Migration to online pharmacy education in Namibia: Successes, challenges and competence implications

Background: COVID-19, a global pandemic, has disrupted pharmacy education in Africa, due to unpreparedness to migrate to online Learning. Aim(s): To assess outcomes and challenges facing migration to online pharmacy education. Method(s): An evaluation of implementation of online learning in the Bachelor of Pharmacy programme in Namibia using key informant feedback. The outcomes were outputs and challenges facing migration to online learning, and its impact on pass rates and scores. Result(s): The pooled mean score was higher in 2020 (66.2%), compared to 2019 (63.4%) and 2018 (62.1%), (p=0.076). A variety of platforms were used as alternatives or supplements to Moodle. The main challenges included inequalities in internet connectivity, monitoring and quality assurance, implementation of experiential learning, and reliability of online assessment. Conclusion(s): Whilst migration to online learning did not impact on pass rates, there is need for policies and systems to address programmatic challenges to eliminate inequalities in online pharmacy education.Copyright © 2020 FIP.

News Media Coverage of the Problem of Purchasing Fake Prescription Medicines on the Internet: Thematic Analysis.

BACKGROUND: More people are turning to internet pharmacies to purchase their prescription medicines. This kind of purchase is associated with serious risks, including the risk of buying fake medicines, which are widely available on the internet. This underresearched issue has been highlighted by many newspaper articles in the past few years. Newspapers can play an important role in shaping public perceptions of the risks associated with purchasing prescription medicines on the internet. Thus, it is important to understand how the news media present this issue. OBJECTIVE: This study aimed to explore newspaper coverage of the problem of purchasing fake prescription medicines on the internet. METHODS: Newspaper articles were retrieved from the ProQuest electronic database using search terms related to the topic of buying fake prescription medicines on the internet. The search was limited to articles published between April 2019 and March 2022 to retrieve relevant articles in this fast-developing field. Articles were included if they were published in English and focused on prescription medicines. Thematic analysis was employed to analyze the articles, and the Theory of Planned Behavior framework was used as a conceptual lens to develop the coding of themes. RESULTS: A total of 106 articles were included and analyzed using thematic analysis. We identified 4 superordinate themes that represent newspaper coverage of the topic of buying prescription medicines on the internet. These themes are (1) the risks of purchasing medicines on the internet (eg, health risks and product quality concerns, financial risks, lack of accountability, risk of purchasing stolen medicines), (2) benefits that entice consumers to make the purchase (eg, convenience and quick purchase, lower cost, privacy of the purchase), (3) social influencing factors of the purchase (influencers, health care providers), and (4) facilitators of the purchase (eg, medicines shortages, pandemic disease such as COVID-19, social media, search engines, accessibility, low risk perception). CONCLUSIONS: This theory-based study explored the news media coverage of the problem of fake prescription medicines being purchased on the internet by highlighting the complexity of personal beliefs and the range of external circumstances that could influence people to make these purchases. Further research is needed in this area to identify the factors that lead people to buy prescription medicines on the internet. Identifying these factors could enable the development of interventions to dissuade people from purchasing medicines from unsafe sources on the internet, thus protecting consumers from unsafe or illegal medicines.

Rogue online pharmacies in the time of pandemic: Capitalising on misinformation and fear

Background: Rogue internet pharmacy networks are run by criminal opportunists-and the COVID-19 pandemic has provided the perfect opportunity for illegal online drug sellers to prey on fearful consumers. These criminals are not new to the game: they are simply targeting a novel disease. Purpose(s): This study establishes the prevalence and practices of websites being used for the illegal sale of prescription-only medicine marketed as a therapy for COVID-19, and calls on internet intermediaries to take action against these websites. Method(s): NABP identified hundreds of domain names (web addresses) that include key words related to COVID-19. Among them were dozens of illegal online pharmacies that were actively peddling prescription-only drugs marketed as COVID-19 treatments. Staff evaluated these sites and looked for commonalities. Result(s): In our review, we found the following: 1) most active websites have clear ties to known criminal networks;2) some newly-created COVID-specific websites redirect users to established rogue network sites;3) many domain names are clustered on "safe haven" registrars;and 4) the domain name registration information for almost all identified websites is anonymised, making it difficult for enforcement agencies to investigate these criminals. Conclusion(s): Numerous websites are indeed being registered and used illegally to sell prescription-only medicine marketed as a therapy for COVID-19. Internet intermediaries must implement long-term policies that will not only put a stop to COVID-19 related cybercrime but will also shut down rogue internet pharmacy networks for good.

Experiential learning in community pharmacy: Online and remote teaching experience in Malaysian higher education

Experiential learning provides opportunities for students to learn beyond the classroom setting. Due to the COVID-19 pandemic, students were unable to complete their attachment modules in community pharmacy settings, thus a four week community pharmacy course was conducted via remote learning. Students were required to have a maximum of two hours of virtual discussion and consultation sessions with a faculty member (with community pharmacy background/experience) twice a week. In each week, students were required to complete all tasks given based on the activities proposed in the community pharmacy logbook. MyDispense (an online pharmacy simulation) and Access Pharmacy (McGraw-Hill) were utilised by students to practice their dispensing skills and familiarisation with non-prescription medications, respectively. Case discussions on responding to minor ailments were also touched on during the online sessions. Students were assessed via logbook, preceptor assessment and an online objective structured clinical examination (OSCE). Copyright © 2020 FIP.

ICT-enabled teaching and learning modalities followed in pharmacy education during COVID-19 in India

The transformation from conventional to online teaching and learning created an unprecedented learning environment and many challenges for the trainers and learners during COVID-19 in India. In this context, many synchronous and asynchronous online teaching tools were used to continue the pharmacy educational process and to develop and update the instructional strategies with suitable online tools & interactive methodologies. Indian Ministry of Education (MoE) initiated massive online open courses platforms which were utilized to understand the fundamentals of pharmacyrelated subjects. Introductory and advanced pharmacy practice experiences learning was provided to students through online simulation activities, video reflection, case, and problem-based online discussions, and objective structured clinical and practical examination. Virtual conferencing applications and digital education platforms of MoE were majorly used to conduct the pharmacy education during the crisis and investments in digitization become mandatory in pharmacy education and COVID-19 fast-forwarded its process. Information and communication technology enabled continuity of pharmacy education during the pandemic and improved the student-teacher contact hours, self-paced, collaborative, and contextual learning environment in India. © 2022 Sadagoban Gopal Krishnamoorthy et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

Problems of purchasing pharmacy products through online orders.

Online pharmacy services and online ordering of pharmaceutical products are in demand, especially in the context of the COVID-19 pandemic. The problems of the purchase of pharmacy products through online orders in the Far Eastern Federal District were analyzed. Sociological survey of the population (n = 3789) was carried out. Spearman's Rank correlation coefficient was used. Drugs, dietary supplements, hygiene, and care items are most often purchased in online pharmacies. There is a correlation with the female sex, which may be related to care about family/loved people. The purchase of prescription drugs through e-pharmacies is also more often in demand among women and older patients. Among prescription drugs, the order of drugs used in the treatment of coronavirus infection and its complications (antibiotics, nonsteroidal anti-inflammatory, gastroenterological, and hormonal) is widespread. The problems of e-pharmacies identified due to the study are the lack of proper control over prescription drugs, low role of the pharmaceutical worker in compliance of the patient, and frequent refusals of Internet orders. It is necessary clarify the regulatory status of e-pharmacies and the role of pharmaceutical specialists in it, to reduce the possibility of error in the preparation and/or assembly of orders, to reduce the risk of the presence of defective goods. These ways can increase customer loyalty to this service.

The Effect of Online Consumers’ Risk Perception, Perceived Usefulness and Subjective Norms on Online Purchase Intention: Cross-Sectional Study on Online Pharmacy in the Context of COVID 19

Over the last decade, India has witnessed an exponential rise in the sales through e-commerce platforms. With the pandemic-related lockdowns and social distancing norms being the new normal, individuals are forced to shop online, for their day-to-day requirements. The trend has become increasingly pronounced in the last year. One such domain that has come to the fore in our fight against the epidemic is e-Pharmacy. Increasing internet penetration, e-commerce adoption, and changing consumer preferences are some of the growth drivers of e-pharmacy and the market is expected to grow at a compounded rate of 44 per cent to reach $ 4.5B by 2025 in India. However, the sector also faces several challenges like lack of trust, privacy issues, legal concerns and limited geographical presence. In the context of the lack of studies examining consumer attitude towards e-pharmacy in India, this study investigates the effects of risk perception, perceived usefulness and subjective norms on customers’ online purchase intention towards e-pharmacy. The data is collected from 490 customers across different parts of India through online and offline data collection modes, out of which 423 was the final sample size, after deleted the incomplete questionnaires. Purposive sampling was employed to select the sample respondents, and data analysis have done using statistical tool IBM SPSS. The study revealed the significant relation between risk perception and perceived usefulness towards online purchase intention while the influence of subjective norms on online purchase intention is found insignificant. Online pharmacies have shown a lot of promise in terms of enhancing pharma retail. Their continued expansion would improve the digital healthcare ecosystem and help the government to achieve its goals of providing efficient and cheap health coverage. The insights gained from this study will significantly help health marketing professionals and other stakeholders to formulate their strategies more effectively.

ASSESSMENT OF THE TRANSITION TO ONLINE PRESCRIPTION REIMBURSEMENTS AT A NYC MEDICAL STUDENT PRIMARY CARE FREE CLINIC

BACKGROUND: Since the start of the COVID-19 pandemic, the Weill Cornell Community Clinic (WCCC) rapidly adapted to a hybrid telehealth model to serve its uninsured patient population. Prior to the pandemic, the WCCC provided coupons and in-person cash reimbursement to defray patients' out-of-pocket medication expenses. In March 2020, the WCCC adopted a hybrid telehealth model and enabled online medicationreimbursement. This study describes how the shift from in-person to online pharmacy reimbursement impacted the reimbursement volume and cost of commonly prescribed medications for uninsured patients. METHODS: Only medication reimbursement records from January 2017 to December 2021 were considered. Reimbursement records included information on the date of reimbursement, medication name, quantity, and cost. The frequency of reimbursement for each medication was calculated and the medications were classified by drug class, disease indication, and treatment course (chronic vs acute) using descriptive statistics. The average cost of each medication was calculated and stratified by mode of reimbursement. RESULTS: Since January 2017, WCCC had 1622 independent reimbursements. Of those, statins (14.7% of total reimbursements) and biguanides (8.2%) remained the two most common drug classes reimbursed. Since transitioning to an online method of reimbursement, reimbursements for medications treating chronic conditions increased 3%. Reimbursements for medications for the following disease indications changed the most upon transition to online reimbursement: diabetes (+4.4%), hyperlipidemia (+4.2%), pain (+4.0%), immune dysfunction (-4.3%), and hypertension/cardiovascular disease (-3.3%). Of the two most reimbursed medications, atorvastatin 40mg had an average cost of $14.72 (range: $10.00 -$30.45) when reimbursed online (RO) and $30.57 ($15.00 -$69.99) when reimbursed in-person (RI);metformin 1000mg had an average cost of $15.08 ($5.00 -$32.99) RO and $20.62 ($6.99 -$32.99) RI. CONCLUSIONS: The online method resulted in a greater proportion of reimbursements for medications treating chronic conditions compared to the in-person method. Additionally, the average costs of our two most prescribed medications were lower when reimbursed online than in-person. Further analysis will be performed to understand the factors contributing to the observed trends in reimbursement at WCCC.

Analyzing and Predicting the Impact of COVID-19 on Online Pharmaceuticals Sectors and Pathological Services in India

The novel coronavirus disease 2019 (COVID-19) is a worldwide pandemic that has impacted the healthcare industry. While retail pharmaceutical and medical stores were classified as vital services, online pharmacies emerged as one of the most significant benefactors of India's pandemic-induced lockdown, as consumers decided to buy medications online to lessen the risk of contamination. The wide-ranging consequences of the COVID-19 outbreak have also prompted healthcare providers to embrace new methods and techniques that allow for at-home lab testing. We conducted a research study and analysis to determine if online pharmacies and at-home lab tests would continue to develop rapidly and become increasingly digital post-COVID pandemic considering that it has been fuelled by the current pandemic crisis and changing customer needs and requirements. The research was carried out considering the factors such as "Gender, Age-group, how often they use online pharmacies, rating their online pharmacy experiences, how often they purchased medicines online before and during COVID, have they used at-home lab testing services, and rating the quality, discounts, safety, genuineness and time taken for at-home lab testing". Based on these factors, in this paper, we have built two prediction models that use supervised learning which would predict how likely a person will utilize online pharmacies and at-home lab tests post COVID 19 pandemic. It consists of 5 probabilities i.e. very likely to use it, likely use it, moderately use it, less likely to use it, and rarely use it. The various classification algorithms employed in the study were logistic regression, decision trees, random forest, support vector machines, and Gradient booster classification algorithm The model's results are based on the previous data that was collected by asking around 250 individuals. Accuracies obtained for predicting how likely a person will use online pharmacies post COVID are as follows, by gradient booster model the accuracy is ~85%, the accuracy obtained by decision tree classifier is ~71%, by logistic regression model the accuracy is ~85% and accuracy obtained by random forest model is ~78%. Accuracies obtained for predicting how likely a person will use at-home lab tests post COVID are as follows, by decision tree classifier accuracy is ~78%, the accuracy obtained by logistic regression is ~50% and the accuracy obtained by support vector machines is ~64%. © 2022 IEEE.

Pharmaceutical marketing of over-the-counter drugs in the current digital era: A review

Digitization is a current era trend that has permeated various daily activities of individuals and businesses. The acceleration of digital adoption can be seen even more with the onset of the COVID-19 pandemic. As a result, a new pattern of pharmaceutical marketing has been defined in the industry in several terms, most notably pharmaceutical digital marketing (PDM). Undeniably, over-the-counter (OTC) drugs, which are pharma-ceuticals sold without a medical prescription, are the most affected drug category by this digital transformation in the pharma industry. The content of this review paper is based on secondary data derived from recent literature and Internet sources. The relevant information from various journal articles, books, reports, and reliable web pages has been presented and discussed. Basically, the main body of the review was divided into two fundamental areas of PDM, with a greater emphasis on the context of OTC drugs: (1) online pharmacies (e-commerce marketing);(2) promotional advertising. In a nutshell, this review provides valuable insights into the emerging concepts of PDM within the scope of OTC drugs.

COVID-19 Treatments Sold Online Without Prescription Requirements in the United States: Cross-sectional Study Evaluating Availability, Safety and Marketing of Medications.

BACKGROUND: The COVID-19 pandemic has increased online purchases and heightened interest in existing treatments. Dexamethasone, hydroxychloroquine, and lopinavir-ritonavir have been touted as potential COVID-19 treatments. OBJECTIVE: This study assessed the availability of 3 potential COVID-19 treatments online and evaluated the safety and marketing characteristics of websites selling these products during the pandemic. METHODS: A cross-sectional study was conducted in the months of June 2020 to August 2020, by searching the first 100 results on Google, Bing, and Yahoo! mimicking a US consumer. Unique websites were included if they sold targeted medicines, were in English, offered US shipping, and were free to access. Identified online pharmacies were categorized as rogue, unclassified, or legitimate based on LegitScript classifications. Patient safety characteristics, marketing techniques, price, legitimacy, IP addresses, and COVID-19 mentions were recorded. RESULTS: We found 117 websites: 30 selling dexamethasone (19/30, 63% rogue), 39 selling hydroxychloroquine (22/39, 56% rogue), and 48 selling lopinavir-ritonavir (33/48, 69% rogue). This included 89 unique online pharmacies: 70% were rogue (n=62), 22% were unapproved (n=20), and 8% were considered legitimate (n=7). Prescriptions were not required among 100% (19/19), 61% (20/33), and 50% (11/22) of rogue websites selling dexamethasone, lopinavir-ritonavir, and hydroxychloroquine, respectively. Overall, only 32% (24/74) of rogue websites required prescriptions to buy these medications compared with 94% (31/33) of unapproved and 100% (10/10) of legitimate websites (P<.001). Rogue sites rarely offered pharmacist counseling (1/33, 3% for lopinavir-ritonavir to 2/22, 9% for hydroxychloroquine). Drug warnings were unavailable in 86% (6/7) of unapproved dexamethasone sites. It was difficult to distinguish between rogue, unapproved, and legitimate online pharmacies solely based on website marketing characteristics. Illegitimate pharmacies were more likely to offer bulk discounts and claim price discounts, yet dexamethasone and hydroxychloroquine were more expensive online. An inexpensive generic version of lopinavir-ritonavir that is not authorized for use in the United States was available online offering US shipping. Some websites claimed hydroxychloroquine and lopinavir-ritonavir were effective COVID-19 treatments despite lack of scientific evidence. In comparing IP addresses to locations claimed on the websites, only 8.5% (7/82) matched their claimed locations. CONCLUSIONS: The lack of safety measures by illegitimate online pharmacies endanger patients, facilitating access to medications without appropriate oversight by health care providers to monitor clinical response, drug interactions, and adverse effects. We demonstrated how easy it is to go online to buy medications that are touted to treat COVID-19 even when current clinical evidence does not support their use for self-treatment. We documented that illegitimate online pharmacies sidestep prescription requirements, skirt pharmacist counseling, and make false claims regarding efficacy for COVID-19 treatment. Health care professionals must urgently educate the public of the dangers of purchasing drugs from illegitimate websites and highlight the importance of seeking treatment through authentic avenues of care.

Trends and Characteristics of the US Adult Population's Behavioral Patterns in Web-Based Prescription Filling: National Survey Study.

BACKGROUND: Filling a prescription on the web has become an alternative to in-person pharmacies for individuals to access their medications. However, the adoption of web-based filling has been gradual, and the use patterns remain to be unclear. OBJECTIVE: This study aims to estimate the trend and prevalence of web-based prescription-filling behavior and identify associated factors among adults in the United States. METHODS: We used data from the US National Health Interview Survey (NHIS) from 2009 to 2018. Adult respondents (aged ≥18 years and over) self-reported their behavior of web-based prescription filling, which was defined as having filled a prescription using the internet in the past 12 months during the survey year. We reported trends using weighted percentages adjusted by the NHIS complex sampling design. We used descriptive statistics and multivariable logistic regression models to examine trends and identify factors associated with web-based prescription-filling behavior. RESULTS: The estimated number of adults reporting web-based prescription-filling behavior significantly increased from 13,319,877 (13,319,877/225,217,942, 5.91%) in 2009 to 28,308,262 (28,308,262/246,611,125, 11.48%) in 2018 (P<.001). Those who were more likely to report filling a prescription on the web were aged between 35 and 74 years, female, White, and frequent users of the computer or internet; these adults also reported higher education, higher income, insurance coverage, and poorer health status. CONCLUSIONS: Web-based prescription-filling behavior among US adults has increased significantly from 2009 to 2018. Health care providers should be aware of the upward trend in the use of web-based pharmacies and ensure the clinical safety of web-based prescriptions.