Researchers examine safety of internet prescriber service providing erectile dysfunction medications

Online Internet shopping today offers many benefits. You can research a product in the privacy of your own home and purchase most anything by clicking a mouse. But should we be allowed to buy prescription drugs via the Internet, bypassing a traditional office visit or conversation with a physician?

In the August issue of Mayo Clinic Proceedings, researchers from Utah and several colleagues compare the relative safety of two systems -- an online prescribing service versus traditional physician consultation -- for patients seeking medication to treat erectile dysfunction.

Online prescribing, also called e-medicine prescribing, is relatively new in the United States. Patient demand for these services appears to be growing, but the researchers acknowledge that the health care industry "has appropriately raised serious concerns about the safety of prescribing over the Internet." In 2002, the state of Utah signed a contract with an Internet prescribing service to prescribe erectile dysfunction drugs called PDE-5 inhibitors. Erectile dysfunction (ED) is the inability of a man to maintain a firm erection long enough to have sex.

The researchers randomly selected 1,000 patient medical records from patients seeking ED treatment from Jan. 1, 2001 to Dec. 31, 2005. Half (500) of these patients used the online prescriber (the e-medicine group), and 500 consulted a physician (the traditional medicine group) for treatment.

Using statistical analyses, the researchers compared the safety of both approaches -- e-medicine versus traditional medicine -- in treating patients who have ED. The safety comparisons looked at a number of criteria, including prescription appropriateness, how often the prescribers used a diagnostic tool called the International Index of Erectile Questions (IIEQs) and the level of patient education provided by prescribers.

Evaluating both systems for these safety criteria, the researchers concluded that the e-medicine system "outperformed the traditional system in most of the safety variables tested." One area in which the e-medicine system appeared to excel was patient education. The authors noted that 100 percent of the e-medicine clients received written manufacturer product information, and 75.2 percent of e-medicine clients received tailored electronic messages. In comparison, study data showed that no medication instructions were recorded for 51.8 percent of patients who received prescriptions via a traditional physician consultation.

"Innovation, technology and current medical practice all factor into the outcome of this study," note the authors. "Application of an expert interview system specifically targeted to erectile dysfunction along with a continuous platform for patient client-physician communications make this particular Internet system comparable to traditional medical practice."

The researchers acknowledge that additional research is needed to confirm these results. They also recommend that state regulatory agencies "consider using the regulatory model of oversight protections implemented by the state of Utah to license Internet prescribing companies."

Authors include: Mark Munger, Pharm.D., and Gregory Stoddard, from the University of Utah - Salt Lake City; Allen Wenner, M.D., West Columbia's Doctor Family Medicine, Lexington, SC; John Bachman, M.D., Mayo Clinic, Rochester, Minn.; John Jurige, M.D., University of Louisville in Kentucky; and Laura Poe and Diana Baker, Utah State Division of Occupational and Professional Licensing, Salt Lake City.

A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at www.mayoclinicproceedings.com.