Yan Weijie,Li Lingxi,Li Yanran,Min Jie,Zhang Zhixuan,Zhou Yuliang,Huang Jiaoling,Zhang Li

(1.School of Medicine,Shanghai Jiaotong University,Shanghai 200025,China;2.School of Public Health,Shanghai Jiaotong University,Shanghai 200025,China)

Abstract Objective To investigate the willingness of Shanghai residents to buy prescription drugs online.Methods By using e-questionnaire,Shanghai residents’ perceptions of online prescription drugs were investigated,and 206 valid questionnaires were collected.Results and Conclusion 96.1% of the respondents knew the correct definition of prescription drugs.46.6% knew they could buy prescription drugs online.67.7%,through social media,knew they could buy prescription drugs online.72.3% knew a medical prescription should be required when buying prescription drugs online.And 83.5% refused to buy prescription drugs online because they were concerned about the quality and safety of drugs.The publicity of online-pharmacies and prescription drugs should be increased in China.Besides,the government supervision should be strengthened in the whole process of service to protect consumers’ rights and benefits.Then,the channels of online purchase must be optimized for customers.Lastly,a medical insurance payment system should be set up for buying prescription drugs online.

Keywords:prescription drugs;online-buying;survey

Article 61 of the “Drug Administration Law of the People’s Republic of China” (effective December 1,2019) stipulates that drug market license holders and pharmaceutical enterprises selling drugs through the Internet shall abide by the relevant provisions of this Law on drug management.The specific administrative measures shall be formulated by the drug supervision and administration department under the State Council in cooperation with the department of health under the State Council and other departments.Drugs under special administration by the state such as vaccines,blood products,narcotic drugs,psychotic drugs,toxic drugs for medical use,radioactive drugs and drug-type easily-topoison chemicals shall not be sold on the Internet[1].

Under the act,prescription drugs are not included in the list of drugs that are not allowed to be sold online.This means that online prescription drugs are not prohibited by law[2].

We investigated and statistically analyzed the factors that affect the willingness of Shanghai residents to buy prescription drugs online by online questionnaire.We aimed to investigate their perception of the definition of prescription drugs,the way of buying prescription drugs online,the awareness of whether a medical prescription is needed when buying prescription drugs online,the reasons for the willingness (unwillingness) to buy prescription drugs online,and the satisfaction and recommendation of buying prescription drugs online.This provides a reference and advice for the online sale and purchase of prescription drugs.

1 Materials and methods

1.1 Questionnaires and respondents

The survey used a self-made questionnaire that included the respondents’ age,gender,monthly income,education,occupation,knowledge of prescription drugs,reasons and willingness to buy prescription drugs online.We surveyed Shanghai residents from July to August 2020.By using convenience sampling,300 e-questionnaires were distributed through the network.206 valid questionnaires were recovered and the effective recovery rate of questionnaires was 68.7%.

1.2 Methods

Excel forms were used for data entry and SPSS22.0 was applied to analyze the data of the survey.

2 Basic information of the respondents

Of the 206 respondents,72 were men (35.0%)and 134 were women (65.0%).82 respondents (39.8%)aged 20 years old and under,31 respondents (15.0%)aged from 21 years old to 30 years old,23 respondents(11.2%) aged from 31 years old to 40 years old,33 respondents (16.0%) aged from 41 years old to 50 years old,30 respondents (14.6%) aged from 51 years old to 60 years old,7 respondents (3.4%) aged above 60 years old.

The quantity distribution of educational background of the respondents were 5 (2.4%) with primary school diplomas,11(5.3%) with junior high school diplomas,50 (24.3%) with high school diplomas,33 (16.0%) with junior colleges diplomas,98(47.6%) with bachelor,degrees,8 (3.9%) with master’s degree and 1 (0.5%) with PhD degree.Altogether,181 respondents (87.9%) possessed diplomas of high school,junior colleges and university.

Monthly income of the respondents:60 respondents (29.1%) got less than 1 000 yuan,49 respondents (23.8%) got from 1 000 to 3 000 yuan,42 respondents (20.4%) got from 3 000 to 5 000 yuan,26 respondents (12.6%) got from 5 000 to 8 000 yuan,and 29 respondents (14.1%) got more than 8 000 yuan.

In order to study whether having a background in the pharmaceutical industry would affect the purchase of prescription drugs online,the respondents were divided into pharmaceutical industry practitioners and non-pharmaceutical industry practitioners.The number of pharmaceutical industry practitioners was 40 (19.4%),and the number of non-pharmaceutical industry practitioners was 166 (80.6%).

3 Results and data analysis

3.1 Cognition about the definition of prescription drugs

In the questionnaire,respondents were asked if they knew they could buy prescription drugs online,and the data showed that 96 respondents (46.6%)knew they could buy prescription drugs online,and 110 (53.4%) did not know it.

In the questionnaire,respondents were asked to choose the correct definition of prescription drugs,and the results showed that 198 respondents (96.1%)knew the correct definition of prescription drugs,and 8 (3.9%) did not know the correct answer.

Respondents under 60 years old had a more than 90% correct rate of prescription drug definitions,while those over 60 years old had a nearly 70% correct rate.

The relationship between the age of the respondents and the awareness rate of correct definition on prescription drugs can be found in Table 1.

Through analysis of variance in Table 1,we conclude that there are significant differences (P<0.05) between the respondents aged above and under 60 years old in understanding the correct definition of prescription drugs.

Table 1 Multiple comparisons between age groups

3.2 Respondents’ perceptions of the way through which prescription drugs are purchased online

In the questionnaire,respondents were asked howthey knew about buying prescription drugs online.The results showed that 67.7% of the respondents knew the way through social media (such as Blogs,QQ,WeChat,etc.),43.8% of the respondents through relatives and friends,37.5% of the respondents through television media,18.8% of the respondents through newspapers and magazines,17.7% of the respondents through laws and regulations/policies,16.7% of the respondents through radio stations,and 14.6% of the respondents through other sources.

3.3 Respondents’ perceptions of whether needing a medical prescription when buying prescription drugs online

In the questionnaire,respondents were asked if they knew that a medical prescription was needed when buying prescription drugs online.The results showed that 72.3% of the respondents knew that the prescription was needed when buying prescription drugs online,and 27.7% lacked understanding of this.It indicated that more introduction and popularization of the process of buying prescription drugs online should be made.

3.4 Reasons why respondents are willing (unwilling)to buy prescription drugs online

In the questionnaire,respondents were asked whether they were willing (unwilling) to buy prescription drugs online.A total of 115 respondents answered the reasons for their willingness to buy prescription drugs online.92.2% chose convenience,51.3% chose reasonable price,50.4% chose many varieties,21.7% chose good service,14.8% chose good quality,and 1.7% chose other reasons.91 respondents answered the reasons for their unwillingness to buy prescription drugs online.83.5% chose concerns about drug quality and safety,60.6% chose concerns about the safety of the purchase channel,45.1% chose inconvenient online-consultation,44% chose concerns about the safety of drug transportation,42.9% chose concerns about unsafe drug storage,35.2% chose showing prescriptions inconveniently,30.8% say they could not use health insurance to pay online,and 2.2 percent chose other reasons.

3.5 Respondents’ satisfaction assessments and suggestions for buying prescription drugs online

In the questionnaire,respondents were asked about their satisfaction and suggestions for buying prescription drugs online.The following 8 factors were taken as the standard:time saving,quality guaranteed,enough kinds of drugs,rapid and efficient delivery,drugs are described as the actual situation,completely packaged when delivered,uncomplicated buying process,and reasonable price.Then,Likert five-points scale[3]was applied to count them.1 point for I disagree very much,2 points for I disagree,3 points for I don’t know,4 points for I agree,and 5 points for I agree totally.Finally,we calculated the average score of 46 valid questionnaires.The average score of consumers’ satisfaction with buying prescription drugs online is shown in Fig.1.

Fig.1 Evaluation of average satisfaction of consumers buying prescription drugs online

In Fig.1,the highest average score is time-saving as 4.2,and the lowest average score is drug quality as 3.7,which reflects the satisfaction with buying the prescription drugs online need to be improved.

Of the 117 recommendations made by the respondents,18 were on strengthening government’supervision and process standardization,39 were on the safety and credibility of selling prescription drugs online,15 were on face-to-face guidance from doctors online,and the online platform with the medical records,6 were on the insufficient popularity of buying prescription drugs online,7 were on using the patients real name and providing medical prescriptions for purchase of prescription drugs online,and 4 were refusals of buying prescription drugs from Internet platform.

4 Discussion and suggestions

4.1 Increasing the publicity of online-pharmacies and prescription drugs

The survey showed that 3.88% of respondents did not understand the correct definition of prescription drugs.51.52% of those who knew the correct definition of prescription drugs did not know they could buy prescription drugs online.27.67%of respondents believed that buying prescription drugs online did not require a medical prescription.This shows that China’s government has not done enough in the popularity of prescription drugs and online-pharmacies,and the spread of the concept of prescription drugs is still an urgent task.

According to the survey,67.71% of respondents learned about the concept of prescription drugs through social media (such as Blog,QQ,WeChat,etc.).But many older people could not use mobile phones and social media skillfully.Only 22.33% of respondents above 60 years old once bought prescription drugs online.90% of respondents under 60 years old had the right understanding of prescription drugs,while only 70% of respondents above 60 years old were correct.Many respondents did not know that prescription drugs could be purchased online.It is an important reason why prescription drugs are not yet fully popularized.Therefore,there is a need to strengthen the popularity of the concept of online-drugstore and prescription drugs[4].The definition of prescription drugs can be promoted directly in hospitals,newspapers and television media.The government can provide consumers with a list of credible onlinedrugstores.Meanwhile,drug supervision departments should publish relevant information on online-buyingdrugs in its official media so that the public can learn more about it.

4.2 Strengthening the whole process of service to protect consumers’ rights and benefits

83.52 % of respondents did not want to buy drugs online because they worried about the quality of the drugs.84.47% of respondents still want to buy drugs in drugstores.

The survey showed that respondents were most satisfied with the time-saving (average score is 4.2) for buying prescription drugs online,while the average score of improving drug quality is 3.7.At present,the drug distribution process has not been fully standardized,many drug delivery men are just ordinary people who have no medical knowledge,and the process of consulting with doctors online is also very cumbersome.Therefore,it is necessary to set up a formal website for all drugstores online that customers can trust.Besides,drug distribution process should be standardized to provide a good after-sales service.

4.3 Strengthening government supervision

18 recommendations from the respondents are on strengthening government supervision.Therefore,the supervision department should establish legislation for online-drug-transactions first.Then,the online drugstores should be strictly censored to ensure that their operating varieties,logistics and distribution,quality backtracking and complaints are standardized.Thirdly,the supervision department should participate in the drug transaction process to ensure the standard of procurement,storage,and distribution process.Last but not the least,information technology should be used to establish a more effective drug monitoring and retracing system.

4.4 Optimizing the channels of online purchase

According to the survey,many consumers find it inconvenient to present medical prescriptions and to consult pharmacists while buying drugs online.This requires the sales platform should improve the prescription audit mode and the online consulting service system,which will be in line with the premise of standard to meet consumer needs.Besides,they should further optimize the web design to achieve accurate categorization of drugs so that customers can find what they want with a detailed description.

4.5 Building a medical insurance payment system for buying prescription drugs online

Many respondents thought that the inability to pay through health insurance is an important reason to restrict online-purchases of prescription drugs.The supervision department should study the specific model of medical insurance payment system,and build a new insurance payment system for buying prescription drugs online.