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Published on 26 July 2011

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Mail order patients ‘better off’, says study


Patients who order their prescriptions via a mail-order pharmacy may be better off in the long run, according to a rather implausible new study published in the Journal of General Internal Medicine.

During a California-based study of patients in need of new statin prescriptions, those who acquired the drug via mail order achieved better cholesterol control in the first 3-15 months following the initiation of therapy than those who obtained their prescriptions via a pharmacy.

Greater adjusted rates of LDL-C control in mail-order pharmacy users were seen across all gender and race-ethnicity groups.

After adjustment for demographic, clinical, and socioeconomic characteristics, as well as for potential unmeasured differences between mail-order and in-person pharmacy users, 85% of patients who used the mail-order pharmacy achieved target cholesterol levels, compared to 74% of patients who used the local 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, 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 healthcare system-level toolbox that can help patients meet their medication needs.”

During the study, researchers tapped a study population of over 100,000 members of a local pharmacy in California, 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. 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 analysing the impact of mail-order pharmacy use on clinical outcomes, and seeks to further understand how healthcare systems can work with patients to optimise 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 patients who obtained them from the local pharmacy.

The Journal of General Internal Medicine

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