Department of Health, Australia.

Objective To systematically review the e ect of consumer use of online health information on decision-making, attitudes, knowledge, satisfaction and health outcomes and utilization. Inclusion criteria All post-1995 comparative studies (including controlled studies, before and after studies, and interrupted time series analyses) of Internet users vs. non-Internet users and other communications mediums, and Internet characteristics such as e-mail vs. other communication mediums, were included. Outcomes included consumer decision-making, attitudes, knowledge, satisfaction and measurable changes in health status or health utilization.Data extraction and synthesis One reviewer screened all papers then two reviewers independently assessed studies against the selection criteria and any discrepancies were resolved by discussion with a third reviewer. No attempt was made to combine the data for further statistical analysis.Main results We identi®ed 10 comparative studies. Studies evaluated the e ectiveness of using the Internet to deliver a smoking cessation programme, cardiac and nutrition educational programmes, behavioural interventions for headache and weight loss, and pharmacy and augmentative services. All studies showed some positive e ects on health outcomes, although the methodological quality of many studies was poor.

Objective: To examine whether the sale of medicines via the internet supports their safe and appropriate use.Design: e-Pharmacy websites were identified using key words and a metasearch engine and the quality of information published on these websites was surveyed using the DISCERN tool. A case scenario and internet pharmacy practice standards were also used to evaluate the quality of care delivered. Setting and participants: Between July and September 2001 104 websites were surveyed and 27 sent either Sudafed (pseudoephedrine HCl), St John's wort products, or both to a residential address in Melbourne, Australia. Main outcome measures: Quality of health information (DISCERN ratings), information exchanged between e-pharmacy staff and consumers, and product and delivery costs. Results: Of 104 e-pharmacies from at least 13 different countries, 63 websites provided some health information but overall the quality of the information was poor. Only three website operators provided adequate advice to consumers to avoid a potential drug interaction. The costs for a daily dose of pseudoephedrine HCl (240 mg) ranged from A$0.81 to A$3.04, and delivery costs from A$3.28 to A$62.70. Conclusion: Consumers who self-select medicines from websites have insufficient access to information and advice at the point of ordering and on delivery to make informed decisions about their safe and appropriate use.T he internet provides consumers with global access to health information, services and support. It has revolutionised the sale of medicines so that consumers can selfselect and buy medicines, often delivered across national and state boundaries, without face to face interaction with a health professional. e-Pharmacies are websites selling prescription only medicines and other products including non-prescription and complementary medicines.To ensure the optimal use of medicines, consumers should have timely access to quality information about their benefits, risks, and appropriate usage.1 Consumers want information about medicines but have different individual needs.2 3 Health professionals who prescribe or dispense medicines have professional, ethical, and legal responsibilities to provide consumers with quality information and facilitate the safe and appropriate use of medicines. Whether e-pharmacies provide such information or advice is largely unknown.Previous studies of e-pharmacies are limited to American websites or those selling lifestyle medications, including sildenafil and finasteride. [4][5][6][7][8][9][10] Most studies regarding quality of online information focus on specific diseases or treatments, rather than the information and advice associated with the delivery of pharmaceutical services.As controversy brews over the announcement of a German health insurance company that encourages consumers to buy medicines via the internet, 11 this study aims to examine whether consumers can do so safely. It is the first study to evaluate the quality of information published on global e-pharmacy websites and to determine what h...

Safeguarding consumers and ensuring the quality of web sites that sell medicines across state and national boundaries is both complex and difficult. Strategies to improve the quality of e-pharmacies include independent third-party regulation of providers, evaluation and enforcement of sanctions in cases of dissemination of fraudulent or harmful information and practices, self-regulation and consumer education. The development of internet regulatory technologies themselves and the resolution of jurisdictional issues offer future solutions but international co-operation is vital.