The document discusses a study on the integration of information and communication technology (ICT) in community pharmacy practice, involving an online survey sent to pharmacists, with a response rate of 11.7%. Key findings reveal the demographics of responding pharmacists, their internet usage, and perceptions of health information online, indicating varying levels of internet utility and participation among integrated versus non-integrated community pharmacists. The analysis also highlights how patients’ online health information habits impact their relationships with pharmacists and their overall health management.

1. The raise of the ‘Integrated Community Pharmacist’ Dr. Francisco Lupi áñez-Villanueva www.ictconsequences.net Interdisciplinary Research Group on ICTs www.i2tic.net Cited as: Lupiañez-Villanueva, F. (2010) “The raise of the ‘Integrated Nurses”. In ICTconsequences, 12 August 2010. Barcelona: ICTconsequences.net Retrieved month, dd, yyyy from http://www.ictconsequences.net/2010/08/16/ the-integration-of-information-and-communication-technology-into-community-pharmacist-practice/

2. Interdisciplinary Research Group on ICTs www.i2tic.net to identify Community Pharmacists’ use of ICT and to develop a typology Community Pharmacists' utilization of these technologies. to identify the factors that may enhance or inhibit the integration of ICT within their practice. Objectives Methods Online survey 7,648 emails were sent to Pharmacists to Professional Association Responses rate 11.7 % ( 898) Response rate 8.6% (1,170 ) November 2006 – February 2007 NOTE : For the purposes of this analysis those pharmacists who do not work within community pharmacies have been excluded, as they have no direct role in the delivery of care to patients. The survey returned information from 648 CPs of which 410 stated that they own the pharmacy in which they worked.

3. Table 2. Age, gender and workplace Interdisciplinary Research Group on ICTs www.i2tic.net Table 1. Comparison between Pharmacist Association of Barcelona population and survey responses by by Gender and Age (percentage) Population Responses Female Male Female Male 29 years or less 14.81 9.42 15.10 6.20 30 to 39 years 34.33 24.77 37.50 25.30 40 to 49 years 24.22 23.04 28.30 33.30 50 to 59 years 14.81 19.76 15.90 23.40 60 years or more 11.83 23.01 3.20 11.80 Gender - Man 27.5 (178) - Female 72.5 (470) Age 29 years or less 12.1 (77) 30 to 39 years 32.8 (209) 40 to 49 years 30.9 (197) 50 to 59 years 18.5 (118) 60 to 69 years 4.6 (29) 70 years or more 1.1 (7) Ownership of the Community pharmacists - Yes 58.2 (377) - No 41.8 (271)

4. Table 3. Internet experience, utility and frequency Interdisciplinary Research Group on ICTs www.i2tic.net Begin to use the Internet since (experience) - Since 2002 47.1 (280) - Between 1997 and 2001 44.8 (266) - Since 1996 8.1 (48) How do you consider the Internet in your work - Very useful 65.5 (416) - Useful 32.0 (203) - Little useful 2.5 (16) Frequency of the Internet use in workplace - Everyday 55.8 (358) - Three or four times per week 17.9 (115) - One or two times per week 16.2 (104) - Less than one or two times per week 1.1 (7) - Never or hardly ever 9.0 (58) Frequency of the Internet use outside workplace - Everyday 34.7 (224) - Three or four times per week 21.7 (140) - One or two times per week 24.2 (156) - Less than one or two times per week 6.0 (39) - Never or hardly ever 13.3 (86)

5. Table 4. Internet presence and participation Interdisciplinary Research Group on ICTs www.i2tic.net Presence on the Internet - Personal website 15.7 (102) - Institutional website 32.7 (212) - Blog 3.1 (20) Do you participate on the Internet - Clarifying questions about diagnosis, treatment or other pharmaceutical issues on professional forums 2.2 (14) - Searching advise on professional forums 20.4 (132) - Providing advise on patient support groups websites 6.3 (41)

6. Table 4. Information sources, ICT and Internet utilization Interdisciplinary Research Group on ICTs www.i2tic.net Never or hardly ever Occasionally Frequently Most frequently Information sources International public institutions 49.8 (323) 39,5 (256) 9.0 (58) 1.7 (11) National public institutions 23.0 (149) 39.8 (258) 30.6 (198) 6.6 (43) International information sources 43.4 (281) 44.3 (287) 10.0 (65) 2.3 (15) National information sources 6.6 (43) 17.4 (113) 53.7 (348) 22.2 (144) International academic journals 45.5 (295) 43.8 (284) 9.0 (58) 1.7 (11) National academic journals 21.5 (139) 37.7 (244) 33.8 (219) 7.1 (46) Workplace information 33.0 (214) 17.9 (116) 30.7 (199) 18.4 (119) Conference, Seminars, professional education 16.4 (106) 40.0 (259) 36.9 (239) 6.8 (44) Other information sources 13.7 (89) 32.1 (208) 45.2 (293) 9.0 (58) Pharmacists Professional Association information 1.4 (9) 5.6 (36) 34.3 (222) 58.8 (381) Pharmaceutical industry information 11.6 (75) 17.0 (110) 45.2 (293) 26.2 (170) ICT and Internet utilization Searching for pharmaceutical practice databases 7.6 (49) 15.9 (103) 53.1 (344) 23.5 (152) Searching for national academic journals 17.1 (111) 43.7 (283) 32.7 (212) 6.5 (42) Searching for international academic journals 33.8 (219) 46.5 (301) 16.2 (105) 3.5 (23) Interaction with healthcare professionals within Spain 33.8 (219) 38.0 (246) 20.7 (134) 7.6 (49) Interaction with healthcare professionals internationally 69.3 (449) 27.0 (175) 2.3 (15) 1.4 (9) Publishing information 80.7 (523) 15.6 (101) 2.5 (16) 1.2 (8) Interaction with patients 27.3 (177) 33.6 (218) 26.7 (173) 12.3 (80) Searching for prices and invoices 11.0 (71) 23.6 (153) 43.7 (283) 21.8 (141) Searching for national public institutions 20.7 (134) 42.6 (276) 30.6 (198) 6.2 (40) Searching for international public institutions 41.4 (268) 43.8 (284) 11.6 (75) 3.2 (21) Interaction with Pharmacists Professional Association 1.2 (8) 3.2 (21) 28.2 (183) 67.3 (436)

7. Table 5. Community Pharmacist/patients relationship and the Internet Table 5. Community Pharmacist/patients relationship and the Internet Table 5. Community Pharmacist/patients relationship and the Internet How do you consider health information available on the Internet? - Very relevant 9.7 (59) - Relevant 73.0 (446) - Little relevant 16.9 (103) - Non relevant .5 (3) Do you recommend your patients to go online for health information? - Yes, I usually do it .8 (5) - Yes, I often do it 3.4 (22) - Yes, I sometimes do it 39.5 (252) - No, I never do it 56.3 (359) Do your patients discuss or share with you their Internet health information findings? Most of the patients do it 6.6 (42) Some of the patients do it 47.6 (304) A few of the patients do it 28.4 (181) Patients do not do it 17.4 (111) Do you think that patients go online for health information - Improve a lot their autonomy and quality of life 5.0 (29) - Improve their autonomy and quality of life 42.7 (247) - Improve a little their autonomy and quality of life 33.0 (191) - Do not improve their autonomy and quality of life 14.2 (82) - Make their autonomy and quality of life worse 5.0 (29)

8. Table 6. Community Pharmacist/patients relationship and the Internet Interdisciplinary Research Group on ICTs www.i2tic.net Do you think that patients go online for health information - Improve a lot their knowledge and facilitate their treatment 3.8 (23) - Improve their knowledge and facilitate their treatment 36.5 (222) - Improve a little their knowledge and facilitate their treatment 43.1 (262) - Do not improve their knowledge and facilitate their treatment 16.6 (101) Do you think that patients go online for health information - Challenge a lot health professional’s knowledge 9.7 (60) - Challenge health professional’s knowledge 41.9 (260) - Challenge a little health professional’s knowledge 34.5 (214) - Do not challenge health professional’s knowledge 13.9 (86) Do you think that patients go online for health information - Challenge a lot health professional’s knowledge 6.3 (36) - Challenge health professional’s knowledge 23.7 (135) - Challenge a little health professional’s knowledge 38.5 (219) - Do not challenge health professional’s knowledge 31.5 (179) Do you think that patients go online for health information - Improve a lot health professional/patient relationship 3.2 (19) - Improve health professional/patient relationship 22.7 (135) - Improve a little health professional/patient relationship 53.6 (319) - Do not improve health professional/patient relationship 20.5 (18.8) Do you think that patients go online for health information - Improve a lot pharmacist/patient relationship 21.1 (127) - Improve pharmacist/patient relationship 25.5 (154) - Improve a little pharmacist/patient relationship 50.6 (305) - Do not improve pharmacist/patient relationship 21.1 (127)

9. Interdisciplinary Research Group on ICTs www.i2tic.net Table 7. Information sources utilization Factor Analysis 1. Emphasis on international information sources 2.Emphasis on national information sources 3. Emphasis on professional education and Association information sources 4. Emphasis on workplace and Pharmaceutical Industry information Commonalities International public institutions .782 .138 .131 .072 .653 National public institutions .461 .3 .329 .055 .414 International information sources .809 .136 .034 .055 .677 National information sources .06 .65 .395 -.056 .585 International academic journals .839 .095 .06 .076 .723 National academic journals .397 .545 .065 .309 .554 Workplace information .18 .057 -.06 .827 .723 Conference. Seminars. Professional education .206 .025 .646 -.007 .460 Other information sources .177 .804 -.109 .048 .692 Pharmacists Professional Association information .012 .067 .725 .159 .556 Pharmaceutical industry information -.032 .048 .406 .64 .578 Auto values 3.356 1.314 1.009 .934 % Variance explained 30.508 11.950 9.169 8.493 Notes: Rotated components matrix; Sampling method: factor analysis by main components; Rotation method: Varimax with Kaiser-Meyer-Olkin 0.824; Bartlett’s test of sphericity p=0.000; Convergence in 6 itenerations; Minimum eigenvalue 0.9.

10. Table 8. ICT and Internet utilization Factor Analysis Interdisciplinary Research Group on ICTs www.i2tic.net 1. Emphasis on Internet for information 2. Emphasis on the Internet for communication and dissemination 3. Emphasis on the Internet for corporate activities Commonalities Searching for pharmaceutical practice databases and web pages .532 .09 .414 .462 Searching for national academic journals .734 .132 .159 .582 Searching for international academic journals .822 .175 -.009 .706 Interaction with healthcare professionals within Spain .134 .713 .331 .636 Interaction with healthcare professionals internationally .354 .666 -.116 .583 Publishing information .263 .594 -.118 .435 Interaction with patients .044 .676 .355 .584 Searching for prices and invoices .117 .17 .669 .49 Searching for national public institutions .658 .212 .324 .583 Searching for international public institutions .742 .291 .027 .636 Interaction with Pharmacists Professional Association .108 -.034 .727 .542 Auto values 3.921 1.210 1.107 % Variance explained 35.644 10.997 10.068 Notes: Rotated components matrix; Sampling method: factor analysis by main components; Rotation method: Varimax with Kaiser-Meyer-Olkin 0.854; Bartlett’s test of sphericity p=0.000; Convergence in 6 itenerations; Minimum eigenvalue 1.

11. Table 9. Profiles of ICT utilization Interdisciplinary Research Group on ICTs www.i2tic.net Cluster 1. Non-integrated Community Pharmacist 59.25% n=384 2. Integrated Community Pharmacist 40.75% n=264 ANOVA Emphasis on international information sources -.59091 .85951 668.815* Emphasis on national information sources -.12437 .1809 14.892* Emphasis on professional education and Association information sources -.07202 .10476 4.918* Emphasis on workplace and Pharmaceutical Industry information -.07977 .11603 6.044* Emphasis on Internet for information -.46588 .67764 298.705** Emphasis on the Internet for communication and dissemination -.36716 .53406 157.872* Emphasis on the Internet for corporate activities -.07991 .11623 6.065* *p<.001 **p<.05 Notes: Results of K-means - quick cluster analysis. Method of analysis: non-hierarchical cluster. final cluster centroids

12. Table 10. C haracteristics of ‘Integrated Community Pharmacist’ and ‘Non integrated Community pharmacist’ (contingency analysis, significance) Table 10. Characteristics of ‘Integrated Community Pharmacist’ and ‘Non integrated Community pharmacist’ (contingency analysis, significance) Interdisciplinary Research Group on ICTs www.i2tic.net 1. Non-integrated Community Pharmacist 59.25% n=384 2. Integrated Community Pharmacist 40.75% n=264 Significance Begin to use the Internet since (experience) .000 - Since 2002 53.1 (181) 39.1 (99) - Between 1997 and 2001 41.1 (140) 49.8 (126) - Since 1996 5.9 (20) 11.1 (28) How do you consider the Internet in your work .000 - Very useful 56.1 (211) 79.2 (205) - Useful 39.9 (150) 20.5 (53) - Little useful 4.0 (15) .4 (1) Frequency of the Internet use in workplace .000 - Everyday 45.0 (171) 71.4 (187) - Three or four times per week 19.7 (75) 15.3 (40) - One or two times per week 21.8 (83) 8.0 (21) - Less than one or two times per week 1.6 (6) .4 (1) - Never or hardly ever 11.8 (45) 5.0 (13) Do you use email to communicate with .000 - Patients 16.4 (62) 33.3 (87) - Health professionals 54.2 (198) 85.1 (217) Presence on the Internet .000 - Blog 2.4 (6) 8.2 (14)

13. Table 11. Characteristics of ‘Integrated Community Pharmacist’ and ‘Non integrated Community pharmacist’ (contingency analysis, significance) Interdisciplinary Research Group on ICTs www.i2tic.net 1. Non-integrated Community Pharmacist 59.25% n=384 2. Integrated Community Pharmacist 40.75% n=264 Significance How do you consider health information available on the Internet? .001 - Very relevant 6.0 (21) 14.7 (38) - Relevant 73.3 (258) 72.6 (188) - Little relevant 20.2 (71) 12.4 (32) - Non relevant .6 (2) .4 (1) Do you recommend your patients to go online for health information? .000 - Yes, I usually do it .0 (0) 1.9 (5) - Yes, I often do it 2.1 (8) 5.3 (14) - Yes, I sometimes do it 32.4 (122) 49.6 (130) - No, I never do it 65.4 (246) 43.1 (113) Do your patients discuss or share with you their Internet health information findings? .000 Most of the patients do it 4.0 (195) 10.2 (97) Some of the patients do it 44.0 (165) 52.9 (139) A few of the patients do it 29.3 (110) 27.0 (139) Patients do not do it 22.7 (85) 9.9 (26)

14. Table 12. Characteristics of ‘Integrated Community Pharmacist’ and ‘Non integrated Community pharmacist’ (contingency analysis, significance) Interdisciplinary Research Group on ICTs www.i2tic.net 1. Non-integrated Community Pharmacist 59.25% n=384 2. Integrated Community Pharmacist 40.75% n=264 Significance Do you think that patients go online for health information .005 - Improve a lot their autonomy and quality of life 5.1 (18) 6.7 (16) - Improve their autonomy and quality of life 40.2 (142) 49.2 (118) - Improve a little their autonomy and quality of life 36.5 (129) 25.8 (62) - Do not improve their autonomy and quality of life 13.6 (48) 12.1 (29) - Make their autonomy and quality of life worse 4.5 (16) 6.3 (15) Do you think that patients go online for health information .000 - Improve a lot health professional/patient relationship 2.3 (8) 4.5 (11) - Improve health professional/patient relationship 18.0 (63) 29.4 (72) - Improve a little health professional/patient relationship 54.0 (189) 53.1 (130) - Do not improve health professional/patient relationship 25.7 (90) 13.1 (32) Do you think that patients go online for health information - Improve a lot pharmacist/patient relationship 1.4 (5) 4.8 (12) - Improve pharmacist/patient relationship 20.6 (73) 32.5 (81) - Improve a little pharmacist/patient relationship 50.8 (180) 50.2 (125) - Do not improve pharmacist/patient relationship 27.1 (96) 12.4 (31) Do you participate on the Internet .000 - Clarifying questions about diagnosis, treatment or other pharmaceutical issues on professional forums 2.1 (4) 8.2 (10) - Searching for advise on professional forums 17.1 (64) 26.4 (68) - Providing advise on patient support groups websites 4.6 (17) 9.2 (24)

15. Table 13. Characteristics of ‘Integrated Community Pharmacist’ and ‘Non integrated Community pharmacist’ (contingency analysis, significance) Interdisciplinary Research Group on ICTs www.i2tic.net 1. Non-integrated Community Pharmacist 59.25% n=384 2. Integrated Community Pharmacist 40.75% n=264 Significance The use of ICT and the Internet in your daily work .000 - Improve communication with other health care professionals 29.5 (91) 45.6 (103) - Improve efficiency and productivity of your work 57.6 (196) 65.9 (162) Barriers .000 - Lack of computers connected to the Internet 17.6 (67) 11.9 (260) - Lack of time 75.1 (286) 65.4 (170) - Concerns about security and confidentiality 21.3 (81) 29.2 (76) - Lack of training 19.9 (76) 11.5 (30) - Do not experience any difficulties 15.2 (58) 22.3 (58)

16. Table 14. Determinants of the ‘Integrated Community Pharmacist&quot; Interdisciplinary Research Group on ICTs www.i2tic.net Variables Estimated coefficient Standard Error Wald Sig. Exp (B) Intensive use of the Internet (every day) .279 .086 10.473 .001 1.322 Recommend patients going on line for health information .682 .170 16.124 .000 1.978 Patients discuss or share with you their Internet health information findings .387 .118 10.686 .001 1.473 Emphasis on the Internet for communication and dissemination 1.004 .113 79.637 .000 2.729 Pharmacists Professional Association information .601 .199 9.076 .003 1.824 Constant -2.554 .367 48.500 .000 .078 -2 Log-likelihood 648.274 R2 Cox-Snell .267 R2 Nagelkerke .359 Test of Hosmer-Lemeshow .439 Notes: Method of regression: binomial logit analysis; depend variable: Integrated Community Pharmacists (value 1, YES; value 0, NO); from -2 Log-likelihood 840.219 to 648.274; standardised coefficients; n=619; % predicted observed: from 58.5 to 79.2

17. Dr. Francisco Lupi áñez-Villanueva Grupo Interdisciplinar de Investigación sobre las TIC (i2TIC) Internet Interdisciplinary Institute (IN3) Cited as: Lupiañez-Villanueva, F. (2010) “The raise of the ‘Integrated Community Pharmacist”. In ICTconsequences, 13 August 2010. Barcelona: ICTconsequences. Retrieved month, dd, yyyy from http://www.ictconsequences.net/2010/08/16/ the-integration-of-information-and-communication-technology-into-community-pharmacist-practice/ Interdisciplinary Research Group on ICTs www.i2tic.net