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About 35.4% (n=105) of the participants reported being advised to consult their doctor within 6 months of their first supply of VC.

Likewise, 11.1% (n = 33) of them reported that they were advised to see their doctor within one month of the first supply, 2.4% (n = 7) of them were advised to see their doctor immediately, and another 2.4% (n = 7) of them were advised to see their doctor within a year of the first supply. About 16.5% (n = 49) of them reported that they were not advised by their pharmacist to see their doctor and 32.3% (n = 96) of them could not recall if they were advised.

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About 35.4% (n=105) of the participants reported being advised to consult their doctor within 6 months of their first supply of VC. Likewise, 11.1% (n = 33) of them reported that they were advised to see their doctor within one month of the first supply, 2.4% (n = 7) of them were advised to see their doctor immediately, and another 2.4% (n = 7) of them were advised to see their doctor within a year of the first supply. About 16.5% (n = 49) of them reported that they were not advised by their pharmacist to see their doctor and 32.3% (n = 96) of them could not recall if they were advised. Patient’s experience of whether they were advised by the pharmacist to consult their doctor during their first request for VC is shown (Table 3). In addition, of the 297 participants, 39.1% (n = 116) reported receiving the tear-off slip with a reminder of when to see their doctor, 23.2% (n = 69) could not remember, and 37.7% (n = 112) stated that they did not receive any tear-off slip.

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Approximately two-thirds of participants (65.0%; n = 193) reported that they either had seen (19.2%; n = 57) or planned to see (45.8%; n = 136) their doctor. Of the 19.2% (n = 57) participants who reported having seen their doctors, majority of them (16.8%; n = 50 [12.8–21.6]) were told by their doctors that they could continue with VC by buying it at the pharmacy without a prescription, while rest of them (n = 7) were not advised to do so. Among the remaining 35% (n = 104) of the participants, 28.3% (n = 84) of them reported not having seen their doctor and had no plans to discuss VC with their doctor. Patients’ experience with visiting or planning to visit their doctor in the near future are shown (Table 4). Regarding the other additional advice, the participants received from the pharmacists, 85.5% (; n = 254) reported being advised on how to take VC correctly, 82.2% (n = 244) reported that they were advised of possible side effects, for which they might have to discontinue taking VC and consult their doctor. Patient’s experience of whether they were advised by the pharmacist to consult their doctor during their first request for VC is shown (Table 3).

• Viagra Connect is an over-the-counter treatment for erectile dysfunction.
• It contains sildenafil, which improves blood flow to the penis.
• Available in pharmacies without a prescription.
• Patients should consult a pharmacist before use.
• Suitable for men aged 18 and over.
• Must be taken at least 30 minutes before activity.

In addition, of the 297 participants, 39.1% (n = 116) reported receiving the tear-off slip with a reminder of when to see their doctor, 23.2% (n = 69) could not remember, and 37.7% (n = 112) stated that they did not receive any tear-off slip.

Approximately two-thirds of participants (65.0%; n = 193) reported that they either had seen (19.2%; n = 57) or planned to see (45.8%; n = 136) their doctor. Of the 19.2% (n = 57) participants who reported having seen their doctors, majority of them (16.8%; n = 50 [12.8–21.6]) were told by their doctors that they could continue with VC by buying it at the pharmacy without a prescription, while rest of them (n = 7) were not advised to do so. Among the remaining 35% (n = 104) of the participants, 28.3% (n = 84) of them reported not having seen their doctor and had no plans to discuss VC with their doctor. Patients’ experience with visiting or planning to visit their doctor in the near future are shown (Table 4). Regarding the other additional advice, the participants received from the pharmacists, 85.5% (; n = 254) reported being advised on how to take VC correctly, 82.2% (n = 244) reported that they were advised of possible side effects, for which they might have to discontinue taking VC and consult their doctor. 80.1% (n = 238) reported that their pharmacist informed them that ED can be caused by underlying conditions such as high BP, diabetes, high cholesterol, and heart disease, while 68.7% (n = 204) reported that they had received lifestyle advice from the pharmacist (Table 5). Regarding the sources of the knowledge about VC and ED, 31.3% (n = 93) of the participants reported that their pharmacist was the main source of knowledge, while for 26.6% (n = 79) of them it was the product information leaflets in the VC box. Finally, regarding the patients’ comfort in being questioned by the pharmacist, 91.2% of the respondents replied that they agreed or strongly agreed with the statement that they were comfortable to answer questions from the pharmacist. Subgroup analyses for participants responses to the questions regarding pharmacists’ assessment of their suitability for VC, and advice on appropriate use of VC and on their need to see doctors were performed by the stratification of few variables. There was no overlap in the 95% CIs between the subgroups defined by most of the variables, except for the subgroups defined by the two variables, described below. When stratifying the participants by whether the pharmacists asked them if they had ED (82.2% “Yes” vs 9.8% “No”), between-group differences for the participants’ responses to the above-mentioned 4 questions did not overlap between the 95% CIs. In general, if the participants reported having ED, the pharmacists were more likely to assess their suitability for VC and provide advice on appropriate use of VC and on their need to see doctors (Table 6). When stratifying the participants by whether they had been prescribed sildenafil or other ED medication by their doctor (13.8% “Yes”, 78.8% “No”, 7.4% “Do not know/prefer not to answer”), their responses to the question “Since purchasing the FIRST supply of VC from your pharmacist, which of the following are true?” 41.5% of the respondents who reported, vs 12.8% who did not report, having previously been prescribed sildenafil or other ED medication selected the answer “I have seen my doctor and the doctor advised I can continue with sildenafil by buying it at the pharmacy without a prescription”. One of the key strengths of the present study is that it has the benefits of implications from two previously conducted pilot surveys.8,14 The first used a consumer panel and identified significant selection and response biases such that there was a high likelihood that the results would not be representative of the patient population seeking to purchase VC. A second pilot was performed whereby patients were recruited via the pharmacists when the patient was supplied with VC. The survey questions in this second pilot were streamlined to focus only on key questions concerning the advice the pharmacist had provided to the patient, and specifically as to whether the patient was assessed to be suitable for VC and whether he was advised to consult his doctor.

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The survey questions in this second pilot were streamlined to focus only on key questions concerning the advice the pharmacist had provided to the patient, and specifically as to whether the patient was assessed to be suitable for VC and whether he was advised to consult his doctor. Overall, the findings from these pilot surveys aided in restructuring of the methodology including 1) change in recruitment methods, ie through pharmacists, which ensured that only patients who had definitely been supplied with VC were invited, 2) the streamlining of survey questions to focus more specifically on the patients’ experiences while interacting with the pharmacist to purchase VC and minimize the burden to patients, and 3) the patients recruited were supplied from various types of pharmacies in wide geographical locations. The effectiveness of the UK VC aRMMs program has been substantiated by a previous study, a post-authorization safety study (PASS) and regulatory commitment to UK MHRA, which was a cross-sectional survey of pharmacists in the UK who had dispensed VC as a “behind the counter” product to ED priligy and viagra patients who purchased it in their pharmacies. It evaluated the pharmacists’ knowledge of key risk messages and their compliance with the required dispensing practices which had been communicated to them in the training of the additional risk minimization measures. In this study, 345 community pharmacists completed the survey.

Data Source and Measurement

The survey revealed that respondents (≥80%) demonstrated high level of knowledge of key risk messages through selection of correct answers for 43/51 items in questionnaire. Also, most respondents (90.1%) reported that they were provided with useful/very useful training materials. They also opined it was an affirmative experience to provide patient counselling about VC. In the current study, we evaluated the effectiveness of the aRMMs program in a survey of ED patients about their interactions with pharmacists when they first purchased VC in pharmacies. The pharmacist survey has been published allowing us to compare the findings between the patient survey and pharmacist survey.14–16 Regarding pharmacists’ assessment of patients’ suitability for VC at the time the patients purchased VC in pharmacies, most patients in the patient survey reported they had been asked about their BP and heart conditions (91.9%), any other illnesses (87.9%) or concomitant medications use (86.5%). Overall, the findings from these pilot surveys aided in restructuring of the methodology including 1) change in recruitment methods, ie through pharmacists, which ensured that only patients who had definitely been supplied with VC were invited, 2) the streamlining of survey questions to focus more specifically on the patients’ experiences while interacting with the pharmacist to purchase VC and minimize the burden to patients, and 3) the patients recruited were supplied from various types of pharmacies in wide geographical locations.

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Of the total 297 patients surveyed, 234 (78.8%) patients reported they had not been prescribed sildenafil or other ED medication by their doctor. Of the 234 patients, 148 (63.2%) reported that they had seen or plan to see their doctors. This finding indicated that (1) majority of ED patients did not receive treatment for ED, and (2) availability of VC in pharmacy can help bring the ED patients who have not seen doctors to see their doctors for their ED condition. In another web-based survey conducted between March 2018 and April 2019, men aged ≥18 years with self-reported ED who were dispensed VC reported having higher number of physician/nurse practitioner and pharmacist visits during the one-year period after their first VC dispension, comparing to those who were not dispensed VC.14,17 Most of the surveyed patients reported that, during their first purchase of VC, they had been advised by the pharmacist regarding how to take VC correctly (85.5%), of VC’s possible side effects which requires the patients to discontinue VC and consult their doctors (82.2%).

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The effectiveness of the UK VC aRMMs program has been substantiated by a previous study, a post-authorization safety study (PASS) and regulatory commitment to UK MHRA, which was a cross-sectional survey of pharmacists in the UK who had dispensed VC as a “behind the counter” product to ED priligy and viagra patients who purchased it in their pharmacies. It evaluated the pharmacists’ knowledge of key risk messages and their compliance with the required dispensing practices which had been communicated to them in the training of the additional risk minimization measures.

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80.1% (n = 238) reported that their pharmacist informed them that ED can be caused by underlying conditions such as high BP, diabetes, high cholesterol, and heart disease, while 68.7% (n = 204) reported that they had received lifestyle advice from the pharmacist (Table 5). Regarding the sources of the knowledge about VC and ED, 31.3% (n = 93) of the participants reported that their pharmacist was the main source of knowledge, while for 26.6% (n = 79) of them it was the product information leaflets in the VC box. Finally, regarding the patients’ comfort in being questioned by the pharmacist, 91.2% of the respondents replied that they agreed or strongly agreed with the statement that they were comfortable to answer questions from the pharmacist. Subgroup analyses for participants responses to the questions regarding pharmacists’ assessment of their suitability for VC, and advice on appropriate use of VC and on their need to see doctors were performed by the stratification of few variables. There was no overlap in the 95% CIs between the subgroups defined by most of the variables, except for the subgroups defined by the two variables, described below.

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When stratifying the participants by whether the pharmacists asked them if they had ED (82.2% “Yes” vs 9.8% “No”), between-group differences for the participants’ responses to the above-mentioned 4 questions did not overlap between the 95% CIs. In general, if the participants reported having ED, the pharmacists were more likely to assess their suitability for VC and provide advice on appropriate use of VC and on their need to see doctors (Table 6). When stratifying the participants by whether they had been prescribed sildenafil or other ED medication by their doctor (13.8% “Yes”, 78.8% “No”, 7.4% “Do not know/prefer not to answer”), their responses to the question “Since purchasing the FIRST supply of VC from your pharmacist, which of the following are true?” 41.5% of the respondents who reported, vs 12.8% who did not report, having previously been prescribed sildenafil or other ED medication selected the answer “I have seen my doctor and the doctor advised I can continue with sildenafil by buying it at the pharmacy without a prescription”. One of the key strengths of the present study is that it has the benefits of implications from two previously conducted pilot surveys.8,14 The first used a consumer panel and identified significant selection and response biases such that there was a high likelihood that the results would not be representative of the patient population seeking to purchase VC. A second pilot was performed whereby patients were recruited via the pharmacists when the patient was supplied with VC. In this study, 345 community pharmacists completed the survey. The survey revealed that respondents (≥80%) demonstrated high level of knowledge of key risk messages through selection of correct answers for 43/51 items in questionnaire. Also, most respondents (90.1%) reported that they were provided with useful/very useful training materials. They also opined it was an affirmative experience to provide patient counselling about VC. In the current study, we evaluated the effectiveness of the aRMMs program in a survey of ED patients about their interactions with pharmacists when they first purchased VC in pharmacies. The pharmacist survey has been published allowing us to compare the findings between the patient survey and pharmacist survey.14–16 Regarding pharmacists’ assessment of patients’ suitability for VC at the time the patients purchased VC in pharmacies, most patients in the patient survey reported they had been asked about their BP and heart conditions (91.9%), any other illnesses (87.9%) or concomitant medications use (86.5%).

In comparison, with the pharmacist survey, the pharmacists’ level of knowledge on the need to ask patients about cardiovascular disease, other illnesses and medication was generally over 80%. The results of this patient survey support the fact that the pharmacists’ knowledge is being put into practice when a patient presents for the first time to purchase VC.14–17 In this patient survey, 51.2% of the patients reported that they were advised, at their first-time purchase of VC, to see their doctor within 6 months or shorter. Approximately, 49% of the patients reported that either they did not recall being advised (32.3%) or were not advised (16.5%) by their pharmacist to see their doctor. In the pharmacist survey, 87.2% of the surveyed pharmacists reported that they were aware that the patients who purchased VC should be advised to visit their doctor within 6 months of the first VC purchase, while 12.8% of them did not have this awareness. In addition, 39.1% of the surveyed patients reported receiving the tear-off slip paper with a reminder of when to see their doctor and 37.7% reported that they did not receive it; however, in the pharmacist survey, 91.3% of the pharmacists had reported that they always provided the tear-off slip when supplying VC.

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In comparison, with the pharmacist survey, the pharmacists’ level of knowledge on the need to ask patients about cardiovascular disease, other illnesses and medication was generally over 80%. The results of this patient survey support the fact that the pharmacists’ knowledge is being put into practice when a patient presents for the first time to purchase VC.14–17 In this patient survey, 51.2% of the patients reported that they were advised, at their first-time purchase of VC, to see their doctor within 6 months or shorter. Approximately, 49% of the patients reported that either they did not recall being advised (32.3%) or were not advised (16.5%) by their pharmacist to see their doctor. In the pharmacist survey, 87.2% of the surveyed pharmacists reported that they were aware that the patients who purchased VC should be advised to visit their doctor within 6 months of the first VC purchase, while 12.8% of them did not have this awareness. In addition, 39.1% of the surveyed patients reported receiving the tear-off slip paper with a reminder of when to see their doctor and 37.7% reported that they did not receive it; however, in the pharmacist survey, 91.3% of the pharmacists had reported that they always provided the tear-off slip when supplying VC.

Patients’ Reported Experience with Visiting or Planning to Visit Their Doctor

Pharmacist identified those patients who were not appropriate to receive currently approved non-prescription sildenafil 50 mg. These patients were then provided with tear -off slips for further evaluation by their health care providers/general physicians. Also, these tear-off slips served as a remainder for subsequent consultation with their doctor within 6 months. Because the samples of the two surveys were not linked, it is difficult to identify reasons for this divergence of results between the two surveys. In this patient survey, 65.0% of the patients reported that they either had seen (19.2%) or planned to see (45.8%) their doctors, although only 51.2% of the patients reported being advised by pharmacists to see their doctors. Pharmacist identified those patients who were not appropriate to receive currently approved non-prescription sildenafil 50 mg. These patients were then provided with tear -off slips for further evaluation by their health care providers/general physicians. Also, these tear-off slips served as a remainder for subsequent consultation with their doctor within 6 months. Because the samples of the two surveys were not linked, it is difficult to identify reasons for this divergence of results between the two surveys. In this patient survey, 65.0% of the patients reported that they either had seen (19.2%) or planned to see (45.8%) their doctors, although only 51.2% of the patients reported being advised by pharmacists to see their doctors.

• Viagra Connect is sold in 50mg tablet form.
• The medication should not be used more than once daily.
• Common side effects include headaches and flushing.
• Do not mix with nitrates or certain medications.
• It is not suitable for people with severe heart conditions.
• Store in a cool, dry place away from children.

Of the total 297 patients surveyed, 234 (78.8%) patients reported they had not been prescribed sildenafil or other ED medication by their doctor. Of the 234 patients, 148 (63.2%) reported that they had seen or plan to see their doctors. This finding indicated that (1) majority of ED patients did not receive treatment for ED, and (2) availability of VC in pharmacy can help bring the ED patients who have not seen doctors to see their doctors for their ED condition.

In another web-based survey conducted between March 2018 and April 2019, men aged ≥18 years with self-reported ED who were dispensed VC reported having higher number of physician/nurse practitioner and pharmacist visits during the one-year period after their first VC dispension, comparing to those who were not dispensed VC.14,17 Most of the surveyed patients reported that, during their first purchase of VC, they had been advised by the pharmacist regarding how to take VC correctly (85.5%), of VC’s possible side effects which requires the patients to discontinue VC and consult their doctors (82.2%).