbiased nature of the information content.15, 16
The lack of direct patient-pharmacist communication in an online pharmacy is also problematic. Some online pharmacies have added an asynchronous communication mechanism where patients may submit questions and receive responses electronically. However, an analysis of such “Ask a pharmacist” features of National Association of Boards of Pharmacy (NABP)–approved and nonapproved online pharmacies revealed varied response rates and incomplete information on some online pharmacy Web sites.17 Different information may be presented on benefits and risks about a drug, further leading to patient confusion and questions of validity.18
In 1999, the NABP established a quality seal of approval known as VIPPS (Verified Internet Pharmacy Practice Sites) for online pharmacies. To be certified, pharmacies must comply with all licensing and inspection regulations of their state and the states to which they dispense medications. Pharmacies must also comply with a site visit by a certification team. Currently, these certifications are voluntary. The certifications provide consumers some protection and assure them that a quality standard is in place with VIPPS pharmacies. Unfortunately, according to the FDA, very few online pharmacies have these quality seals of approval; in fact, only 12 pharmacy or pharmacy chains are listed on the NABP Web site.2, 3, 19
The availability of well-designed, high-quality CMI may improve patient trust, safety, and understanding of medication information. According to the FDA, annually there are approximately 300,000 preventable adverse events in the US, many of which are due to confusing medical information.20 Our objective, therefore, was to assess the quality of CMI available on 3 popular pharmacy Web sites. We chose to assess the information quality of Web sites maintained by the 3 largest brick and mortar pharmacies in the US. Our rationale for choosing the largest brick and mortar pharmacies was based on research indicating a high degree of consumer trust in online versions of traditional brick and mortar pharmacies.21 Our aim was to test whether such confidence is justified with regard to quality of CMI of online versions of brick and mortar pharmacies.
Section snippets
Pharmacy Web sites evaluated
We selected Web sites from the top 3 retail pharmacy chains in the US on the basis of their respective number of brick and mortar stores. CVS (5375 stores), Walgreens (4800 stores), and Rite Aid (3350 stores) have a combined total of over 13,000 stores in the US,22, 23, 24 and each ranks within the top 10 most visited pharmacy Web sites.1 These Web sites are also listed prominently in search engines. For example, a search for “pharmacy” in Google (conducted on January 12, 2006) reveals that
Interrater reliability
Agreement between reviewers was acceptable (K = 0.6). Discrepancies occurred primarily due to one reviewer inadvertently missing the presence of a statement. In some instances, reviewers also disagreed on the level of adherence to the criteria (full adherence or partial adherence). In rare cases where the decision to award full or partial adherence was not clear, full adherence was awarded to the site. All differences were discussed and resolved to the satisfaction of both reviewers.
Content quality
Table 1 shows
Discussion
Our findings indicate that the Web sites for Walgreens, CVS, and Rite Aid provide good overall quality content relating to 4 commonly prescribed medications. CVS and Rite Aid used the same drug information provider, leading to similar results.
Approximately 77% of the information was deemed accurate (criterion 7). Walgreens received the lowest score for the medication nitroglycerin (31%) under criterion 2, contraindications, and CVS and Rite Aid received the lowest score for the medication
Conclusion
This study observed what might arguably be called adequate content quality (77% adherence) of medication information in 3 major pharmacy Web sites. However, high readability levels, some areas of incomplete information, and the use of advertisements suggest room for improvement. Further, pharmacy Web sites should use the features and functionalities afforded by the Internet to enhance the usefulness and understanding of medication information.
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