There are multiple ways in which community pharmacies can present themselves on the Internet, e.g., as a platform for drug information or as an advertising platform for their services.
To estimate the number of Swiss community pharmacies on the Internet over the period of 32 months (2000-2003), to describe their current e-commerce services, and to explore the experiences and plans these pharmacies have with regard to their Internet presence.
A longitudinal study was performed to determine the number of Swiss German pharmacies on the Internet by conducting Internet searches in 2000, 2001, and 2003. In April 2002, a cross-sectional Internet-based survey was administered to explore the pharmacies' experiences and plans regarding their Web sites.
As of April 2003, 373 (44%) of 852 community pharmacies from the German speaking part of Switzerland were on the Internet. One hundred eighty four listed an e-mail address and were asked to complete a questionnaire. Of the 107 pharmacies answering the survey questions (58% response rate): 46% had been on the Internet for 1 to 2 years; 33% of the Web sites are part of a pharmacy group's Web portal; 31% of the pharmacies plan to expand their Internet appearance in the future; 74% provide e-commerce services, with 81% of those pharmacies filling five or less orders per month; and 12% plan on expanding their e-commerce services in the future.
The number of community pharmacies offering Internet services steadily increased over 32 months. Given the importance of the Internet as a tool for information, communication, and advertising for pharmacy products and services, it can be expected that the increase will continue. Pharmacy-group portals are important promoters of pharmacies on the Internet. For many community pharmacies, Internet portals that provide an Internet presence for the pharmacies and provide regularly-updated content (e.g., health news, tips, drug information) seem to be the most effective solutions. Even though 40% of the pharmacies already offer e-commerce services, these services are still of minor importance. For many pharmacists, the current legal regulations seem to be unclear. Most pharmacies want to maintain their Internet services.
Worldwide, more and more people are using the Internet. In 2002, 49% of the Swiss population was reported to be online [
Given the rapidly-growing number of Web sites offering drugs on the Internet, community pharmacists are not willing to leave this new trade channel to often unidentifiable and dubious suppliers. Studies have shown that the drugs offered over the Internet are sometimes of bad quality and expensive; the origin of the drugs is often untraceable; or counseling is often unsatisfactory [
In Switzerland, several ways of distributing drugs via the Internet have emerged during the last couple of years. The federal law on medicinal products and medical devices,
the medical product (including OTC products) has been prescribed by a medical doctor
no safety requirements stand against it
appropriate consultation is guaranteed
sufficient medical supervision of the effect of the medicinal product is guaranteed.
A special form of mail-order trade that does not require a special authorization is shipping drugs to regular community-pharmacy customers. A pre-existing personal relationship (face-to-face) between the pharmacy and the patient is required. Furthermore, the service is only allowed in justified cases, e.g., if it is impossible for the patient to pick up the drug personally in the pharmacy [
In the view of many experts, pharmacies that combine a traditional retail operation with Internet-based business-to-consumer (B2C), so-called "bricks and clicks" pharmacies, are poised to become the most successful type of pharmacy in the future [
This study determines the presence of Swiss German community pharmacies on the Internet from 2000 to 2003, with special focus on e-commerce. The study addressed these questions:
How many Swiss community pharmacies have an Internet presence?
What are the characteristics of the community pharmacy Web sites?
How many community pharmacies offer e-commerce services?
What are the pharmacists' experiences and plans regarding their Internet presence?
To determine the number of Swiss German community pharmacy Web sites, an Internet search was conducted in August 2000, with follow-up searches in December 2001, and April 2003. The Internet searches were performed with different search engines using the search term
All hits found in the two directories were explored by clicking on each link. In addition, to complete the list, the first 200 hits found with each search engine were explored by clicking on each link. If the link turned out to be a pharmacy, name and Internet address was entered into a database. In addition, in the 2003 search, each identified Web site was checked for the presence of e-commerce services.
Number of links found in various directories and search engines
Directory / Search engine | Number of Links Found | ||
2000 | 2001 | 2003 | |
Pharmacy Internet-Address Directories | |||
|
64 | 56 | 117 |
|
232 | 306 | 356 |
Search engines | |||
|
3745 | 11470 | 396095 |
|
4637 | 9000 | 13000 |
|
17300 | 20900 | 27200 |
|
5217 | 6267 | 89163 |
An Internet-based questionnaire survey (conducted from June 2002 to July 2002) was developed to explore the pharmacists' experiences with and future plans for their Web sites. The questionnaire had 21 items and was tested in a pilot survey among 20 pharmacies. Among the 235 pharmacies that were on the Internet (according to the Internet search of 2001, 184 had provided an e-mail address. These were approached by sending an e-mail that stated the purpose of the survey and invited them to take part. The participants were given the option of completing the questionnaire online or printing the questionnaire-attached to the e-mail as a portable document format (PDF) file-and send it back by fax or by regular mail. As an incentive, the participants were promised a summary of the survey results.
Questions had preformulated responses (yes-no options, multiple-choice options) and free-text fields for adding comments. Topics addressed included: (1) general information, (2) experiences or plans for the future, (3) patients' feedback, and (4) e-commerce. The original Internet-based questionnaire is in the
Pharmacists who did not return the questionnaire in time were sent up to 2 reminders. In the second reminder, the nonrespondents were asked to state the reason (e.g., no time or no interest in the topic) for their nonparticipation.
Data-quality assurance was conducted by randomly selecting 5% of all cases following data entry and cross-checking with the coding sheet. No miscoded data was found. No cases had to be deleted due to very unlikely or extreme values.
The data (for all 3 survey parts) were collected in an anonymous manner and transferred to an Access database. SPSS (SPSS Inc, Chicago/IL, USA) was used for statistical analysis. Chi-square tests were used to test the type of Internet presence (individual Web site / part of pharmacy group's portal) and the offering of e-commerce or the duration of the Internet sites' existence and the offering of e-commerce. The a priori level of significance for type I errors (alpha) was set at <.05.
In April 2003, 44% (373/852) of the Swiss German community pharmacies had an Internet presence (
Number of community pharmacy Web sites: 2000, 2001, and 2003
The total number of pharmacies was obtained from the annual report published by the Swiss Pharmaceutical Society [
Basic characteristics of community pharmacy Web sites, as obtained through the 2002 Internet-survey.(n=107 respondents)
Characteristic | N | % |
Duration of Internet presence |
6 |
6 |
Type of Internet presence |
71 |
66 |
Frequency of updates |
24 |
22 |
Communication with patients via e-mail |
98 |
92 |
† Overlap of durations (1-2 years, 2-5 years) is an error from the questionnaire.
Pharmacists' reasons for their Internet presence and future plans, as obtained through the 2002 Internet-survey.(n=107 respondents)
Variable | N | % |
Reasons for Internet presence |
54 |
25 |
Future plans regarding the pharmacy Web site |
67 |
62 |
* N = 223 answers; allowed multiple answers.
† Based on 107 cases.
Characteristics of the pharmacies offering e-commerce services, as obtained through the 2002 Internet-survey.(n=107 respondents)
Variable | N | % |
E-commerce model |
55 |
37 |
Range of products |
70 |
39 |
Number of orders per month |
64 |
84 |
Concerns |
38 |
35 |
Regarding safety of patient data: |
61 |
|
Knowledge of the legal situation |
38 |
|
Future of e-commerce |
59 |
80 |
* N = 143 answers; allowed multiple answers.
† N = 180 answers; allowed multiple answers.
‡ Addressed to the pharmacies offering E-commerce (N = 79); based on 74 to 76 cases due to missing responses. Overlap of durations (up to 5, 5-10, 10-20) is in the questionnaire.
§ Addressed to all the participants (N = 107)
Basic characteristics of pharmacies online are shown in
As illustrated in
As reasons for a planned expansion of the Internet site (n=31), the pharmacies stated that they want: to emphasize services in a more extensive way (34); to offer more-extensive counseling services via the Internet (e.g., provision of information regarding new drugs, health news, tips for consumers) (22); to offer e-commerce services (10); and to provide interactive communication channels (e.g., chats, forums, mailing lists) (3) (multiple answers were allowed).
As reasons for a planned downsizing (n=6) or discontinuation (n=1) of the Internet site, the pharmacies listed: financial aspects (6); expenditure of human labor (4); lack of customer feedback (4); data security (1); drug safety (1); and legal aspects (1) (multiple answers were allowed).
According to our survey, e-commerce services were offered by 74% of the pharmacies. Three pharmacies that are not yet offering e-commerce said that it is out of the question for them to do so in the future. The other pharmacies that are not yet offering e-commerce services either want to monitor the market (36%), want to monitor the legal situation (21%), or are planning to introduce e-commerce services within the next 12 months (11%) or by a later point of time (21%).
Regarding the different ways of distributing drugs via the Internet, an Internet-based reservation system (37%) or affiliation with an Internet partner (25%) are the most popular e-commerce models. There was no significant association regarding either the type of Internet presence (individual Web site / part of pharmacy group's portal) and the offering of e-commerce (Χ 2
2= 5.19.
This study revealed that the number of pharmacies with an Internet presence doubled (109 in 2000; 235 in 2001) within the first 16 months and increased by another 59% (373 in 2003) within the second 16 months. A further increase can be expected, as there are still 479 community pharmacies (April 2003) that do not yet have an active presence on the Internet. In a recently-conducted survey (2001) with Swiss pharmacists, 41% stated they would like to be on the Internet with a Web site and 88% already had access to the Internet in the pharmacy [
One third of the pharmacies' Internet sites are part of a pharmacy-group's Internet portal. The pharmacy-groups' Internet portals (60% of the Swiss community pharmacies belong to chain or group organizations [
As a recent Swiss patient survey revealed, 55% of patients do not feel the need for a community pharmacy Web site [
So far, only 19% of the pharmacists see their Web site as an additional value and only 18% as a platform for independent information, to become a drug-information center as proposed by experts in a recent survey [
In the summer of 2002, 74% of the Swiss pharmacies that were on the Internet provided e-commerce services. In Germany, this figure amounted to 32% in 2001 [
Seventy-two percent of the pharmacies that offer e-commerce services in Switzerland are affiliated with the Swiss Internet pharmacy partner Wellshop [
Because relatively little information was known about the nonresponders, it could not be ruled out that pharmacies offering e-commerce services were overrepresented among the respondents. Regarding this possible bias, the pharmacy Web sites were checked for the presence of e-commerce services during the search of April 2003. The fact that in 2003 a total of 40% of the Web sites offered e-commerce services confirmed the assumption that the respondents of the 2002 survey might not be representative regarding the provision of e-commerce services (according to the 2002 survey, e-commerce services were offered by 74% of the pharmacies).
According to a British study, the 4 main groups buying pharmaceutical products online are: busy executives, mothers at home, the elderly or disabled, and those making embarrassing purchases [
Our finding that many pharmacists have only partial or no knowledge of the legal situation regarding e-commerce with drugs in Switzerland was confirmed by an investigation in 2003 [
Relatively little information is known regarding the Internet-based survey nonrespondents. Only a minority of them stated the reason for not taking part in the survey. It cannot be ruled out that those who took part in the survey are more Internet savvy and are utilizing their Internet site in a more extensive way, e.g., regarding e-commerce. Furthermore, this study only measures the situation in Switzerland from 2000 to 2003. Considering the dynamic development in Internet presence and drug distribution over the Internet, this study would have to be repeated on a regular basis.
The number of community pharmacies offering Internet services steadily increased over the 32 months covered by the survey. Because of the importance of this new medium as a tool for information, communication, and advertising for pharmacy products and services, the increase can be expected to continue. Pharmacy-group portals are important promoters of pharmacies on the Internet. For many community pharmacies, Internet portals that provide an Internet presence for the pharmacies and provide regularly-updated content seem to be the most effective solution. Even though 40% of the pharmacies already offer e-commerce services, it is still of minor importance. For many pharmacists, the current legal regulations seem to be unclear. Most pharmacies want to maintain their Internet services.
We wish to thank Documed AG for financial support.
Documed AG publishes the official Swiss drug reference book (Arzneimittelkompendium) and other publications in the field of drug information in print as well as in electronic form and is active in the field of eHealth. Documed AG gave input at the beginning of the studies and their interests lie in the number of pharmacies with an Internet presence and in e-commerce services offered.
Questionnaire "Pharmacies on the Internet: Survey concerning past experiences and future plans":
Over-the-counter (non-prescription)