Physician Designed and Directed Internet-based Vardenafil and Sildenafil Prescribing

Miles J Jones 1, Bernard S Bloom 2
1 Net Doctor International, 2 University of Pennsylvania, USA

Abstract: The Internet is becoming increasingly important as a way for patients to acquire medical information, as a means for patient-physician communication and most importantly access to medical treatment and therapies. Questions about appropriate use of this new technology have been brought to the fore by the many patients using the Internet to seek medications to treat erectile dysfunction.

Objective: To present a description of a Discuss for the treatment of erectile dysfunction together with data covering more than 25,000 patient encounters. Design: Retrospective analysis of a large case series, with informal comparison to patients seen in a conventional office based practice setting.

Setting: A medical practice that prescribes sildenafil and vardenafil based on medical and sexual information obtained through a physician designed and directed Internet site. For comparison, we utilized patients from clinics at a Midwestern inner city medical center, patient comments about their office based care and survey information form questionnaires.

Patients: All 26,650 Internet patients seeking vardenafil and/or sildenafil prescriptions between June 14, 1998, and September 10, 2003.

Main Outcome Measures: Completeness of medical record; patient safety as noted by the follow up responses of all patients requesting refills, any comments received by the Internet site , satisfaction as noted by the follow up responses of all patients requesting refills, any comments received by the Internet site survey data collected during the summer of 2003.

Results: Seventy-six percent of Internet requests came from United States, and 24% from other countries. Most request reviewed by the physicians were granted. All patients requesting medication refills: reported erections sufficient for intercourse and 69% said their satisfaction exceeded all expectations; none were totally dissatisfied with either the service or medication. Side effect rates were comparable to those in the literature. Comparison of the medical history obtained from Internet patients with that recorded in clinic patients charts revealed that the former was far more complete as were the instructions given to each patient. The dissatisfaction rate of sildenafil seems higher than previously suspected. There were no reported deaths or serious complications.

Conclusions: Internet-based vardenafil and sildenafil prescribing provides the physician with a complete and very detailed medical and sexual history for 100% of patients without denying any information routinely obtained in a direct patient contact setting. Internet-based practice, which may be expected to require far fewer healthcare resources than traditional settings, rates very high in patient satisfaction. Overall, these data support the safety, convenience, cost and clinical effectiveness of Internet prescribing of selected medications. Internet prescribing appears to offer greater and faster patient access and superior patient confidentiality than does traditional office practice. More intensive study of this new style of practice is warranted.