July 22, 2011 Kaiser Permanente Northern California patients who obtained new statin prescriptions via a mail-order pharmacy achieved better cholesterol control in the first 3-15 months following the initiation of therapy -- compared to those patients who only obtained their statin prescription from their local Kaiser Permanente Northern California pharmacy.
Greater adjusted rates of LDL-C control in mail-order pharmacy users were seen across all gender and race-ethnicity groups, according to the study that appears in the current online issue of the Journal of General Internal Medicine.
After adjustment for demographic, clinical, and socioeconomic characteristics, as well as for potential unmeasured differences between mail-order and in-person pharmacy users, 85 percent of patients who used the mail-order pharmacy achieved target cholesterol levels, compared to 74.2 percent of patients who only used the local Kaiser Permanente pharmacy.
Previous studies have shown that mail-order pharmacy use is associated with greater medication adherence. However, this is the first study to examine whether mail-order pharmacy use is related to improved cardiovascular risk factor outcomes, according to Julie Schmittdiel, PhD, an investigator with the Kaiser Permanente Division of Research in Oakland, Calif., and the lead author of the study.
"While the findings of this study should be confirmed in a randomized controlled trial, they provide new evidence that mail-order pharmacy use may be associated with improved care and outcomes for patients for risk factors with cardiovascular disease," Schmittdiel said.
"Though mail order may not be right for all patients, this study shows that it is one possible tool in the broader health care system-level toolbox that can help patients meet their medication needs."
At Kaiser Permanente, members have 24/7 access to online pharmacy and pharmacy refills at kp.org using My Health Manager, which can be mailed to them free of shipping charges or made available for pick-up at any Kaiser Permanente pharmacy.
In comparing the effectiveness of mail-order pharmacy vs. local pharmacy use on cholesterol control in new statin users, investigators tapped a study population of 100,298 Kaiser Permanente members who were statin users between Jan. 1, 2005, and Dec. 31, 2007. Statin use was obtained from automated pharmacy records and patients were considered to be new users if they had not recorded use of statin in records prior to the initial statin prescription date.
Greater adherence to these medications by mail-order pharmacy users may reflect improved access to medications, researchers explain. Mail order does not require travel to the local pharmacy, which may provide ease and convenience for patients refilling medications. To address possible selection biases -- for example, the possibility that patients who use mail-order pharmacy services are more motivated to take care of their health than patients who do not use such services -- researchers conducted additional analyses.to minimize such biases. All analyses, even those accounting for such potential differences, showed a positive, significant association between mail order pharmacy use and cholesterol control.
This study is part of an ongoing body of work analyzing the impact of mail-order pharmacy use on clinical outcomes, and seeks to further understand how health care systems can work with patients to optimize medication use without compromising patient choice or safety.
In a January 2010 study in the American Journal of Managed Care, researchers from UCLA and the Kaiser Permanente Division of Research found that patients with diabetes, high blood pressure or high cholesterol who ordered their medications by mail were more likely to take them as prescribed by their doctors than did patients who obtained them from the local pharmacy.
Additional authors on the Journal of General Internal Medicine study include Andrew J. Karter, PhD; Wendy Dyer, MS; Melissa Parker, MS; and Connie Uratsu, all with the Kaiser Permanente Division of Research. James Chan, PharmD, PhD, with the Kaiser Permanente Pharmacy Outcomes and Research Group, and O.Kenrik Duru, MD, MSHS, with the UCLA David Geffen School of Medicine, also are co-authors. Funding was provided by the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive Kidney Diseases.
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