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The Safety and Effectiveness of Mail Order Pharmacy Use in Diabetes Patients
  • Published Date:
    Nov 2013
  • Source:
    Am J Manag Care. 19(11):882-887.
Filetype[PDF - 219.81 KB]


Details:
  • Pubmed ID:
    24511986
  • Pubmed Central ID:
    PMC4278640
  • Funding:
    1P30 DK092924/DK/NIDDK NIH HHS/United States
    K08 AG033630/AG/NIA NIH HHS/United States
    R01 DK080726/DK/NIDDK NIH HHS/United States
    R01 DK080726/DK/NIDDK NIH HHS/United States
    R01 DK0817960/DK/NIDDK NIH HHS/United States
    U58 DP002641/DP/NCCDPHP CDC HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Background

    Research suggests mail order pharmacy use is associated with greater medication adherence and CVD risk factor control. However, no research has examined the potential impact of mail order pharmacy use on patient safety and utilization.

    Objective

    To compare safety and utilization outcomes in patients using mail order vs. local pharmacies.

    Subjects

    17,217 Kaiser Permanente Northern California (KPNC) adult diabetes patients prescribed new cardiometabolic medications in 2006.

    Research Design

    Cross-sectional, observational study.

    Measures

    Outcomes included any all-cause and preventable hospitalizations and emergency department (ED) visits; laboratory tests for monitoring persistent medications; and overlapping days’ supply of contraindicated medications. Multivariate logistic regression results were stratified by patient age and converted to adjusted predicted percentages.

    Results

    Overall, there were few differences in outcomes between mail order and local pharmacy users. Patients < 65 using mail order had fewer ED visits (34.0% vs. 40.2%; p<.001); preventable ED visits (7.8% vs. 9.6%; p<.01); and serum creatinine laboratory monitoring tests after ACE/ARB or diuretic initiation (41.4% vs. 47.2%; p<.01). Among patients ≥65, mail order users had fewer preventable ED visits (13.4% vs. 16.3%; p<.01); but more occurrences of overlapping days’ supply of contraindicated medications (1.1% vs. 0.7%; p<.01).

    Conclusions

    Mail order pharmacy use is not associated with adverse outcomes in most diabetes patients, and is associated with lower ED use. Interventions to increase mail order pharmacy use may be an important strategy for improving care; however, these interventions should employ a patient-centered approach that is sensitive to primary and preventive care access.