Research in Social and Administrative Pharmacy j (2013) j–j
Original Research
Community pharmacists, Internet and social media: An empirical investigation Natalia Shcherbakova, Ph.D.a,*, Marv Shepherd, Ph.D.b a
Department of Pharmaceutical and Administrative Sciences, College of Pharmacy, Western New England University, 1215 Wilbraham Rd., Springfield, MA 01119, USA b Center for Pharmacoeconomic Studies, College of Pharmacy, The University of Texas at Austin, TX, USA
Abstract Background: Use of social media and Internet for health information sharing is expanding among patients, physicians, and other health care professionals. Research on professional use of social media by community pharmacists is limited. Objectives: 1) To determine the extent to which Texas (U.S. state) independent community pharmacists use text messaging, email, Facebook, Twitter, and/or other information technology for professional communication with patients and health care professionals and identify the perceptions of Texas independent community pharmacists toward such usage; 2) to determine the extent to which Texas independent community pharmacists develop and employ their pharmacy websites to provide drug information and patient care services. Methods: A 25-item survey with questions addressing the objectives of the study as well as basic demographic questions (gender, age, and type of pharmacy degree) was mailed to a random sample of 1196 independent community pharmacists in Texas in January 2012. Results: The study response rate was 23.7%, with 284 usable questionnaires returned. The majority of respondents reported that Internet access is available at their pharmacies (98% (278)), and 91% (258) are familiar with the term ‘social media’. To communicate with health care professionals, 56% (n ¼ 160) of respondents use email, 34% (n ¼ 97) use text messages and 5% (n ¼ 14) use Facebook. To communicate with patients, 36% (n ¼ 102) of respondents use email, 30% (n ¼ 86) use text messages and 7% (n ¼ 19) use Facebook. The perceptions of pharmacists who communicate with patients using electronic tools about information related to drug therapy once a month or more frequently were more positive than those of pharmacists who never or hardly ever communicate with patients via electronic tools about drug therapy (P ! 0.05). Over 50% of independent pharmacists reported maintaining a pharmacy website. Conclusions: This study is the first U.S. statewide assessment of the use of electronic communication and social media for professional pharmacist’s communications and perceptions toward the use of social media in patient–pharmacist communications among independent community pharmacists in Texas. Future Conflict of interest: No conflict of interest exists. The opinions, interpretations of results and conclusions presented here are those of the authors and are independent from the funding source. Funding source: The authors would like to acknowledge the funding support for this study provided via investigator-initiated grant by the Community Pharmacy Foundation. The results of this study were presented in part at the annual meeting of the American Pharmacists Association in New Orleans, LA, March 10, 2012 * Corresponding author. Tel.: þ1 413 796 2441; fax: þ1 413 796 2266. E-mail address: [email protected] (N. Shcherbakova). 1551-7411/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2013.11.007
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studies conducted in other states as well as nationwide will contribute to a better understanding of the use of electronic communication, Internet, and social media in the daily professional activities of independent community pharmacists. Ó 2013 Elsevier Inc. All rights reserved. Keywords: Social media; Internet; Community pharmacy; e-Health communication; Pharmacist e-communication
Introduction Health care communication through electronic channels, including social media, has gained popularity among both patients and health care providers over the past several years.1–12 Recent review papers attempted to summarize the body of literature on social media use for various purposes by health care professionals, students and educators.13,14 Research on electronic communications and social media use for professional purposes by pharmacists in the U.S. has been limited to a few studies, which examined either the general use of social media by pharmacists or the use of social media for professional activities other than patient– pharmacist communication.15–17 Alkhateeb et al surveyed 50 attendees of the West Virginia Pharmacy Association Convention in 2009 and found that the majority of pharmacists use social media primarily for personal purposes.15 Kukreja et al surveyed a sample of pharmacists that are registered as preceptors for Purdue University College of Pharmacy in early 2010 and also found that respondents use Facebook primarily for social purposes.16 Hajar et al in 2012 conducted a qualitative study of 204 pharmacists’ Twitter accounts and found that only 10% of accounts are of professional rather than social nature according to examination of 30 most recent tweets.17 LupianezVillanueva et al conducted a web-based survey in 2006 to assess Internet usage by physicians, nurses and pharmacists in the Catalonia region of Spain.18 The primary use of the Internet for professional purposes by pharmacists (n ¼ 898) was reported as follows: 46.7% of pharmacists share information with citizens, 38% share information with friends and relatives, 9.2% spread their own scientific papers to the scientific community, 7.4% promote a debate in their specialty, and 18.8% share information with their patients. In the Catalonian study, 73.3% of pharmacists use email to communicate with other health care professionals, while only 38% of pharmacists do so with patients. A 2012 national survey of U.S. pharmacists practicing primarily in clinical settings identified increased use
of mobile technology and social media as the key change in patient communication that pharmacists foresee in the next five years.19 To date, no studies in the U.S. have assessed community pharmacists’ use and perceptions toward their use of electronic communication and social media for professional purposes, including patient–pharmacist communication. With about 15% of community pharmacists nationally practicing at an independent pharmacy setting, this study focused solely on this group due to its flexibility in adopting various tools, including electronic communication and social media, to improve patient care.20 The primary objective of this study was to examine independent pharmacists’ use and perceptions toward the use of social media for professional communication, including communication between patients and the pharmacist. The secondary objective was to assess the degree to which independent pharmacists develop their pharmacy websites to provide drug information and patient care services. Methods The study was a cross-sectional survey of independent community pharmacists practicing in the U.S. state of Texas. We obtained approval from the University of Texas at Austin IRB to conduct the study. Survey A 25-item survey instrument was developed for the study, piloted, and revised based on comments from eight practicing community pharmacists. The items included questions addressing the objectives of the study as well as basic demographics (i.e., gender, age, type of pharmacy degree, year pharmacy degree was completed, professional affiliations, pharmacy location, and primary employment position at the pharmacy). The 12-item scale assessing perceptions toward the use of social media in patient–pharmacist communication was developed in part based on a study conducted by LupianezVillanueva et al among physicians, pharmacists and
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11
nurses in Catalonia, Spain.18 The scale’s face validity was found to be satisfactory based on the feedback from the pilot participants. The scale’s reliability was assessed upon completion of data collection via calculation of the Cronbach’s alpha coefficient. Study sample A random sample of 1196 pharmacists practicing at an independent community pharmacy setting (non-chain, owned by an individual or a small group) and representing about 50% of Texas independent pharmacists was drawn from the roster maintained by the Texas Board of Pharmacy. At the time of the study, the Texas Board of Pharmacy did not maintain a record of each pharmacist’s electronic mailing address, and thus we used the postal service to distribute the questionnaires. The previous response rates to mailed surveys of pharmacists in Florida and Texas range between 18% and 26%.21,22 Data collection A cover letter, the survey questionnaire and an addressed and stamped return envelope were mailed in early January 2012. Data collection continued through February and March 2012. The cover letter stated that pharmacists interested in completing the survey online could do so by following the website link provided in the letter. The online version of the questionnaire was created using the QualtricsÒ survey platform. Returned surveys did not contain any identifiable information, and no incentive for completion was offered. Statistical analyses Descriptive statistics were used for all demographic and social media use variables. Comparisons across groups (pharmacist users and pharmacist non-users of electronic communication and social media for patient communication, pharmacists with positive vs. negative perceptions toward social media use for patient–pharmacist communication) were performed using the t-test for continuous variables and the chi-square test for categorical variables. An alpha level of 0.05 was employed.
Results Demographics A total of 16 surveys were completed online, and 297 questionnaires were returned by mail. However, only 284 mailed questionnaires and
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Table 1 Comparison of demographic characteristics between Texas independent pharmacists and questionnaire respondents Characteristic
Sample (n ¼ 1196)
Respondents (n ¼ 284)
% Male (n) 70 (844) 70 (200) Age (SD) 54.5 (12.2) 54.4 (11.4) Years since graduation (SD) 28.5 (13.3) 28.2 (12.6) % BS Pharm (n) 85 (1016) 83 (235)
electronically completed surveys were sufficiently complete to be included in the analyses. The final response rate was 23.7%. To assess non-response bias, we compared key demographic characteristics of the survey respondents (gender, age, type of pharmacy degree and years since graduation) to the overall sample. The results of the comparison are presented in Table 1. There were no significant differences between the two groups in relation to age, gender, type of pharmacy degree, and years since graduation. The demographics, practice setting and educational characteristics of respondents are presented in Table 2. We stratified the pharmacists according to their responses on the item “Communicating with patients about information related to their drug therapy via text, email or social media” (item 8(1); response options ranged from ‘several times a day’ to ‘never or hardly ever’) into two groups: pharmacists who communicate with patients via text, email or social media regarding drug therapy once a month or more and those who never communicate with patients via the listed tools (Table 2). Analyses revealed that pharmacists who use electronic tools, including social media, for patient communication are slightly younger (52 vs. 55 years old, P ¼ 0.013), completed their pharmacy education more recently (26 vs. 29 years ago, P ¼ 0.0702), reside in metropolitan or small urban areas as opposed to small communities or rural areas (33% and 38% vs. 23% and 14%, respectively, P ¼ 0.021), are more likely to hold membership in one or more professional pharmacy associations (31% vs. 18%, P ¼ 0.025), and are more likely to provide medication therapy management services in their pharmacies (47% vs. 22%, P ¼ 0.000). General use of electronic communication for professional purposes Table 3 presents the electronic tools independent pharmacists use to communicate with health
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Table 2 Demographic, education and practice setting characteristics of the respondents controlling for whether or not independent community pharmacists communicated with patients via social media Demographic characteristic
All respondents Communicated with (n ¼ 284) patients via text, email or social media regarding drug therapy once a month or more frequently (n ¼ 81)
Never communicated with a patient regarding drug therapy via text, email or social media (n ¼ 203)
Age (M (SD))* Gender Male (n ¼ 200) Female (n ¼ 84) Number of years since graduation (M (SD)) Degree BS (n ¼ 235) PharmD (n ¼ 49) Completion of CE online R50% online (n ¼ 218) !50% or none online (n ¼ 66) Professional association membershipa,* Belong to R1 (n ¼ 227) Do not belong (n ¼ 57) Geographic location of practice setting* Metropolitan (n ¼ 128) Small urban (n ¼ 52) Small community (n ¼ 54) Rural (n ¼ 50) Store owners Yes (n ¼ 167) No (n ¼ 117) Provision of MTM services* Yes (n ¼ 72) No (n ¼ 212)
54.4 (11.4)
52.1 (10.6)
55.3 (11.6)
70% 30% 28.2 (12.6)
28% 32% 26.1 (12.4)
72% 68% 29.0 (12.6)
83% 17%
29% 27%
71% 73%
77% 23%
27% 33%
73% 67%
80% 20%
31% 18%
69% 82%
45% 18% 19% 18%
33% 38% 23% 14%
67% 62% 77% 86%
60% 40%
30% 27%
70% 73%
25% 75%
47% 22%
53% 78%
CE ¼ continuing education; M (SD) ¼ mean (standard deviation); MTM ¼ medication therapy management. *P ! 0.05 using chi-square tests for categorical variables and t-tests for continuous variables for pharmacists who communicated with a patient via text, email or social media regarding drug therapy once a month or more frequently vs. those who never did. a Includes membership in state (Texas Pharmacists Association) and national (NCPA, APhA, ASHP, IACP) professional associations.
care professionals and patients. Slightly over half of respondents use email to communicate with health care professionals, while 36% of respondents use email to communicate with patients. Text messaging is used by 34 and 30% of respondents to communicate with health care professionals and patients, respectively. Facebook is used by 5 and 7% of respondents to communicate with health care professionals and patients, respectively. In the ‘other’ category, where pharmacists could have written in a medium for communicating with health care professionals, the majority of respondents list fax and/or phone (n ¼ 106) followed by escribe or escript software (n ¼ 13), Google Talk (n ¼ 1), LinkedIn (n ¼ 1) and sidenotes (n ¼ 1). In the ‘other’ category for communicating
with patients, the majority of respondents list phone (n ¼ 129), followed by ‘none’ (n ¼ 16), postal mail (n ¼ 1) and escript/surescript (n ¼ 1). General use of Internet for professional purposes We were also interested in examining the types of professional activities pharmacists may be performing using the Internet as well as how frequently they do the activity. The majority of pharmacists reported that Internet access is available at their pharmacies (n ¼ 278, 98%). Table 4 presents the frequencies of the Internet activities. The findings showed that pharmacists use the Internet “several times a day” to determine product availability (53% of respondents), followed
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11
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Table 3 Frequencies and proportions of social media use for communicating with health care professionals and patients by independent community pharmacists (n ¼ 284)a Communication with
Health care professionals Patients a
Email
Text
Facebook
Twitter
Other
n (%)
n (%)
n (%)
n (%)
n (%)
160 (56) 102 (36)
97 (34) 86 (30)
14 (5) 19 (7)
1 (0.4) 2 (0.7)
129 (45) 147 (52)
Numbers and percentages do not add up to total (100%) because multiple selections were possible.
by drug prices (38% of respondents) and drug and disease-related information (36 and 28% of respondents, respectively). Conversely, many respondents selected ‘never or hardly ever’ going on the Internet for the following activities: patient communication regarding drug therapy (71%), wholesale deals (45%), formulary status of patients’ drugs (42%), drug recall information (37%), drug shortage information (33%) and information related to managedcare policies (30%). Independent pharmacy websites and social media accounts We also examined the availability of independent pharmacy websites and social media accounts. Table 5 summarizes our findings. Approximately half of the respondents reported that their pharmacy has a website (54%), with approximately 40% maintaining email addresses for some of their patients. Among social media channels, Facebook is the most popular, with 29% of respondents reporting that they maintain a Facebook account for their pharmacies. However, only 4% of respondents maintain a Twitter account. The most popular content items on pharmacy websites are links to other health care resources (60%), tips on how to use drug products (42%) and tips on compliance (36%) (Table 6). Perceptions of social media use in patient– pharmacist communications The internal consistency of the 12-item scale to measure pharmacist perceptions of the use of social media in patient–pharmacist communications after reverse coding the negatively worded items (items 4, 5 and 10) was 0.89 (Cronbach’s alpha). A descriptive summary of responses is presented in Table 7. The perceptions of pharmacists who communicate with patients using electronic tools about information related to drug therapy once a month or more are more positive (higher score ¼ more positive perception) than those of pharmacists who never or hardly ever
communicate with patients via electronic tools about drug therapy (mean (SD) total score on 12-item perceptions scale 45.6 (7.9) vs. 39.0 (8.9), P ¼ 0.000 (data not shown)). Discussion Our findings on the pharmacists’ use of email for patient communication were similar to those of an older study conducted among health care professionals in 2006 by Lupianez-Villanueva et al in Catalonia, Spain: 36% of pharmacists communicated with patients via email in Texas vs. 38% in Spain.18 Alternatively, the proportion of pharmacists using email to communicate with other health care professionals is lower in our study (56%) than in the study in Catalonia (73.3%). This difference may likely be attributed in part to differences in health care systems between Spain and the U.S. Spain offers universal health care coverage through its national system, and thus, communication between health care professionals may likely be more streamlined and centralized.23 The study by Lupianez-Villanueva et al focused on the impact of health information found on the Internet on pharmacist–patient communications, while our study assessed the impact of information found on social media on pharmacist–patient communications (a more recent phenomenon that likely was not as widespread at the time of the study in Spain). A comparison of the findings shows that 43% of pharmacists in Texas are concerned that information found on social media may challenge pharmacists’ knowledge compared to 35% of pharmacists in Spain expressing a similar concern in relation to health information found on the Internet. In contrast, 53 and 75% of pharmacists in Texas thought that social media may improve patients’ quality of life and patients’ knowledge, respectively. Meanwhile, 40 and 37.9% of pharmacists in Catalonia agreed that health information found on the Internet may improve patients’ quality of life and knowledge, respectively. Perhaps the observed differences may be explained by the
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Type of activity Patient-related use Communicating with patients about information related to their drug therapy via text, email or social media, n (% of respondents) Administrative use Searching information related to managed-care policies and procedures, n (% of respondents) Searching formulary status of patients’ drugs (tier 1, 2, 3, etc.), n (% of respondents) Searching drug recall information, n (% of respondents) Searching drug shortage information, n (% of respondents) Searching drug prices, n (% of respondents) Searching wholesale deals, n (% of respondents) Searching availability of products at wholesalers, n (% of respondents) Drug/disease-related use Searching for drug-related information, n (% of respondents) Searching for disease-related information, % of respondents a b
Total may not add to 284 due to missing responses. Row percentages may not add to 100% due to rounding.
Several times a day
Once a day
3–4 times a week
1–2 times a week
Less than 1–2 times a week
Never or hardly ever
18 (6)
8 (3)
16 (6)
11 (4)
28 (10)
202 (71)
40 (14)
12 (4)
29 (10)
30 (11)
86 (31)
85 (30)
22 (8)
9 (3)
26 (9)
29 (10)
78 (28)
117 (42)
14 20 25 31 25
31 44 22 19 10
9 23 107 49 149
(3) (8) (38) (17) (53)
102 (36) 80 (28)
13 25 21 21 31
(5) (9) (7) (7) (11)
37 (13) 34 (12)
(5) (7) (9) (7) (9)
53 (19) 45 (17)
(11) (16) (8) (7) (4)
34 (12) 39 (14)
110 78 24 41 22
(39) (28) (9) (14) (8)
41 (14) 55 (19)
105 92 82 129 42
(37) (33) (29) (45) (15)
17 (6) 29 (10)
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11
Table 4 Internet use and frequencies of use for professional activities by independent community pharmacists (n ¼ 284)a,b
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11 Table 5 Frequency and proportion of social media accounts reported by independent pharmacists for the pharmacies where they are employed Internet/social media account
n (% of total respondents) (n ¼ 284)
Pharmacy website Email addresses of all patients Email addresses of patients who agree to provide their addresses Facebook account Electronic newsletter Blog
154 (54) 16 (6) 113 (40) 80 (29) 25 (9) 6 (2)
difference in the nature of peer-to-peer communications via social media vs. health information gathering through a static webpage. Sharing disease or condition experiences among patients on social media sites such as PatientsLikeMe may encourage greater patient engagement, and as a consequence, improve quality of life through a sense of belonging and knowledge exchange.24–27 McGowan et al assessed the use and attitudes toward social media by a national sample of primary care physicians and oncologists for sharing medical knowledge with other physicians.10 The authors report variability of social media use by channel, e.g. 52% used online physician-only communities while only 6.8% used Twitter. In addition, the authors found that 61% and 42% of respondents scanned and contributed to social media weekly or more frequently, respectively. Finally, McGowan et al found that 60% of physicians thought that social media enables them to deliver better patient care. This study found 56%, 34% and 5% of independent pharmacists use email, texting and Facebook, respectively to communicate with other health care professionals. The broader focus of this study on multiple electronic communication tools (including email and texting) as well as broader definition of professional communication (not only knowledge exchange) limit direct comparison of McGowan’s study and the current study of independent pharmacists. An older study of physicians practicing at outpatient settings in Florida conducted in 2008 found that about 20% use email for patient communication.28 The adjusted analyses showed higher use of email for patient communication among females, specialists (vs. primary care physicians), those in multispecialty practices and those self-reporting higher level
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Table 6 Information offered on independent community pharmacy websites (n ¼ 154)a Resource
n (% of respondents reporting having a pharmacy website)
Tips on how to use medicines Tips on being compliant Drug coverage information (copayments, deductibles) Links to other health resources OTC sales announcements Medical device sales announcements Other items sales announcements Opportunity to schedule an appointment with a pharmacist
65 (42) 56 (36) 17 (11) 92 (60) 47 (30) 29 (19) 48 (31) 32 (21)
a Column does not add to 100% due to multiple selections.
of computer competency.28 This study of pharmacists did not find an association between gender and social media and Internet communication use in the unadjusted analysis. Another study of social media and electronic communication use among academic psychiatrists (n ¼ 178) conducted in 2010 by Koh et al reported that 32% and 7% of respondents use email and text messaging for patient communication, respectively, as compared to 36% and 30% in this study of Texas independent community pharmacists.29 This study found that respondents who were older and completed their pharmacy training earlier were less likely to use any type of electronic communication. The age and years since graduation may in part explain the small difference in the use of email between the two studies: respondents in the study by Koh et al were on average 58 years old and completed their medical training 32 years ago vs. 54.5 years old and 28.5 years since completion of pharmacy training in this study of independent community pharmacists, respectively.29 On the other hand, the substantial difference in the use of text messaging is likely due to the nature of patient–psychiatrist communication vs. that of patient–pharmacist. It is of note that 43% (122/ 281) and 60% (169/281) of respondents in this survey somewhat agreed or agreed with the statements “social media needs to be used more at my workplace in communicating with other health care professionals” and “social media has a potential to become an established channel for patient– pharmacist communication,” respectively. These findings may indicate that though the pharmacists
8
Statement
Mean score (SD)a
Disagree, n (%)
Somewhat Disagree, n (%)
Neither agree nor disagree, n (%)
Somewhat agree, n (%)
Agree, n (%)
Social media can be effectively used by pharmacists to improve patient communication (n ¼ 280) Social media needs to be used more at my workplace in communicating with patients (n ¼ 281) Social media needs to be used more at my workplace in communicating with other health care professionals (n ¼ 281) Social media is not useful for patient–pharmacist communication (n ¼ 281) Social media takes too much time to communicate with patients (n ¼ 280) Social media has a potential to become an established channel for patient–pharmacist communication (n ¼ 281) Social media may improve patients’ quality of life (n ¼ 280) Social media may improve patients’ knowledge (n ¼ 279) Social media may facilitate drug therapy (n ¼ 279) Social media may cause patients to challenge pharmacists’ knowledge (n ¼ 279) Social media may enhance pharmacist/patient relationships (n ¼ 281) Social media changes the way patients and pharmacists interact (n ¼ 280)
3.8 (1.1)
19 (6.8)
16 (5.7)
46 (16.4)
130 (46.4)
69 (24.6)
3.2 (1.3)
52 (18.5)
24 (8.5)
80 (28.5)
80 (28.5)
45 (16.0)
3.1 (1.3)
48 (17.1)
26 (9.3)
85 (30.2)
87 (31.0)
35 (12.5)
2.7 (1.3)
64 (22.8)
67 (23.8)
84 (29.9)
36 (12.8)
30 (10.7)
3.1 (1.2)
41 (14.6)
35 (12.5)
93 (33.2)
71 (25.4)
40 (14.3)
3.5 (1.2)
26 (9.3)
26 (9.3)
60 (21.4)
109 (38.8)
60 (21.4)
3.4 3.9 3.5 3.1
28 18 25 46
25 10 22 31
79 41 64 82
110 132 116 87
38 78 52 33
a
(1.1) (1.1) (1.2) (1.3)
(10.0) (6.3) (9.0) (16.5)
(8.9) (3.6) (7.9) (11.1)
(28.2) (14.7) (22.9) (29.4)
(39.3) (47.3) (41.6) (31.2)
(13.6) (28.0) (18.6) (11.8)
3.6 (1.2)
29 (10.3)
13 (4.6)
61 (21.7)
124 (44.1)
54 (19.2)
3.8 (1.1)
15 (5.4)
12 (4.3)
71 (25.4)
113 (40.4)
69 (24.6)
Likert scale: 1 – ‘disagree,’ 2 – ‘somewhat disagree,’ 3 – ‘neither agree nor disagree,’ 4 – ‘somewhat agree,’ 5 – ‘agree.’ Cronbach’s alpha (12 items) ¼ 0.89.
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11
Table 7 Pharmacist perceptions of the use of social media in patient-pharmacist communications
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11
may be reserved to a widespread adoption of social media use for communication with other health care professionals in their current workplace, they, just like physicians, see value of social media in improving patient–pharmacist communication and patient care. It must be noted that this study did not examine barriers for social media use. Several respondents who provided comments in the end of the survey listed privacy and potential for HIPPA violations as the reason for not using social media for patient communication. A 2012 study of gynecology health professionals and gynecology patients in Netherlands examined motives, barriers and expectations for social media use and found that privacy concerns and legal grounds were among the barriers listed by health care professionals who did not use social media.30 Education and guidance may be the key to help overcome these barriers. Professional pharmacy associations in many countries including American Society of Health-System Pharmacists, Royal Pharmaceutical Society, The Pharmaceutical Society of Ireland, Pharmaceutical Society of Australia provide recommendations for practitioners on appropriate use of social media including aspects related to patient privacy.31–34 The self-reported presence of their pharmacies on the Internet and social media was moderate to low, with slightly over a half of respondents reporting maintaining a website and approximately 30%, a social media account (Facebook) for their pharmacies. A study in Canada examined customers’ perceptions toward the brand and personality of pharmacies and found that independent pharmacies were perceived as more trustworthy than national and multinational chains, with sincerity and competence being the key predictors of trust.35 Expanding independent pharmacies’ competence through digital presence and engagement may further increase current patients’ loyalty and attract new patients. Recent news reports demonstrate that independent pharmacies are starting to proactively embrace social media opportunities via use of pharmacybranded disease and medication information mobile applications for drug and disease patient education.36 Social media offers pharmacists unique opportunities to monitor patient adherence and care.37,38 The Internet is now the patient’s primary source of information on diseases, health care and pharmaceuticals.39 Successful pharmacies will be the ones that incorporate these technologies in their practice.
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Limitations Although the study’s response rate may raise concerns about non-response bias, it appears the findings are fairly representative of the Internet and social media use patterns for professional communications among Texas independent pharmacists. On the other hand, caution should be taken before extrapolating the results to independent pharmacists across the U.S. due to potential differences in legal, demographic and practice characteristics. Conclusion This study is the first statewide assessment of the Internet and social media use for professional activities by independent pharmacists in Texas. The findings show that independent pharmacists who are members of one or more professional organization as well as those who provide medication therapy management services at their workplace are more likely to communicate with patients via text, email or social media. In addition, the pharmacists’ perceptions toward such usage varies with the frequency of use, with those who communicate with patients via the electronic channels once a month or more having more positive perceptions. These findings may be useful to both practitioners and educators. Pharmacists practicing in an independent setting may consider embracing digital tools to strengthen brand loyalty and provide patient education via modern communication channels. Exposing pharmacy students during their formal years of training to opportunities offered by social media for patient outreach and education may increase adoption of these tools for professional purposes. Pharmacists are among the more accessible health care professionals and thus well-positioned to provide drugrelated information to the public not only through traditional face-to-face interactions but also via electronic channels. Acknowledgments The authors would like to thank the following individuals for their assistance with the questionnaire pilot testing and mail-out preparation: Rene Acosta, Omar Al-Hinai, Maryam Ali, Dr. Carolyn Brown, Dr. Jordi Calveras, Janine O’Dea, Dr. Marc Fleming, Renee Garza, Tammy Gray, Dawn Kim, Dr. Kenneth Lawson, Alex Loh, Scott Maitland, Dorinda Martin, Mick Normington, Busuyi Olotu, Dr. Haesuk Park, Nathan Pope,
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Susan Rush, Julieta Scalo, Garyn Shuler, Danijela Stojanovich, Alexandra Tungol, Jeff Warnken. Special thanks go to Tom Vamvanij, JD for reading through the final manuscript. References 1. Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved quality at Kaiser Permanente through e-mail between physicians and patients. Health Aff 2010;29:1370–1375. 2. Wilson G, Chokkalingam S, Velazquez C, Smarr K, Fresen J, Petruc M. Are United States rheumatologists interested in using electronic mail in patient care? Concerns from a national survey. Arthritis Rheum 2011;63. 3. Smalls HT. Tweets, friends, and links: the use of social media by NICU health care providers. Neonatal Netw 2012;31:407–408. 4. Fisher J, Clayton M. Who gives a tweet: assessing patients’ interest in the use of social media for health care. Worldviews Evid Based Nurs 2012;9:100–108. 5. Greene JA, Choudhry NK, Kilabuk E, Shrank WH. Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook. J Gen Intern Med 2011;26:287–292. 6. Pho K, Gay S. Establishing, Managing and Protecting Your Online Reputation. Greenbranch Publishing; 2013. 7. Mayo Clinic Center for Social Media. Bringing the Social Media #Revolution to Health Care. Mayo Foundation for Medical Education and Research; 2012. 8. Schickedanz A, Huang D, Lopez A, et al. Access, interest, and attitudes toward electronic communication for health care among patients in the medical safety net. J Gen Intern Med 2013;28:914–920. 9. Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff 2013;32:1361–1367. 10. McGowan BS, Wasko M, Vartabedian BS, Miller RS, Freiherr DD, Abdolrasulnia M. Understanding the factors that influence the adoption and meaningful use of social media by physicians to share medical information. J Med Internet Res 2012;14:e117. 11. Stellefson M, Chaney B, Barry AE, et al. Web 2. 0 chronic disease self-management for older adults: a systematic review. J Med Internet Res 2013;15:e35. 12. Zhang Y, He D, Sang Y. Facebook as a platform for health information and communication: a case study of a diabetes group. J Med Syst 2013;37:9942. 13. von Muhlen M, Ohno-Machado L. Reviewing social media use by clinicians. J Am Med Inform Assoc 2012;19:777–781. 14. Grindrod K, Forgione A, Tsuyuki RT, Gavura S, Giustini D. Pharmacy 2.0: a scoping review of social media use in pharmacy. Res Social Adm Pharm 2014; 10:256–270.
15. Alkhateeb FM, Clauson KA, Latif DA. Pharmacist use of social media. Int J Pharm Pract 2011;19: 140–142. 16. Kukreja P, Heck Sheehan A, Riggins J. Use of social media by pharmacy preceptors. Am J Pharm Educ 2011;75:176. 17. Hajar Z, Clauson K, Jacobs R, Melomed Y. Leveraging social media in pharmacy: analysis of pharmacists’ engagement and use of Twitter. American Society Health-System Pharmacists 2012 Clinical Meeting & Exhibition. Poster 5–257. Available at: http://www.ashpmedia.org/mcm12/documents/Onsite %20Program%20Book.pdf; Accessed 07.11.13. 18. Lupianez-Villanueva F, Mayer MA, Torrent J. Opportunities and challenges of Web 2.0 within the health care systems: an empirical exploration. Inform Health Soc Care 2009;34:117–126. 19. Cherian J, Patel K, Reed M, Timko J. Evolving role of pharmacists in care coordination: a national survey. Ther Innov Regul Sci; 2013, in press. 20. Liu Y. Pharmacists and US health care. In: Smith M, Wertheimer A, Fincham J, eds. Pharmacy and the US Health Care System. London, UK: Pharmaceutical Press; 2013. p. 79–80. 21. Fass JA, Hardigan PC. Attitudes of Florida pharmacists toward implementing a state prescription drug monitoring program for controlled substances. J Manag Care Pharm 2011;17:430–438. 22. Gavaza P, Brown CM, Lawson KA, Rascati KL, Wilson JP, Steinhardt M. Influence of attitudes on pharmacists’ intention to report serious adverse drug events to the Food and Drug Administration. Br J Clin Pharmacol 2011;72:143–152. 23. Blanco-Moreno A, Urbanos-Garrido RM, Thuissard-Vasallo IJ. Public healthcare expenditure in Spain: measuring the impact of driving factors. Health Policy 2013;111:34–42. 24. Wicks P. Abandoned HealthSpace. Sharing access might increase engagement. BMJ 2010;341:c7209. 25. Wicks P, Keininger DL, Massagli MP, et al. Perceived benefits of sharing health data between people with epilepsy on an online platform. Epilepsy Behav 2012;23:16–23. 26. Wicks P, Massagli M, Frost J, et al. Sharing health data for better outcomes on PatientsLikeMe. J Med Internet Res 2010;12:e19. 27. deBronkart D, Sands DZ. Let Patients Help! A ‘Patient Engagement’ Handbook – How Nurses, Patients and Caregivers Can Partner for Better Care. CreateSpace Independent Publishing Platform; 2013. 28. Menachemi N, Prickett CT, Brooks RG. The use of physician-patient email: a follow-up examination of adoption and best-practice adherence 2005-2008. J Med Internet Res 2011;13:e23. 29. Koh S, Cattell GM, Cochran DM, Krasner A, Langheim FJ, Sasso DA. Psychiatrists’ use of electronic communication and social media and a proposed framework for future guidelines. J Psychiatr Pract 2013;19:254–263.
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11 30. Antheunis ML, Tates K, Nieboer TE. Patients’ and health professionals’ use of social media in health care: motives, barriers and expectations. Patient Educ Couns 2013;92:426–431. 31. American Society of Health-System Pharmacists. ASHP statement on use of social media by pharmacy professionals. Am J Health Syst Pharm 2012;69:2095–2097. 32. The Pharmaceutical Society of Ireland. Guidance for Pharmacists on the Use of Digital and Social Media, 2013. Available at: http://www.thepsi.ie/Libraries/ Guidance_for_Pharmacists/Guidance_for_Pharmacists_on_the_use_of_Digital_and_Social_Media.sflb. ashx. Accessed 06.11.13. 33. Royal Pharmaceutical Society. Top Social Media Best Practice Tips for Pharmacists, 2013. Available at: http://www.rpharms.com/support-pdfs/top-social-media-tips-for-pharmacists.pdf. Accessed 06.11.13. 34. Pharmaceutical Society of Australia. Guidance for Pharmacists Using Internet and Social Media, 2011. Available at: http://www.psa.org.au/media-releases/ guidance-for-pharmacists-using-interent-and-socialmedia. Accessed 11.11.13.
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35. Perepelkin J, Di Zheng D. Brand personality and customer trust in community pharmacy. Int J Pharm Healthc Market 2011;5:175–193. 36. Community Pharmacy Goes Mobile to Deliver Patient Education. RxWiki Mobile App Extends Patient Education Outside of the Pharmacy, 2013. Available at: http:// www.prnewswire.com/news-releases/community-pharmacy-goes-mobile-to-deliver-patient-education-202671 861.html. Accessed 21.04.13. 37. Macready N. Adherence efforts go high-tech. Am J Transplant 2012;12:2263–2264. 38. Stip E, Vincent PD, Sablier J, Guevremont C, Zhornitsky S, Tranulis C. A randomized controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia. Front Pharmacol 2013; 4:100. 39. Fox S, Duggan M. Health Online 2013. Pew Internet & American Life Project. Available at: http://www. pewinternet.org/w/media/Files/Reports/2013/Pew% 20Internet%20Health%20Online%20report.pdf; Accessed 07.11.13.
Original Research
Community pharmacists, Internet and social media: An empirical investigation Natalia Shcherbakova, Ph.D.a,*, Marv Shepherd, Ph.D.b a
Department of Pharmaceutical and Administrative Sciences, College of Pharmacy, Western New England University, 1215 Wilbraham Rd., Springfield, MA 01119, USA b Center for Pharmacoeconomic Studies, College of Pharmacy, The University of Texas at Austin, TX, USA
Abstract Background: Use of social media and Internet for health information sharing is expanding among patients, physicians, and other health care professionals. Research on professional use of social media by community pharmacists is limited. Objectives: 1) To determine the extent to which Texas (U.S. state) independent community pharmacists use text messaging, email, Facebook, Twitter, and/or other information technology for professional communication with patients and health care professionals and identify the perceptions of Texas independent community pharmacists toward such usage; 2) to determine the extent to which Texas independent community pharmacists develop and employ their pharmacy websites to provide drug information and patient care services. Methods: A 25-item survey with questions addressing the objectives of the study as well as basic demographic questions (gender, age, and type of pharmacy degree) was mailed to a random sample of 1196 independent community pharmacists in Texas in January 2012. Results: The study response rate was 23.7%, with 284 usable questionnaires returned. The majority of respondents reported that Internet access is available at their pharmacies (98% (278)), and 91% (258) are familiar with the term ‘social media’. To communicate with health care professionals, 56% (n ¼ 160) of respondents use email, 34% (n ¼ 97) use text messages and 5% (n ¼ 14) use Facebook. To communicate with patients, 36% (n ¼ 102) of respondents use email, 30% (n ¼ 86) use text messages and 7% (n ¼ 19) use Facebook. The perceptions of pharmacists who communicate with patients using electronic tools about information related to drug therapy once a month or more frequently were more positive than those of pharmacists who never or hardly ever communicate with patients via electronic tools about drug therapy (P ! 0.05). Over 50% of independent pharmacists reported maintaining a pharmacy website. Conclusions: This study is the first U.S. statewide assessment of the use of electronic communication and social media for professional pharmacist’s communications and perceptions toward the use of social media in patient–pharmacist communications among independent community pharmacists in Texas. Future Conflict of interest: No conflict of interest exists. The opinions, interpretations of results and conclusions presented here are those of the authors and are independent from the funding source. Funding source: The authors would like to acknowledge the funding support for this study provided via investigator-initiated grant by the Community Pharmacy Foundation. The results of this study were presented in part at the annual meeting of the American Pharmacists Association in New Orleans, LA, March 10, 2012 * Corresponding author. Tel.: þ1 413 796 2441; fax: þ1 413 796 2266. E-mail address: [email protected] (N. Shcherbakova). 1551-7411/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2013.11.007
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studies conducted in other states as well as nationwide will contribute to a better understanding of the use of electronic communication, Internet, and social media in the daily professional activities of independent community pharmacists. Ó 2013 Elsevier Inc. All rights reserved. Keywords: Social media; Internet; Community pharmacy; e-Health communication; Pharmacist e-communication
Introduction Health care communication through electronic channels, including social media, has gained popularity among both patients and health care providers over the past several years.1–12 Recent review papers attempted to summarize the body of literature on social media use for various purposes by health care professionals, students and educators.13,14 Research on electronic communications and social media use for professional purposes by pharmacists in the U.S. has been limited to a few studies, which examined either the general use of social media by pharmacists or the use of social media for professional activities other than patient– pharmacist communication.15–17 Alkhateeb et al surveyed 50 attendees of the West Virginia Pharmacy Association Convention in 2009 and found that the majority of pharmacists use social media primarily for personal purposes.15 Kukreja et al surveyed a sample of pharmacists that are registered as preceptors for Purdue University College of Pharmacy in early 2010 and also found that respondents use Facebook primarily for social purposes.16 Hajar et al in 2012 conducted a qualitative study of 204 pharmacists’ Twitter accounts and found that only 10% of accounts are of professional rather than social nature according to examination of 30 most recent tweets.17 LupianezVillanueva et al conducted a web-based survey in 2006 to assess Internet usage by physicians, nurses and pharmacists in the Catalonia region of Spain.18 The primary use of the Internet for professional purposes by pharmacists (n ¼ 898) was reported as follows: 46.7% of pharmacists share information with citizens, 38% share information with friends and relatives, 9.2% spread their own scientific papers to the scientific community, 7.4% promote a debate in their specialty, and 18.8% share information with their patients. In the Catalonian study, 73.3% of pharmacists use email to communicate with other health care professionals, while only 38% of pharmacists do so with patients. A 2012 national survey of U.S. pharmacists practicing primarily in clinical settings identified increased use
of mobile technology and social media as the key change in patient communication that pharmacists foresee in the next five years.19 To date, no studies in the U.S. have assessed community pharmacists’ use and perceptions toward their use of electronic communication and social media for professional purposes, including patient–pharmacist communication. With about 15% of community pharmacists nationally practicing at an independent pharmacy setting, this study focused solely on this group due to its flexibility in adopting various tools, including electronic communication and social media, to improve patient care.20 The primary objective of this study was to examine independent pharmacists’ use and perceptions toward the use of social media for professional communication, including communication between patients and the pharmacist. The secondary objective was to assess the degree to which independent pharmacists develop their pharmacy websites to provide drug information and patient care services. Methods The study was a cross-sectional survey of independent community pharmacists practicing in the U.S. state of Texas. We obtained approval from the University of Texas at Austin IRB to conduct the study. Survey A 25-item survey instrument was developed for the study, piloted, and revised based on comments from eight practicing community pharmacists. The items included questions addressing the objectives of the study as well as basic demographics (i.e., gender, age, type of pharmacy degree, year pharmacy degree was completed, professional affiliations, pharmacy location, and primary employment position at the pharmacy). The 12-item scale assessing perceptions toward the use of social media in patient–pharmacist communication was developed in part based on a study conducted by LupianezVillanueva et al among physicians, pharmacists and
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11
nurses in Catalonia, Spain.18 The scale’s face validity was found to be satisfactory based on the feedback from the pilot participants. The scale’s reliability was assessed upon completion of data collection via calculation of the Cronbach’s alpha coefficient. Study sample A random sample of 1196 pharmacists practicing at an independent community pharmacy setting (non-chain, owned by an individual or a small group) and representing about 50% of Texas independent pharmacists was drawn from the roster maintained by the Texas Board of Pharmacy. At the time of the study, the Texas Board of Pharmacy did not maintain a record of each pharmacist’s electronic mailing address, and thus we used the postal service to distribute the questionnaires. The previous response rates to mailed surveys of pharmacists in Florida and Texas range between 18% and 26%.21,22 Data collection A cover letter, the survey questionnaire and an addressed and stamped return envelope were mailed in early January 2012. Data collection continued through February and March 2012. The cover letter stated that pharmacists interested in completing the survey online could do so by following the website link provided in the letter. The online version of the questionnaire was created using the QualtricsÒ survey platform. Returned surveys did not contain any identifiable information, and no incentive for completion was offered. Statistical analyses Descriptive statistics were used for all demographic and social media use variables. Comparisons across groups (pharmacist users and pharmacist non-users of electronic communication and social media for patient communication, pharmacists with positive vs. negative perceptions toward social media use for patient–pharmacist communication) were performed using the t-test for continuous variables and the chi-square test for categorical variables. An alpha level of 0.05 was employed.
Results Demographics A total of 16 surveys were completed online, and 297 questionnaires were returned by mail. However, only 284 mailed questionnaires and
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Table 1 Comparison of demographic characteristics between Texas independent pharmacists and questionnaire respondents Characteristic
Sample (n ¼ 1196)
Respondents (n ¼ 284)
% Male (n) 70 (844) 70 (200) Age (SD) 54.5 (12.2) 54.4 (11.4) Years since graduation (SD) 28.5 (13.3) 28.2 (12.6) % BS Pharm (n) 85 (1016) 83 (235)
electronically completed surveys were sufficiently complete to be included in the analyses. The final response rate was 23.7%. To assess non-response bias, we compared key demographic characteristics of the survey respondents (gender, age, type of pharmacy degree and years since graduation) to the overall sample. The results of the comparison are presented in Table 1. There were no significant differences between the two groups in relation to age, gender, type of pharmacy degree, and years since graduation. The demographics, practice setting and educational characteristics of respondents are presented in Table 2. We stratified the pharmacists according to their responses on the item “Communicating with patients about information related to their drug therapy via text, email or social media” (item 8(1); response options ranged from ‘several times a day’ to ‘never or hardly ever’) into two groups: pharmacists who communicate with patients via text, email or social media regarding drug therapy once a month or more and those who never communicate with patients via the listed tools (Table 2). Analyses revealed that pharmacists who use electronic tools, including social media, for patient communication are slightly younger (52 vs. 55 years old, P ¼ 0.013), completed their pharmacy education more recently (26 vs. 29 years ago, P ¼ 0.0702), reside in metropolitan or small urban areas as opposed to small communities or rural areas (33% and 38% vs. 23% and 14%, respectively, P ¼ 0.021), are more likely to hold membership in one or more professional pharmacy associations (31% vs. 18%, P ¼ 0.025), and are more likely to provide medication therapy management services in their pharmacies (47% vs. 22%, P ¼ 0.000). General use of electronic communication for professional purposes Table 3 presents the electronic tools independent pharmacists use to communicate with health
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Table 2 Demographic, education and practice setting characteristics of the respondents controlling for whether or not independent community pharmacists communicated with patients via social media Demographic characteristic
All respondents Communicated with (n ¼ 284) patients via text, email or social media regarding drug therapy once a month or more frequently (n ¼ 81)
Never communicated with a patient regarding drug therapy via text, email or social media (n ¼ 203)
Age (M (SD))* Gender Male (n ¼ 200) Female (n ¼ 84) Number of years since graduation (M (SD)) Degree BS (n ¼ 235) PharmD (n ¼ 49) Completion of CE online R50% online (n ¼ 218) !50% or none online (n ¼ 66) Professional association membershipa,* Belong to R1 (n ¼ 227) Do not belong (n ¼ 57) Geographic location of practice setting* Metropolitan (n ¼ 128) Small urban (n ¼ 52) Small community (n ¼ 54) Rural (n ¼ 50) Store owners Yes (n ¼ 167) No (n ¼ 117) Provision of MTM services* Yes (n ¼ 72) No (n ¼ 212)
54.4 (11.4)
52.1 (10.6)
55.3 (11.6)
70% 30% 28.2 (12.6)
28% 32% 26.1 (12.4)
72% 68% 29.0 (12.6)
83% 17%
29% 27%
71% 73%
77% 23%
27% 33%
73% 67%
80% 20%
31% 18%
69% 82%
45% 18% 19% 18%
33% 38% 23% 14%
67% 62% 77% 86%
60% 40%
30% 27%
70% 73%
25% 75%
47% 22%
53% 78%
CE ¼ continuing education; M (SD) ¼ mean (standard deviation); MTM ¼ medication therapy management. *P ! 0.05 using chi-square tests for categorical variables and t-tests for continuous variables for pharmacists who communicated with a patient via text, email or social media regarding drug therapy once a month or more frequently vs. those who never did. a Includes membership in state (Texas Pharmacists Association) and national (NCPA, APhA, ASHP, IACP) professional associations.
care professionals and patients. Slightly over half of respondents use email to communicate with health care professionals, while 36% of respondents use email to communicate with patients. Text messaging is used by 34 and 30% of respondents to communicate with health care professionals and patients, respectively. Facebook is used by 5 and 7% of respondents to communicate with health care professionals and patients, respectively. In the ‘other’ category, where pharmacists could have written in a medium for communicating with health care professionals, the majority of respondents list fax and/or phone (n ¼ 106) followed by escribe or escript software (n ¼ 13), Google Talk (n ¼ 1), LinkedIn (n ¼ 1) and sidenotes (n ¼ 1). In the ‘other’ category for communicating
with patients, the majority of respondents list phone (n ¼ 129), followed by ‘none’ (n ¼ 16), postal mail (n ¼ 1) and escript/surescript (n ¼ 1). General use of Internet for professional purposes We were also interested in examining the types of professional activities pharmacists may be performing using the Internet as well as how frequently they do the activity. The majority of pharmacists reported that Internet access is available at their pharmacies (n ¼ 278, 98%). Table 4 presents the frequencies of the Internet activities. The findings showed that pharmacists use the Internet “several times a day” to determine product availability (53% of respondents), followed
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11
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Table 3 Frequencies and proportions of social media use for communicating with health care professionals and patients by independent community pharmacists (n ¼ 284)a Communication with
Health care professionals Patients a
Text
Other
n (%)
n (%)
n (%)
n (%)
n (%)
160 (56) 102 (36)
97 (34) 86 (30)
14 (5) 19 (7)
1 (0.4) 2 (0.7)
129 (45) 147 (52)
Numbers and percentages do not add up to total (100%) because multiple selections were possible.
by drug prices (38% of respondents) and drug and disease-related information (36 and 28% of respondents, respectively). Conversely, many respondents selected ‘never or hardly ever’ going on the Internet for the following activities: patient communication regarding drug therapy (71%), wholesale deals (45%), formulary status of patients’ drugs (42%), drug recall information (37%), drug shortage information (33%) and information related to managedcare policies (30%). Independent pharmacy websites and social media accounts We also examined the availability of independent pharmacy websites and social media accounts. Table 5 summarizes our findings. Approximately half of the respondents reported that their pharmacy has a website (54%), with approximately 40% maintaining email addresses for some of their patients. Among social media channels, Facebook is the most popular, with 29% of respondents reporting that they maintain a Facebook account for their pharmacies. However, only 4% of respondents maintain a Twitter account. The most popular content items on pharmacy websites are links to other health care resources (60%), tips on how to use drug products (42%) and tips on compliance (36%) (Table 6). Perceptions of social media use in patient– pharmacist communications The internal consistency of the 12-item scale to measure pharmacist perceptions of the use of social media in patient–pharmacist communications after reverse coding the negatively worded items (items 4, 5 and 10) was 0.89 (Cronbach’s alpha). A descriptive summary of responses is presented in Table 7. The perceptions of pharmacists who communicate with patients using electronic tools about information related to drug therapy once a month or more are more positive (higher score ¼ more positive perception) than those of pharmacists who never or hardly ever
communicate with patients via electronic tools about drug therapy (mean (SD) total score on 12-item perceptions scale 45.6 (7.9) vs. 39.0 (8.9), P ¼ 0.000 (data not shown)). Discussion Our findings on the pharmacists’ use of email for patient communication were similar to those of an older study conducted among health care professionals in 2006 by Lupianez-Villanueva et al in Catalonia, Spain: 36% of pharmacists communicated with patients via email in Texas vs. 38% in Spain.18 Alternatively, the proportion of pharmacists using email to communicate with other health care professionals is lower in our study (56%) than in the study in Catalonia (73.3%). This difference may likely be attributed in part to differences in health care systems between Spain and the U.S. Spain offers universal health care coverage through its national system, and thus, communication between health care professionals may likely be more streamlined and centralized.23 The study by Lupianez-Villanueva et al focused on the impact of health information found on the Internet on pharmacist–patient communications, while our study assessed the impact of information found on social media on pharmacist–patient communications (a more recent phenomenon that likely was not as widespread at the time of the study in Spain). A comparison of the findings shows that 43% of pharmacists in Texas are concerned that information found on social media may challenge pharmacists’ knowledge compared to 35% of pharmacists in Spain expressing a similar concern in relation to health information found on the Internet. In contrast, 53 and 75% of pharmacists in Texas thought that social media may improve patients’ quality of life and patients’ knowledge, respectively. Meanwhile, 40 and 37.9% of pharmacists in Catalonia agreed that health information found on the Internet may improve patients’ quality of life and knowledge, respectively. Perhaps the observed differences may be explained by the
6
Type of activity Patient-related use Communicating with patients about information related to their drug therapy via text, email or social media, n (% of respondents) Administrative use Searching information related to managed-care policies and procedures, n (% of respondents) Searching formulary status of patients’ drugs (tier 1, 2, 3, etc.), n (% of respondents) Searching drug recall information, n (% of respondents) Searching drug shortage information, n (% of respondents) Searching drug prices, n (% of respondents) Searching wholesale deals, n (% of respondents) Searching availability of products at wholesalers, n (% of respondents) Drug/disease-related use Searching for drug-related information, n (% of respondents) Searching for disease-related information, % of respondents a b
Total may not add to 284 due to missing responses. Row percentages may not add to 100% due to rounding.
Several times a day
Once a day
3–4 times a week
1–2 times a week
Less than 1–2 times a week
Never or hardly ever
18 (6)
8 (3)
16 (6)
11 (4)
28 (10)
202 (71)
40 (14)
12 (4)
29 (10)
30 (11)
86 (31)
85 (30)
22 (8)
9 (3)
26 (9)
29 (10)
78 (28)
117 (42)
14 20 25 31 25
31 44 22 19 10
9 23 107 49 149
(3) (8) (38) (17) (53)
102 (36) 80 (28)
13 25 21 21 31
(5) (9) (7) (7) (11)
37 (13) 34 (12)
(5) (7) (9) (7) (9)
53 (19) 45 (17)
(11) (16) (8) (7) (4)
34 (12) 39 (14)
110 78 24 41 22
(39) (28) (9) (14) (8)
41 (14) 55 (19)
105 92 82 129 42
(37) (33) (29) (45) (15)
17 (6) 29 (10)
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11
Table 4 Internet use and frequencies of use for professional activities by independent community pharmacists (n ¼ 284)a,b
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11 Table 5 Frequency and proportion of social media accounts reported by independent pharmacists for the pharmacies where they are employed Internet/social media account
n (% of total respondents) (n ¼ 284)
Pharmacy website Email addresses of all patients Email addresses of patients who agree to provide their addresses Facebook account Electronic newsletter Blog
154 (54) 16 (6) 113 (40) 80 (29) 25 (9) 6 (2)
difference in the nature of peer-to-peer communications via social media vs. health information gathering through a static webpage. Sharing disease or condition experiences among patients on social media sites such as PatientsLikeMe may encourage greater patient engagement, and as a consequence, improve quality of life through a sense of belonging and knowledge exchange.24–27 McGowan et al assessed the use and attitudes toward social media by a national sample of primary care physicians and oncologists for sharing medical knowledge with other physicians.10 The authors report variability of social media use by channel, e.g. 52% used online physician-only communities while only 6.8% used Twitter. In addition, the authors found that 61% and 42% of respondents scanned and contributed to social media weekly or more frequently, respectively. Finally, McGowan et al found that 60% of physicians thought that social media enables them to deliver better patient care. This study found 56%, 34% and 5% of independent pharmacists use email, texting and Facebook, respectively to communicate with other health care professionals. The broader focus of this study on multiple electronic communication tools (including email and texting) as well as broader definition of professional communication (not only knowledge exchange) limit direct comparison of McGowan’s study and the current study of independent pharmacists. An older study of physicians practicing at outpatient settings in Florida conducted in 2008 found that about 20% use email for patient communication.28 The adjusted analyses showed higher use of email for patient communication among females, specialists (vs. primary care physicians), those in multispecialty practices and those self-reporting higher level
7
Table 6 Information offered on independent community pharmacy websites (n ¼ 154)a Resource
n (% of respondents reporting having a pharmacy website)
Tips on how to use medicines Tips on being compliant Drug coverage information (copayments, deductibles) Links to other health resources OTC sales announcements Medical device sales announcements Other items sales announcements Opportunity to schedule an appointment with a pharmacist
65 (42) 56 (36) 17 (11) 92 (60) 47 (30) 29 (19) 48 (31) 32 (21)
a Column does not add to 100% due to multiple selections.
of computer competency.28 This study of pharmacists did not find an association between gender and social media and Internet communication use in the unadjusted analysis. Another study of social media and electronic communication use among academic psychiatrists (n ¼ 178) conducted in 2010 by Koh et al reported that 32% and 7% of respondents use email and text messaging for patient communication, respectively, as compared to 36% and 30% in this study of Texas independent community pharmacists.29 This study found that respondents who were older and completed their pharmacy training earlier were less likely to use any type of electronic communication. The age and years since graduation may in part explain the small difference in the use of email between the two studies: respondents in the study by Koh et al were on average 58 years old and completed their medical training 32 years ago vs. 54.5 years old and 28.5 years since completion of pharmacy training in this study of independent community pharmacists, respectively.29 On the other hand, the substantial difference in the use of text messaging is likely due to the nature of patient–psychiatrist communication vs. that of patient–pharmacist. It is of note that 43% (122/ 281) and 60% (169/281) of respondents in this survey somewhat agreed or agreed with the statements “social media needs to be used more at my workplace in communicating with other health care professionals” and “social media has a potential to become an established channel for patient– pharmacist communication,” respectively. These findings may indicate that though the pharmacists
8
Statement
Mean score (SD)a
Disagree, n (%)
Somewhat Disagree, n (%)
Neither agree nor disagree, n (%)
Somewhat agree, n (%)
Agree, n (%)
Social media can be effectively used by pharmacists to improve patient communication (n ¼ 280) Social media needs to be used more at my workplace in communicating with patients (n ¼ 281) Social media needs to be used more at my workplace in communicating with other health care professionals (n ¼ 281) Social media is not useful for patient–pharmacist communication (n ¼ 281) Social media takes too much time to communicate with patients (n ¼ 280) Social media has a potential to become an established channel for patient–pharmacist communication (n ¼ 281) Social media may improve patients’ quality of life (n ¼ 280) Social media may improve patients’ knowledge (n ¼ 279) Social media may facilitate drug therapy (n ¼ 279) Social media may cause patients to challenge pharmacists’ knowledge (n ¼ 279) Social media may enhance pharmacist/patient relationships (n ¼ 281) Social media changes the way patients and pharmacists interact (n ¼ 280)
3.8 (1.1)
19 (6.8)
16 (5.7)
46 (16.4)
130 (46.4)
69 (24.6)
3.2 (1.3)
52 (18.5)
24 (8.5)
80 (28.5)
80 (28.5)
45 (16.0)
3.1 (1.3)
48 (17.1)
26 (9.3)
85 (30.2)
87 (31.0)
35 (12.5)
2.7 (1.3)
64 (22.8)
67 (23.8)
84 (29.9)
36 (12.8)
30 (10.7)
3.1 (1.2)
41 (14.6)
35 (12.5)
93 (33.2)
71 (25.4)
40 (14.3)
3.5 (1.2)
26 (9.3)
26 (9.3)
60 (21.4)
109 (38.8)
60 (21.4)
3.4 3.9 3.5 3.1
28 18 25 46
25 10 22 31
79 41 64 82
110 132 116 87
38 78 52 33
a
(1.1) (1.1) (1.2) (1.3)
(10.0) (6.3) (9.0) (16.5)
(8.9) (3.6) (7.9) (11.1)
(28.2) (14.7) (22.9) (29.4)
(39.3) (47.3) (41.6) (31.2)
(13.6) (28.0) (18.6) (11.8)
3.6 (1.2)
29 (10.3)
13 (4.6)
61 (21.7)
124 (44.1)
54 (19.2)
3.8 (1.1)
15 (5.4)
12 (4.3)
71 (25.4)
113 (40.4)
69 (24.6)
Likert scale: 1 – ‘disagree,’ 2 – ‘somewhat disagree,’ 3 – ‘neither agree nor disagree,’ 4 – ‘somewhat agree,’ 5 – ‘agree.’ Cronbach’s alpha (12 items) ¼ 0.89.
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11
Table 7 Pharmacist perceptions of the use of social media in patient-pharmacist communications
Shcherbakova & Shepherd / Research in Social and Administrative Pharmacy j (2013) 1–11
may be reserved to a widespread adoption of social media use for communication with other health care professionals in their current workplace, they, just like physicians, see value of social media in improving patient–pharmacist communication and patient care. It must be noted that this study did not examine barriers for social media use. Several respondents who provided comments in the end of the survey listed privacy and potential for HIPPA violations as the reason for not using social media for patient communication. A 2012 study of gynecology health professionals and gynecology patients in Netherlands examined motives, barriers and expectations for social media use and found that privacy concerns and legal grounds were among the barriers listed by health care professionals who did not use social media.30 Education and guidance may be the key to help overcome these barriers. Professional pharmacy associations in many countries including American Society of Health-System Pharmacists, Royal Pharmaceutical Society, The Pharmaceutical Society of Ireland, Pharmaceutical Society of Australia provide recommendations for practitioners on appropriate use of social media including aspects related to patient privacy.31–34 The self-reported presence of their pharmacies on the Internet and social media was moderate to low, with slightly over a half of respondents reporting maintaining a website and approximately 30%, a social media account (Facebook) for their pharmacies. A study in Canada examined customers’ perceptions toward the brand and personality of pharmacies and found that independent pharmacies were perceived as more trustworthy than national and multinational chains, with sincerity and competence being the key predictors of trust.35 Expanding independent pharmacies’ competence through digital presence and engagement may further increase current patients’ loyalty and attract new patients. Recent news reports demonstrate that independent pharmacies are starting to proactively embrace social media opportunities via use of pharmacybranded disease and medication information mobile applications for drug and disease patient education.36 Social media offers pharmacists unique opportunities to monitor patient adherence and care.37,38 The Internet is now the patient’s primary source of information on diseases, health care and pharmaceuticals.39 Successful pharmacies will be the ones that incorporate these technologies in their practice.
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Limitations Although the study’s response rate may raise concerns about non-response bias, it appears the findings are fairly representative of the Internet and social media use patterns for professional communications among Texas independent pharmacists. On the other hand, caution should be taken before extrapolating the results to independent pharmacists across the U.S. due to potential differences in legal, demographic and practice characteristics. Conclusion This study is the first statewide assessment of the Internet and social media use for professional activities by independent pharmacists in Texas. The findings show that independent pharmacists who are members of one or more professional organization as well as those who provide medication therapy management services at their workplace are more likely to communicate with patients via text, email or social media. In addition, the pharmacists’ perceptions toward such usage varies with the frequency of use, with those who communicate with patients via the electronic channels once a month or more having more positive perceptions. These findings may be useful to both practitioners and educators. Pharmacists practicing in an independent setting may consider embracing digital tools to strengthen brand loyalty and provide patient education via modern communication channels. Exposing pharmacy students during their formal years of training to opportunities offered by social media for patient outreach and education may increase adoption of these tools for professional purposes. Pharmacists are among the more accessible health care professionals and thus well-positioned to provide drugrelated information to the public not only through traditional face-to-face interactions but also via electronic channels. Acknowledgments The authors would like to thank the following individuals for their assistance with the questionnaire pilot testing and mail-out preparation: Rene Acosta, Omar Al-Hinai, Maryam Ali, Dr. Carolyn Brown, Dr. Jordi Calveras, Janine O’Dea, Dr. Marc Fleming, Renee Garza, Tammy Gray, Dawn Kim, Dr. Kenneth Lawson, Alex Loh, Scott Maitland, Dorinda Martin, Mick Normington, Busuyi Olotu, Dr. Haesuk Park, Nathan Pope,
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