OBJECTIVE
To determine the safety of a US-based, state-regulated Internet system vs a multispecialty
primary care system for prescribing phosphodiesterase type 5 (PDE-5) inhibitors for
erectile dysfunction.
PATIENTS AND METHODS
From January 1, 2001, through December 31, 2005, 500 e-medicine clients (mean ± SD
age, 47±11 years; hypertension, 60%; type 2 diabetes mellitus, 2%; mean ± SD number
of medications, 0.4±0.8) vs 500 traditional medicine patients (mean ± SD age, 57±12
years; hypertension, 50%; type 2 diabetes mellitus, 23%; mean ± SD number of medications,
5.1±3.1) with erectile dysfunction symptoms were assessed. Noninferiority safety was
assessed in this retrospective, cross-sectional study with stratified random sampling
by identification of prescribing in the presence of clinically important PDE-5 inhibitor
drug interactions with or without high-risk cardiovascular disease, by asking about
diagnostic symptoms specific to erectile dysfunction, and by determining frequency
of patient counseling.
RESULTS
Noninferiority of the e-medicine system was shown for the 6 safety end points, relative
to a traditional medicine system. Numbers of inappropriate prescriptions, after correction
for disease and medication covariates, did not differ between systems. Medication
counseling showed superiority of the e-medicine system. Standard diagnostic questions
were required for e-medicine prescribing but were infrequently asked in traditional
medicine.
CONCLUSION
Safety in prescribing PDE-5 inhibitors for erectile dysfunction was similar between
a US-based, state-regulated Internet prescribing system and a multispecialty primary
care system.
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REFERENCES
- Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey.JAMA. 2005; 165: 2618-2624
- HarrisInteractive. The Harris Poll Web site.(Accessed June 24, 2008.)
- Pew/Internet: Pew Internet and American Life Project Web site.(Accessed June 24, 2008.)
- Policing the “Wild West” world of Internet pharmacies.Chi-Kent L Rev. 2001; 76: 1333
- Model guidelines for the appropriate use of the internet in medical practice.(Accessed June 24, 2008.)
- Report of Conference Committee H.
- (Accessed June 24, 2008.)
- The patient-computer interview: a neglected tool that can aid the clinician.Mayo Clin Proc. 2003; 78: 67-78
- Instant medical history.Proc Annu Symp Comput Appl Med Care. 1994; : 1036
- Will patients use a computer to give a medical history?.J Fam Pract. 2000; 49: 921-923
- (Accessed June 24, 2008.)
- Detecting alcoholism: the CAGE questionaire.JAMA. 1984; 252: 1905-1907
- The CES-D Scale: a self-report depression scale for research in the general population.Appl Psychol Measures. 1997; 1: 385-401
- The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction.Urology. 1997; 49: 822-830
- Assessing equivalence: an alternative to the use of difference tests for measuring disparities in vaccination coverage.Am J Epidemiol. 2002; 156: 1056-1061
- Reporting of noninferiority and equivalence randomized trials: an extension of the CONSORT Statement.JAMA. 2006; 295: 1152-1160
- Multiple testing of noninferiority hypotheses in active controlled trials.J Biopharm Stat. 2004; 14: 327-335
- Some comments on frequently used multiple endpoint adjustment methods in clinical trials.Stat Med. 1997; 16: 2529-2542
- A modified Poisson regression approach to prospective studies with binary data.Am J Epidemiol. 2004; 159: 702-706
- Impotence.JAMA. 1993; 270: 83-90
- Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study.J Urol. 2000; 163: 460-463
- The demise of the physical exam.N Engl J Med. 2006; 354: 548-551
- Verified Internet Pharmacy Practice Sites (VIPPS) Application Website.(Accessed June 24, 2008.)
- Practice patterns in sildenafil prescribing.Fam Med. 2006; 38: 110-115
- Consumer advice: buying drugs online.Harv Health Lett. 2000; 25: 1-3
- Cyberpharmacies and the role of the US Food and Drug Administration.J Med Internet Res. 2001; 3: E3
- Be WWWary of Internet drugs.Heart Advis. 2002; 5: 4-5
- The Internet, confidentiality, and the.Camb Q Healthc Ethics. 2001; 10 (pharmacy.coms): 157-160
- Virtual pharmacies boast easy access, privacy safeguards.Am J Health Syst Pharm. 1999; 56 (1177-1179.): 1174
- A health questionnaire based on paper-and-pencil medium individualized and produced by computer. II. Testing and evaluation.JAMA. 1969; 208: 2064-2068
- Responsive regulation of Internet pharmacy practice.Ann Health Law. 2001; 10: 75-103
- Evaluation and medical management of erectile dysfunction.Mayo Clin Proc. 2006; 81: 385-390
Article info
Footnotes
This work was supported by the University of Utah Clinical Cardiovascular Pharmacology Program.
Dr Jurige is a compensated medical advisor for KwikMed.com.
Identification
Copyright
© 2008 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
