1
Working Bibliography
Maria Fatima Balcita
KNOWLEDGE ON AND ACCEPTABILITY OF ONLINE PHARMACY PRACTICE
AMONG COMMUNITY PHARMACISTS AND
REFERENCE
G.Prashanti, S.Sravani, Saleha
Noorie. (2017);
A Review on Online
Pharmacy;
IOSR Journal of Pharmacy
and Biological Sciences
(IOSR-JPBS) e-ISSN:2278-
3008, p-ISSN:2319-7676.
Volume 12, Issue 3 Ver. IV
(May – June 2017), PP 32-34
www.iosrjournals.org
CONSUMERS IN LA UNION
CITATIONS
Online pharmacy is one of the technology advancements that is about
to create a huge demand in the upcoming days. Though it is
convenient to get them, there is high risk of self medication and
misuse of drugs especially that come under schedule H and X.
Advantages:
Online pharmacy market has undoubted advantages for patients:
Access to drugs for the disabled or housebound,
Access 24 hours a day,
A virtually unlimited number of products available,
Relative privacy, which may encourage patients to ask questions
about embarrassing issues, and more affordable prices.
Free access to information, comparison shopping.
Disadvantages:
Lack of meaningful interaction with physician and pharmacists.
In many cases, customers are not aware that products offered by
online pharmacies may not have the same quality that a retail
pharmacy may offer.
It is difficult to determine whether a website is legitimate or not,
because it is difficult to determine whether drugs purchased online
are counterfeit, unapproved, or illegal.
Misdiagnosis and inappropriate use of medicines. These

Carlisle George. (2016).
Internet Pharmacies: Global
threat requires a global
approach to regulation.
Hertfordshire Law Journal
4(1), 12-25
ISSN 1479-4195 Online /
2
disadvantages and dangers are further exacerbated in the case of
unlicensed and illegally operated online pharmacies.
Some other issues associated with the online availability of
medicines:
This encourages more self-medication.
The medicines do require appropriate storage for retaining potency.
There is no assurance of temperature control either at their storage
points or during transport.
The patients loose the opportunity to have a face to face discussion
with the professional pharmacists.
The brand names may often cause confusion. There may be the
same brand but with different drugs. Ultimately, the patient is at
receiving and getting wrong medicines.
The most worried thing is the sale of antibiotics; India is already
fighting against antibiotic resistance for irrational use of antibiotics.
Though e-pharmacy is more liable than local pharmacy especially
in remote areas, it should be aimed to establish rules and regulation
like upload of scanned prescriptions. Patients should be aware on
use of prescription medications. It would be good to adopt the
plans and programs of leading countries to design and develop the
e-pharmacy system.
Various drugs and medical services can be accessed online, via
businesses known as ‘Internet Pharmacies’, also called
‘cyberpharmacies’, ‘ePharmacies’, and ‘online pharmacies’ among
other names. An Internet Pharmacy is used to sell a variety of
products including beauty products, over-the-counter drugs (which
does not require a prescription) and prescription) drugs (which
requires a prescription issued by a licensed health professional).
 3

ISSN 1479-4209 CDRom Some Internet Pharmacies also provide a variety of online services
(e.g. advice on medications). In the US Internet Pharmacies have
been in existence since January 1999 (with the opening of
Soma.com), following a long history (from 1872) of selling drugs via
mail-order8. In the UK Internet Pharmacies began operations a few
months later (November 1999) with the opening of
Pharmacy2u.co.uk9.

Benefits include:
• Ease, convenience & increased choice. Online services allow 24-7
access, and easy comparison of products. This is especially relevant
to consumers who live in sparsely populated areas where there are no
pharmaceutical services, and disabled people who have difficulty in
travelling to a Pharmacy11, among others;
• Increased consumer information and information exchange.
Through online searches, consumers can investigate issues such as
the effectiveness of different drugs, side/adverse effects of
medications, and new/alternative treatments among others12. In some
cases patients are also able to check and verify the advice and
treatment they receive from their doctors;
• Privacy and anonymity. Consumers buying online can ask questions
regarding medications and treatments which they may otherwise be
embarrassed to ask in a public place;
• Generally cheaper costs. Some studies have found that US residents
import drugs into the US from Canada, due to lower prices which can
be up to 70% cheaper;
• Availability of alternative treatments. The licensing of drugs can a
very slow process (due to testing requirements) but the Internet can
facilitate access to effective non-licensed drugs that patients with
terminal illness (e.g. Cancer, AIDS) may be willing to use on an
experimental basis. This however, may not always be a benefit since

Manila Standard Lifestyle.
(2016). Convenience at your
fingertips with online
pharmacy company
4
there are many fraud1ulent treatments and drugs available online.
Although the Internet continues to bring many benefits to the global
community, the widespread availability of drugs and medical services
via the Internet (especially through illegal activity) has the potential
to result in problems of a global nature. Examples of such problems
include: widespread drug addiction which may have consequences for
the wider society; harm (or death) from drugs that may be
contaminated, counterfeit, sub-potent or above
potency; the development of new strains of bacteria (and hence new
diseases) due to indiscriminate use of antibiotics; and increased
criminal activity related to illegal medical practice and the supply of
drugs;
MediCard Philippines, a leading health maintenance organization in
the country, has partnered with MedGrocer.com, an online pharmacy
that delivers FDA-certified medicines to your doorstep. This is in line
with the HMO’s mission to make quality and affordable healthcare
accessible for every Filipino.

Alberto Cordioli; Themis
Palpanas. (2017). An
Automated System for
Internet Pharmacy
Verification
David Mills. (2000).
Cybermedicine: The Benefits
and Risks of
Purchasing Drugs Over The
Internet. Journal of
Technology Law & Policy
Volume 5 | Issue 2 Article 1
5
The growth of web-related technologies, and in particular
ecommerce, has offered companies the opportunity to increase their
own business, selling directly their products and goods to customers
within and across borders. Even though this has led to unquestionable
benefits for customers, untrusted companies can also access the
market and sell products, for which it is not always possible to assess
the quality.
There are different factors that make a pharmacy illegitimate. In
U.S.A. (as well as in many other countries), an online pharmacy must
satisfy regulations and meet strict requirements. The requirements
that are most frequently violated in the U.S. are, for example, the
selling of products without prescriptions and the selling of drugs that
are not “FDA-Approved”. Evidently, checking these factors is not an
easy task, especially for people that do not have any kind of
competence and knowledge in this field, such as the normal
consumers.
It is for this reason that specialized LegitScript, for example, offers an
internet pharmacy verification service and collaborates with the major
search engines (e.g., Google, Bing) in order to enforce policies
against illegitimate online pharmacies, which can be as much as 90%
of the total number of online pharmacies
In today's rapidly changing world of e-commerce, almost anything
can be bought over the Internet and delivered right to your front door.
Virtually everyday there is news of yet another company selling some
type of product online. Included in this barrage of products is
prescription medication. Not only is it possible to order prescription
medication over the Internet, in some cases it is not necessary to be
examined, or even to consult with a physician. ~ To some, this new
type of "cybermedicine" is an affront to traditional medicine, as well
as potentially dangerous to consumers. In addition, the availability of
medication over the Internet presents a vexing and complex challenge

Vagnozzi, ERCOLE. (2015).
E-commerce Adoption in the
Pharmacy Retailing: The Smart
Social Commerce Distributive
Innovation. Retrieved from
https://www.researchgate.net/
6
to state and federal agencies charged with enforcing drug laws. A
second category of online pharmacies are prescribing based sites.
These sites often employ both pharmacists and doctors. However,
they should be distinguished from the web sites that also may employ
doctors and pharmacists, but only offer medical advice or health
related information. Finally, a third type of online pharmacy is
referred to as online drug shops. This is an appropriate description
because these web sites are primarily engaged in the sale of drugs.
Here, essentially all a consumer needs to do in order to obtain a
controlled substance or any other prescription drug, is simply go to
the site, pick out the drug of choice, and make the purchase with a
credit card. With these sites, no examination is necessary and no
medical questionnaire needs to be answered.
“E-commerce, in the popular sense, can be defined as: the use of
the Internet and the Web to conduct business transactions. A more
technical definition would be: e-commerce involves digitally
enabled commercial transactions between and among organizations
and individuals”
The pharmacy has undergone many changes over the years, due to
both the change in demand from the consumers, and to the
succession of laws and decrees that have helped to change its
nature. The pharmacist, therefore, has to develop and to innovate in
order to meet the competition. According to an economic and
business vision, innovation is the process that allows the pharmacy
(enterprise), through a set of activities, to propose a new
assortment or new business processes. In order to build an
effective e-pharmacy platform, organizational competences and
human resources are important as well as the hardware, the
software and the IT infrastructure.
 7

Keeping apart informatics-specific details, to show a first

appearance of a web pharmacy platform will be used a virtuous
example from United States, i.e. Drugstore.com, one of the first
legal pharmaceutical e-commerce sites born in the USA and in the
rest of the world. That website appeared on the Internet scenes in
the late 1999, soon after the introduction of Soma.com (which
now exists with the name CVS.com) and PlanetRx.com; These
three sites were widely regarded as among the most credible and
reputable in the industry and Wall Street awarded billion-dollar
valuations to companies like drugstore.com at the beginning of
1999

Bhatia, S. (2013). Role of E- E-pharmacy is presently more prominent in developed countries

Pharmacy in Reducing which have put in place a comprehensive regulatory framework and
Accessibility Dispersion an enabling environment including provision for necessary financial
Between Indian States. incentives. The goal of e-pharmacy, other than to improve patient
Retrieved from https://www. care and safety, has also been to reduce racial and ethnic disparities.
www.iiis.org/
Khurshid, F.; Mahammed A.; Internet or online pharmacies sell pharmaceuticals, including
Al-Dhawailie A. (2015). prescription and non-prescription medications. The online sale of
Perception and Knowledge to drugs started in the late 1990s and has extended so considerably that
Online Pharmacy Services the US Food and Drug Administration (FDA) has executed an entire
among Consumers in Riyadh, section on its website dedicated to “BeSafeRx: Know Your Online
Saudi Arabia: A Pilot Survey. Pharmacy. The online pharmacy industry can be categorized into
Latin America Journal of three major types. The first and most legitimate type is the traditional
Pharmacy Retrieved October online pharmacy. These pharmacy only dispense medicine to a
2018 from consumer who has first obtained a prescription from a doctor and
https://www.researchgate.net/ then submits it to the online pharmacy. The second type of online
pharmacy is generally known as online consultation pharmacies,
remote consulting pharmacies, or prescribing pharmacies where
physicians review a patient’s self-reported medical history and then
 8

write a prescription. This type of online pharmacy is more appealing

to consumers because it offers both physician services and pharmacist
services to consumers 3. Finally, a third type of online pharmacy is
classified as a “rogue” pharmacy or online drug shops which allows
consumers to purchase prescription drugs without a physician’s
consultation and a valid prescription. Such pharmacy is considered
illegal by most law enforcement agencies.
Inciardi J.; Surratta H.; Cicero Although prescription drugs are readily available on the Internet, little
T.; Rosenblum A.; Ahwah C.; is known about the prevalence of Internet use for the purchase of
Bailey E.; Dart R.; Burke J. medications without a legitimate prescription, and the characteristics
(2010). Prescription drugs of those that obtain non-prescribed drugs through online sources. The
purchased through the internet: earliest report in the medical literature describing the sale of illicit
Who are the end users? NIH drugs through the Internet was in 2001, and since that time a number
Public Access. of provocative phrases have been heard chronicling the ready
availability of prescription drugs online.
Karberg, J. (2010). Progress in Generally speaking, “online pharmacies are divided into three broad
the Challenge to Regulate categories: traditional online pharmacy, prescribing-based site
Online Pharmacies 2010. pharmacy, and rogue pharmacy. The traditional pharmacies are little
Retrieved January 2018 from more than an online extension of brick and mortar pharmacies. Often,
https://www.researchgate.net/ this type of pharmacy is a nationally known or recognized chain.
Traditional online pharmacies require a prescription before an order
for medicine will be filled or delivered. Traditional online pharmacies
place value on consumer protection and have self-imposed standards
that are commonly more protective than the regulations the Ryan
Haight Act will put in place.
Traditional online pharmacies place value on consumer protection
and have self-imposed standards that are more commonly more
protective than the regulation that what the Ryan Haight Act will put
in place. The National Association of Boards of Pharmacy, a non-
government association that rates online pharmacies, developed the
Verified Internet Pharmacy Practice Sites (VIPPS). The VIPPS
 9

program was developed “in response to public concern of the safety

of pharmacy practices on the Internet. Eligible online pharmacies
display a seal prominently on the front page of their site after VIPPS
accreditation. To earn VIPPS accreditation, a pharmacy must
“comply with the licensing and inspection requirements of their state
and each state to which they dispense pharmaceuticals. Furthermore,
the pharmacies must demonstrate compliance with “VIPPS criteria
including patient rights to privacy, authentication and security of
prescription orders, adherence to a recognized quality assurance
policy, and provision of meaningful consultation between patients
and pharmacists.”
A second category of online pharmacy, prescribing-based, is a remote
consultation pharmacy. This type of pharmacy will often provide both
the prescription and the medication. A customer obtains a
prescription after filling out a short questionnaire that is subsequently
reviewed by a doctor for approval.
A third online pharmacy category is the “rogue pharmacy.” The
defining characteristic of a rogue pharmacy is that medication is
dispensed without a prescription.24 Rogue pharmacies are considered
extremely dangerous and are currently illegal. Many of them operate
from outside of the United States. Rogue pharmacy customers are
often the targets of fraud and counterfeit medicine.
Online pharmacies are companies that sell pharmaceutical
Orizio, G.; Merla, A.; Schulz
preparations, including prescription-only drugs, on the Internet. Very
J.; Gelatti U. (2017). Quality
little is known about this phenomenon because many online
of online pharmacies and
pharmacies operate from remote countries, where legal bases and
websites selling prescription
business practices are largely inaccessible to international research.
drugs: a systematic review.
Online pharmacies are an important phenomenon that is continuing to
spread, despite partial regulation, due to intrinsic difficulties linked to
the impalpable and evanescent nature of the Web and its global
 10

dimension. To enhance the benefits and minimize the risks of online

pharmacies, a 2-level approach could be adopted. The first level
should focus on policy, with laws regulating the phenomenon at an
international level. The second level needs to focus on the individual.
This approach should aim to increase health literacy, required for
making appropriate health choices, recognizing risks and making the
most of the multitude of opportunities offered by the world of
medicine 2.0.

Samadbeik, M.; Ahmadi, M.;

Rejection of the non-national electronic prescription in the selected
Ali, S.; Sahdoughi, F.;
countries is due to the lack of standardization and legislation in this
Garavand, A. (2017). A
area, legal prohibition, verification and authentication problems,
comparative review of
concerns about privacy and security of electronic prescriptions, and
electronic prescription
poor interaction and communication between health systems.
systems: Lessons learned from
developed countries. Iran Over the years, hand-written prescription has been a preferred
University of Medical communication method for physicians in decisions relating to
Sciences. Volume : 6 | Issue : medication therapy and for pharmacists to distribute medications.
1 It is also considered as a valuable resource for the patients on how
to use the medicine to achieve the maximum benefit.

In the last decade, electronic prescription is always considered as

an interested subject among other electronic health solutions to
process the health-related data.

In fact, electronic prescription is a broad term that means using the

computer devices to enter, modify, review, and generate or
transmit medicine prescriptions that prepare two-way transmissions
between the point of care and the dispenser. This form of
technology would safely transmit prescription or prescription-
related information between stakeholders (prescribers, dispensers,

Mavlanova, T.;. Benbunan-
Fich, R. (2010). What Does
Your Online Pharmacy Signal? online vendors create risks for consumers by promoting medicines of
A Comparative Analysis of
Website Trust Features.
Proceedings of the 43rd
Hawaii International
Conference on System
Sciences
Norah Abanmy. (2017). The
extent of use of online
pharmacies in Saudi Arabia.
journal homepage:
www.sciencedirect.com
Shallcross, A.; Ford, B.;
11
pharmacies, health plans, and health insurers) either directly or
through an intermediary (including an electronic prescription
network) using electronic media.
The growth of electronic commerce has offered a new channel for the
commercialization of pharmaceutical products. While regulated
online pharmacies offer convenient distribution of drugs, unregulated
unknown origin and jeopardizing sensitive medical information.
Technology is seen as a facilitator of transformation in health related
organizations both nationally and locally. The development of
electronic commerce has provided pharmacies with a new means of
the distribution of pharmaceutical products. Since pharmacies are
able to enter online markets freely, combating the sale of medicines
of unidentified quality has become more challenging. Online
pharmacies contribute greatly to illegal and counterfeit drug
distribution: drugs of unknown origin worth $39 billion are sold
online annually. Illegitimate online commercialization of
pharmaceutical products puts into question the security of existing
drug supply chains. On the one hand, online pharmacies offer a more
convenient distribution alternative than their physical counterparts.
On the other hand, they may introduce unexpected risks to consumers
by offering counterfeit medicines that lack key ingredients or contain
poisonous substances.
Online pharmacies sell medicine over the Internet and deliver them
by mail. The first online pharmacy was started in the United States
(US) in the late 1990s, and sold both nonprescription and
prescription-only medicines. In the US, around 3000 websites were
selling prescription medicines in 2009. This had increased to more
than 5000 in 2010, and continues to rise rapidly
Acceptance is defined as the process of deliberately and non-
 12

Floerke, V, Mauss, I. (2013). judgmentally engaging with negative emotions. It is conceptualized

Getting better with age: The
relationship between age,
acceptance, and negative
affect. Retrieved December
2017 from
https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC3609879/
as an active process that leads to greater emotional awareness and
understanding, and is thus not the same as resignation. Acceptance
is the opposite of avoiding negative emotion and has been shown
to lead to lower negative affect, across experimental and clinical
intervention studies.

Bansal, Y. (2015). Age And

Age is a very important factor when it comes to influencing
Buyer Behavior. Retrieved
behavior. Every age has its own state of mind, its own perception
from
and its own characteristics. Age is the time period a person or thing
http://webuser.bus.umich.edu/y
has survived till date. Age is a sign of existence. It is usually said
oonc/research/Papers/Yoon_C
that age brings wisdom. Age brings knowledge.
ole_2008_Aging_and_Consum
er_Behavior_HCP.pdf
 13

Toral Janet (2013).

E-commerce is not only for big companies. The small to medium
Introduction to E-Commerce
sized companies should consider e-commerce more and has a
in the Philippines. Retrieved
much higher need for it. With the advent of greater global trade
from
(GATT, ASEAN, APEC initiatives), it is imperative that small to
http://digitalfilipino.com/e-
medium sized companies automate their business to compete with
commerce-101/
foreign brands, as international and intra-regional trade will
increase exponentially. Manual processes in the supply chain that
are slow, redundant, unreliable, inefficient can be replaced with
more efficient ones.

Since 1994, e-commerce changed a lot and entrepreneurs uses

websites for business. Entrepreneurs who sell goods and services to
a global audience, can utilize the Internet as a medium. With less
human intervention, Internet-based businesses are open 24 hours a
day, 7 days a week that can accommodate any customer regardless
of their time zones. But of course, an Internet-based business is not
just about building websites and expect profits to just come, the
infrastructure to complete the sales cycle must be all covered from
B2B to B2C. It is similar to building a physical branch or office
but accessible to a global audience.

Mills David. (2005). In today's rapidly changing world of e-commerce, almost anything
Cybermedicine: The Benefits can be bought over the Internet and delivered right to your front door.
and Risks of Purchasing Drugs Virtually every day there is news of yet another company selling
Over The Internet, Volume 5 some type of product online. Included in this barrage of products is
Issue 2. Retrieved from prescription medication. Not only is it possible to order prescription
https://www.researchgate.net// medication over the Internet, in some cases it is not necessary to be
examined, or even to consult with a physician. ~ To some, this new
type of "cybermedicine" is an affront to traditional medicine, as well
as potentially dangerous to consumers. In addition, the availability of
 14

medication over the Internet presents a vexing and complex challenge

Petrakaki, Dimitra and
Cornford, Tony and Hibberd,
Ralph and Lichtner, Valentina
and Barber, Nick (2011) The
role of technology in shaping
the professional future of
community pharmacists: the
case of the electronic
prescription service in the
English NHS.
to state and federal agencies charged with enforcing drug laws. This
problem has recently led to the Commerce Committee of the U.S.
House hold hearings on the subject in an effort to understand what is
involved with this new type of medicine, and which federal and state
agencies have jurisdiction over online prescription sales.
Unfortunately, it still remains unclear as to exactly which agencies do
have jurisdiction. Nevertheless, as Congress and individual states
rush to address the issue, entrepreneurs and drugstore chains are
racing to establish the next on-line pharmacy.
The role of information technology in pharmacy practice is dynamic
and not likely to lose relevance in the coming years. To some degree,
pharmacists are interested in information technology because we can
envision it increasing efficiency in our daily tasks and improving our
access to vital information. (Petrakaki, Cornford, Hibberd, Lichtner,
& Barber, 2011)

http://www.pharmacytimes.co
m/publications/

health-system-
edition/2013/january2013/the-

role-of-information-
technology-in-advancing-

pharmacy-practice-models-to-
improve-patient-4safety

Kremer, J. (2015). Consumer
eHealth
15
Developments in eHealth are occurring rapidly. In this advisory
report the Council for Public Health and Health Care draws attention
to the emergence of consumer eHealth. The Council defines
consumer eHealth as information and communication technologies
offered directly on the market to consumers without the intermediary
of care providers1, the aim of which is to support and improve users'
health.
Consumer eHealth responds directly to people's wishes and offers
people solicited and unsolicited possibilities. It offers users the
opportunity to shape their personal healthcare for themselves as far as
possible.
Examples include apps for smartphones and wearables (mobile
Health or mHealth), health platforms and personal health records
(PHRs). Smartphone add-ons and applications, such as smart contact
lenses and electronic chips in medication, are further options. Not
only does this concern lifestyle and prevention but also self-
diagnostics and self-treatment.
Consumer eHealth does not yet play a significant role in the current
healthcare system. However, developments are set to occur in rapid
succession and consumer eHealth could profoundly change the
regular healthcare services in various ways. The Council expects that
consumer eHealth and the regular healthcare services will become
partially intertwined. A number of components offered by the regular
healthcare services could also be substituted by consumer eHealth.
Care is set to become increasingly time and location-independent.
The relationship between patients and care providers will change.
Consumer eHealth enables people to take greater control of their
personal health. An increasing number of self-diagnosis and self-
treatment possibilities will arise. Care providers are likely to focus
more specifically on complex diagnostics and joint decision-making,
in which personal considerations play an important role. They will

Stephen Goundrey-Smith
(2014), Examining the role of
new technology in pharmacy:
now and in the future
16
furthermore continue to assume a key role in caring for the
vulnerable. The range of consumer eHealth services offered has
brought new players to the healthcare market, who (in part) are
internationally and commercially oriented.
Consumer eHealth can contribute to improving citizens' health.
Consumer eHealth is on the rise and is expected to become
increasingly important and more comprehensive. Developments are
occurring rapidly, they could have profound consequences and wide-
ranging interests are at stake. The developments that lie ahead can
merely be partially predicted at present and merely be partially
influenced. The regular healthcare services and consumer eHealth are
predicted to become increasingly intertwined. However,
intertwinement poses a number of problems.
Pharmacists are already using IT systems to support their daily work
and, when considering the IT requirements for emerging working
practices, pharmacists should consider what functions could be
provided by systems that they already use.
For example, all pharmacies use pharmacy management systems for
medication records, dispensing, labelling, ordering and stock control.
However, many pharmacies do not use all of the available
functionality of their system, for example, modules to handle patient-
centred services, such as medicines use reviews or prescription
interventions.
Pharmacists should also make the most of services that are available
in their locality, for example, electronic prescription service release 2.
Adoption and use of EPS release 2 in areas where it is available has
the potential to make dispensing and reimbursement processes more
efficient for community pharmacists and the nomination process may
 17

help pharmacists to secure prescription business.

help pharmacists to secure prescription business.

Access to patient record systems will assist pharmacists with

professional decision-making in providing patient-centred services.
For example, the summary care record is now available in many
areas, and has been shown to be beneficial for hospital pharmacists
for medicines reconciliation. In future, it may be used by community
pharmacists, for example with MURs and emergency supplies. As
pharmacists deliver more patient-focused services in future, they will
increasingly use national and local patient record services to do so.

Stephen Goundrey-Smith The power of the internet

(2014), Examining the role of
The internet has been widely adopted for business and social
new technology in pharmacy:
communications. In future, as internet use becomes universal, there
now and in the future
may be an increase in the number of internet pharmacies, and use of
the internet to display and disseminate information on medicines and
health from pharmacies.

Electronic prescribing and discharge

Electronic prescribing (EP) systems automate prescribing, supply and

administration of medicines in hospitals, where they have been shown
to reduce medication errors and have a major impact on patient
safety. However, the effect on error reduction is dependent on system
design and a poorly implemented system can actually increase error
rates.
 18

EP systems were pioneered in the US in the early 1990s, but there are
still relatively few hospitals in the UK with whole-hospital EP
systems. The Technology Fund, announced by the Government in
May 2013, will, hopefully, increase the adoption and use of EP in
hospitals.

Timely and accurate transmission of a patient’s discharge prescription

from secondary to primary care is important to ensure seamless
patient care, and also to prevent errors arising from
miscommunications. Recently, many hospitals have adopted
electronic discharge systems (sometimes as a “quick-win” compared
with a whole-hospital EP system). However, these systems may have
inadequate decision support functions, and data fields that are not in a
standard format. Furthermore, they route the discharge information to
GPs, not to community pharmacists.

The use of electronic ward cabinets is the next level of automation in

hospitals. These have been shown to provide benefits such as reduced
number of medication errors, reduction in number of missed doses,
supply delays and stock outages, and reduction of stock-holding and
wastage.
However, installation of ward cabinets constitutes a considerable
expense, a major implementation project and a significant change in
working practice for both pharmacy and nursing staff. For these
reasons, ward cabinets have not been installed in many UK hospitals
to date.

Mobile technology

The use of mobile telephones is widespread in society. Some

pharmacies are using text alerts to remind patients that repeat
prescriptions are ready or to offer services, but sophisticated apps
 19

have been developed for disease monitoring, for example, recording

of peak flow readings in asthma, monitoring of blood glucose levels,
medication adherence support and health education. These apps will
have a greater impact on pharmacy practice in future.

Telecare involves the use of digital communications technology

(audio and visual) to provide healthcare consultations and services to
patients remotely at home. Telecare has various potential benefits: it
puts patients at the centre of their care and supports personalised
medicine; it improves access to healthcare by reducing the need for
hospital attendance (for people with poor mobility, or those in remote
areas); and it can reduce the travelling times and costs of healthcare
professionals.
In pharmacy, use of remote consultations, together with EPS release 2
and an internet pharmacy supply service, could transform the way
that pharmacy services are provided. However, adoption of telecare
in pharmacy would be dependent on the availability of reliable
communications and integration architectures, the willingness of
pharmacy operators to invest in these and also a critical mass of
domestic use of digital technologies in all patient demographics.

Fatehi, F. and R. Wootton
(2012). “Original article
telehealth or e-health? A
bibliometric analysis of the
trends in the use of these
terms.” In: Journal of
Telemedicine and Telecare
The terms 'telemedicine', 'telehealth' and 'e-health' are often used
interchangeably. We examined the occurrence of these terms in the
Scopus database. A total of 11,644 documents contained one of the
three terms in the title or abstract. Telemedicine was the most
common term, with 8028 documents referring to it, followed by e-
health (n = 2573) and then telehealth (n = 1679). Telemedicine was
referred to in documents from 126 countries; the terms telehealth
and e-health were found in publications from 55 and 99 countries,
respectively. Documents with telemedicine in their title or abstract

Feletto, E., L. K. Wilson, A.
Roberts, and S. Benrimoj
(2010). “Flexibility in
community pharmacy: a
qualitative study of business
models and cognitive
services.” In: Pharmacy
World & Science
20
first appeared in 1972, and continued to appear at a low rate until
1994 when they started to increase rapidly; telehealth showed a
similar pattern, but with the growth beginning about five years
later. Although articles containing the term e-health appeared later
than the other two terms, the rate of increase was higher. Articles
(journal papers) were the most common type for the three key
terms, followed by conference papers and review articles.
Publication rates for telemedicine or telehealth or e-health were
compared with two other relatively new fields of study: Minimally
Invasive Surgery (MIS) and Highly Active Antiretroviral Therapy
(HAART). Publications concerning HAART seem to have reached
a peak and are now declining, but those with the three key terms
and those concerning MIS are both growing. The variation in the
level of adoption for the three terms suggests ambiguity in their
definition and a lack of clarity in the concepts they refer to.
Community pharmacies have used the four types of flexibility to
build capacity in distinct ways and react to changes in the local
environment. This capacity building was manifested in four emerging
business models which integrate services to varying degrees: classic
community pharmacy, retail destination pharmacy, health care
solution pharmacy and networked pharmacy. The perception of
viability is less focused on dispensing medications and more focused
on differentiating pharmacies through either a retail or services focus.
Strategic flexibility appeared to offer pharmacies the ability to
integrate and sustainably deliver services more successfully than
other types, as exhibited by health care solution and networked
pharmacies.
Active support and encouragement to transition from being dependent
on dispensing to implementing services is needed. Pharmacies where
services were implemented and showed success are those
 21

strategically differentiating their businesses to become focused health

care providers. This holistic approach should inevitably influence the
sustainability of services.

Gurp, J. van, J. Hasselaar, E.

A systematic review of the literature examined intervention studies
van Leeuwen, P. Hoek, K.
designed to increase patients' participation in medical consultations.
Vissers, and M. van Selm
Twenty-five papers describing twenty studies met the inclusion
(2013). “Connecting with
criteria. About half of the intervention studies were randomized
patients and instilling realism
placebo controlled experimental designs. The studies were
in an era of emerging
predominantly conducted in outpatient or primary care settings, with
communication possibilities: a
50% of the interventions presented in a written form. Overall, half of
review on palliative care
the interventions resulted in increased patient participation, with
communication heading to
slightly more significant results found for bids for clarification than
telecare practice.” In: Patient
question-asking. However, of the 10 written interventions only two
education and counseling
reported a significant increase in question-asking. Patient satisfaction
was the most commonly measured outcome, but few significant
improvements were found. However, there were significant
improvements in other outcomes, including perceptions of control
over health, preferences for an active role in health care, recall of
information, adherence to recommendations, attendance, and clinical
outcomes. Few studies examined the links between patient
characteristics and the success of the interventions. Future research
needs to establish which forms of intervention are most effective and
practical, for which groups of patients.