Safety of prescribing PDE-5 inhibitors via e-medicine vs traditional medicine.
OBJECTIVE
To determine the safety of a US-based, state-regulated Internet system vs a multispecialty primary care system for prescribing phosphodiesterase type 5 (PDE-5) inhibitors for erectile dysfunction.


METHODS
From January 1, 2001, through December 31, 2005, 500 e-medicine clients (mean+/-SD age, 47+/-11 years; hypertension, 60%; type 2 diabetes mellitus, 2%; mean+/-SD number of medications, 0.4+/-0.8) vs 500 traditional medicine patients (mean+/-SD age, 57+/-12 years; hypertension, 50%; type 2 diabetes mellitus, 23%; mean+/-SD number of medications, 5.1+/-3.1) with erectile dysfunction symptoms were assessed. Noninferiority safety was assessed in this retrospective, cross-sectional study with stratified random sampling by identification of prescribing in the presence of clinically important PDE-5 inhibitor drug interactions with or without high-risk cardiovascular disease, by asking about diagnostic symptoms specific to erectile dysfunction, and by determining frequency of patient counseling.


RESULTS
Noninferiority of the e-medicine system was shown for the 6 safety end points, relative to a traditional medicine system. Numbers of inappropriate prescriptions, after correction for disease and medication covariates, did not differ between systems. Medication counseling showed superiority of the e-medicine system. Standard diagnostic questions were required for e-medicine prescribing but were infrequently asked in traditional medicine.


CONCLUSIONS
Safety in prescribing PDE-5 inhibitors for erectile dysfunction was similar between a US-based, state-regulated Internet prescribing system and a multispecialty primary care system.
Munger
Mark A
MA
Department of Internal Medicine, Universityof Utah, Salt Lake City 84112-5820, USA. mmunger@hsc.utah.edu
Stoddard
Gregory J
GJ
Wenner
Allen R
AR
Bachman
John W
JW
Jurige
John H
JH
Poe
Laura
L
Baker
Diana L
DL
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003376:Counseling; D003430:Cross-Sectional Studies; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D007172:Erectile Dysfunction / Q000188:drug therapy*; D006801:Humans; D020407:Internet; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010353:Patient Education as Topic; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
D010726:Phosphodiesterase Inhibitors