Epidemiology and Treatment Barriers of Patients With Erectile Dysfunction Using an Online Prescription Platform: A Cross-Sectional Study

Abstract

Introduction Erectile dysfunction (ED) is a highly common sexual dysfunction of men but often undertreated as patients experience high treatment barriers. Aim The aims of this study were to characterize patients with ED using an online prescription platforms (OPPs) and determine treatment barriers that might prevent patients from seeking care in conventional health care settings. Methods Data from a German OPP were retrospectively analyzed with focus on patients suffering from ED with at least one online prescription of phosphodiesterase-5 (PDE5) inhibitors between May 2019 and November 2019. In addition, a voluntary questionnaire was used to assess additional social features and prior treatment barriers. Main Outcome Measure The main outcome measures were the epidemiological data, prescription metadata, and follow-up questionnaires. Results A total of 11,456 male patients received prescriptions via the OPP (mean age: 49 years [95% CI 46.92–47.45]). Patients lived mainly in rural areas (69%) and frequently sought prescriptions outside the average office times of German urologists (49%). From all patients that responded to a follow-up questionnaire (n = 242), the majority were employed full-time (81%), married (50%), and native German (94%); 63.5% had not used PDE5 inhibitors before. From all repeat users, 41% had received them from unreliable sources. Reasons to seek treatment via the OPP were convenience (48%), shame (23%), and lack of discretion (13%). Conclusion In this first study, to epidemiologically characterize ED patients of an OPP, it was confirmed that inconvenience is a treatment barrier, along with shame and perceived lack of discretion. This is the first evidence that OPPs reduce treatment barriers and ease access for patients to the medical system. Rodler S, von Büren J, Buchner A, et al. Epidemiology and Treatment Barriers of Patients With Erectile Dysfunction Using an Online Prescription Platform: A Cross-Sectional Study. Sex Med 2020;8:370–377.

Digital Real-world Data Suggest Patient Preference for Tadalafil over Sildenafil in Patients with Erectile Dysfunction

“…OPP study population had a median age of 49 yr in the treatment groups. The number of patients without prior therapy was higher than reported in previous studies (63.5%), which is likely due to the younger age and the lower contact exposure as a result of the digital treatment and home delivery of the drug [5]. The proportion of tadalafil prescriptions increased significantly, considering repeat orders over time in all patients.…”

“…The differences in patient characteristics are statistically significant due to the high number of prescriptions but are clinically irrelevant (with the exception of medication dosages). We realized that beneficiaries of digital health services are mainly treatment naive [5], are younger (29,4% of our study population is 40 yr, which is Fig. 1 -Preference for tadalafil over sildenafil in patients familiar with "both" Drugs.…”

“…Some patients might have answered inaccurately sensitive questions in the questionnaire. Further, we must consider that the population might differ from the general ED population due to marketing channels used, and patient selection bias caused by the careful and systematic exclusion of patients with risk factors for potential substance side effects [5].…”

“…A large previously unknown ED population that used an online prescription platform (OPP) to treat their disease was epidemiologically characterized [5]. Compared with the population in approval studies [6,7] and a recent review comparing sildenafil with tadalafil [8], the group from the OPP study is younger, mostly treatment naïve, and not yet well characterized.…”

The Impact of Telemedicine on Sexual Medicine at a Major Academic Center During the COVID-19 Pandemic

“…cardiovascular disease) that are indications for referral to outside specialists. 19,21 The superior ability of primary care physicians and urologists to treat, diagnose, and if needed refer their patients via telemedicine could improve patient safety amidst the rapidly evolving landscape of remote care. Nonetheless, we must also recognize the potential shortcomings of telemedicine.…”