Investigating Patient Perspectives on Medical Returns and Buying Medicines Online in Two Communities in Melbourne, Australia: Results from a Qualitative Study

Original Research Article

Abstract

Aims

By going online or overseas, patients can purchase a range of prescription and over-the-counter drugs and complementary and alternative medicine (CAM), without prescription and without input from a qualified health professional. Such practices raise questions about medicine safety and how and why patients choose to procure medicines using such methods. The aim of this paper is to examine two unconventional types of medicine procurement—medical returns and purchasing medicines online—from the patient perspective.

Methods

Data are drawn from a large qualitative study examining health-seeking practices among Indian-Australians (28) and Anglo-Australians (30) living with depression in Melbourne, Australia. Semi-structured face-to-face interviews were undertaken. Thematic analysis was performed.

Findings

A total of 23 (39.6 %) participants reported having obtained medicines either through the internet or via medical returns. Indian-Australians sourced medicines from India while Anglo-Australians purchased CAM products from domestic and international e-pharmacies. Neither group encountered any difficulties in the medicines entering Australia. Cost and convenience were the main reasons for buying medicines online but dissatisfaction with Australian health services also influenced why Indian-Australians sought medicines from India. Nearly all participants reported benefits from consuming these medicines; only one person reported adverse effects.

Conclusion

The increased availability of medicines transnationally and patients’ preparedness to procure these medicines from a range of sources raise important issues for the safe use of medicines. Further research is needed to understand how patients forge their own transnational therapeutic regimes, understand and manage their levels of risk in relation to safe medicine use and what points of intervention might be most effective to promote safe medicine use.

Notes

Acknowledgments

The authors acknowledge the support of the funding bodies that have facilitated this study: Bianca Brijnath is supported by a fellowship from the Australian National Health and Medical Research Council (NHMRC), Josefine Antoniades is funded to undertake this research by an Australian Postgraduate Award and Jon Adams is supported by a fellowship from the NHMRC. We thank Ms. Nabita Singh for her assistance with the recruitment of some of the Indian-Australian participants. Bianca Brijnath, Josefine Antoniades and Jon Adams declare no conflict of interest, financial or otherwise.

Contributions

Bianca Brijnath designed the study, undertook data collection and analyses and drafted the first iteration of this article. Josefine Antoniades contributed to the data collection, final data analyses and various drafts of the article. Jon Adams contributed to the article argument, final data analyses and various drafts of the article. All authors approved the final manuscript; Bianca Brijnath is the overall guarantor of the manuscript.

References

  1. 1.
    Whittaker A, Manderson L, Cartwright E. Patients without borders: understanding medical travel. Med Anthropol. 2010;29(4):336–43.CrossRefPubMedGoogle Scholar
  2. 2.
    Woodward D, Drager N, Beaglehole R. Globalization, global public goods and health. In: Lipson D, Drager N, Vieira C, editors. Trade in health services: global, regional, and country perspectives. Washington DC: Pan American Health Organization; 2002. p. 1–16.Google Scholar
  3. 3.
    Horton S. Medical returns as class transformation: situating migrants’ medical returns within a framework of transnationalism. Med Anthropol. 2012;32(5):417–32. doi:10.1080/01459740.2012.749875.CrossRefGoogle Scholar
  4. 4.
    Horton S, Cole S. Medical returns: seeking health care in Mexico. Soc Sci Med. 2011;72(11):1846–52. doi:10.1016/j.socscimed.2011.03.035.CrossRefPubMedGoogle Scholar
  5. 5.
    Lee JY, Kearns RA, Friesen W. Seeking affective health care: Korean immigrants’ use of homeland medical services. Health Place. 2010;16(1):108–15. doi:10.1016/j.healthplace.2009.09.003.CrossRefPubMedGoogle Scholar
  6. 6.
    Tiilikainen M, Koehn P. Transforming the boundaries of health care: insights from Somali migrants. Med Anthropol. 2011;30(5):518–44.CrossRefPubMedGoogle Scholar
  7. 7.
    Wallace SP, Mendez-Luck C, Castaneda X. Heading south: why Mexican immigrants in California seek health services in Mexico. Med Care. 2009;47(6):662–9. doi:10.1097/MLR.0b013e318190cc95.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Brown HS. Do Mexican immigrants substitute health care in Mexico for health insurance in the United States? The role of distance. Soc Sci Med. 2008;67(12):2036–42. doi:10.1016/j.socscimed.2008.09.014.CrossRefPubMedGoogle Scholar
  9. 9.
    Bergmark R, Barr D, Garcia R. Mexican immigrants in the US living far from the border may return to Mexico for health services. J Immigr Minor Health. 2010;12(4):610–4. doi:10.1007/s10903-008-9213-8.CrossRefPubMedGoogle Scholar
  10. 10.
    Orizio G, Gelatti U. Public eHealth and new scenarios in terms of risks and opportunities: a specific focus on cyberpharmacies. Soc Semiot. 2010;20(1):29–41.CrossRefGoogle Scholar
  11. 11.
    Orizio G, Schulz P, Domenighini S, Caimi L, Rosati C, Rubinelli S, et al. Cyberdrugs: a cross-sectional study of online pharmacies characteristics. Eur J Public Health. 2009;19(4):375–7. doi:10.1093/eurpub/ckn146.CrossRefPubMedGoogle Scholar
  12. 12.
    Orizio G, Merla A, Schulz PJ, Gelatti U. Quality of online pharmacies and websites selling prescription drugs: a systematic review. J Med Internet Res. 2011;13(3):e74. doi:10.2196/jmir.1795.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Department of Immigration and Citizenship. 2012–2013 Migration Program Report. Canberra: Australian Government; 2013.Google Scholar
  14. 14.
    Denzin NK, Lincoln YS. The Sage handbook of qualitative research. 4th ed. Thousand Oaks: Sage; 2011.Google Scholar
  15. 15.
    The American Psychiatric Association. Diagnostic criteria from DSM-IV. Washington, DC: The American Psychiatric Association; 2000.Google Scholar
  16. 16.
    Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959–76.CrossRefPubMedGoogle Scholar
  17. 17.
    Australian Bureau of Statistics. 6306.0–Employee earnings and hours, Australia, May 2012. Canberra: Australian Bureau of Statistics; 2013.Google Scholar
  18. 18.
    Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychology. 2006;3(2):77–101. doi:10.1191/1478088706qp063oa.CrossRefGoogle Scholar
  19. 19.
    Olszewski B, Macey D, Lindstrom L. The practical work of <coding>: an ethnomethodological inquiry. Hum Stud. 2006;29(3):363–80. doi:10.1007/s10746-006-9029-2.CrossRefGoogle Scholar
  20. 20.
    Australian Customs and Border Protection Services. Arriving travellers. Canberra. http://www.customs.gov.au/site/page4351.asp#items (2014). Accessed 11 Feb 2014.
  21. 21.
    Orizio G, Rubinelli S, Schulz PJ, Domenighini S, Bressanelli M, Caimi L, et al. “Save 30 % if you buy today”. Online pharmacies and the enhancement of peripheral thinking in consumers. Pharmacoepidemiol Drug Saf. 2010;19(9):970–6. doi:10.1002/pds.2007.CrossRefPubMedGoogle Scholar
  22. 22.
    Mays N, Pope C. Qualitative research in health care. Assessing quality in qualitative research. BMJ. 2000;320(7226):50–2.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Whittemore R, Chase SK, Mandle CL. Validity in qualitative research. Qual Health Res. 2001;11(4):522–37.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Bianca Brijnath
    • 1
  • Josefine Antoniades
    • 1
  • Jon Adams
    • 2
  1. 1.Monash UniversityMelbourneAustralia
  2. 2.University of Technology SydneySydneyAustralia

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