LOS ANGELES, Jan. 13 Buying mail-order medications may encourage patients to stick to their doctor-prescribed medication regimen, new research suggests.
In a first-of-its-kind study, researchers from UCLA and Kaiser Permanente's Division of Research in Oakland, Calif. 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 a local pharmacy.
The study is published online in the American Journal of Managed Care.
"The field of medication adherence research typically focuses on patient factors for poor adherence, leading to a 'blame the patient' approach for non-adherence," said Dr. O. Kenrik Duru, assistant professor in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, and the study's lead researcher.
"Our work helps to place this issue in a larger perspective," Duru added. "Our findings indicate that mail-order pharmacies streamline the medication acquisition process, which is associated with better medication adherence."
In a recent survey, Kaiser Permanente members listed mail-order pharmacy among the top benefits of managing their health via Kaiser Permanente's personal health record, My Health Manager. More then 3.4 million members use My Health Manager to conveniently view lab results, refill prescriptions, schedule appointments and securely email their doctors.
For this 12-month study, the researchers analyzed 2006 and 2007 medication refill data from 13,922 Kaiser Permanente members in Northern California. They defined "good adherence" as having medication available and on hand at least 80 percent of the time.
They found that 84.7 percent of patients who received their medications by mail at least two-thirds of the time stuck to their physician-prescribed regimen, versus 76.9 percent who picked up their medications at "brick and mortar" Kaiser Permanente pharmacies.
"The results were consistent for all three classes of medication, including medications to control diabetes, high blood pressure, and high cholesterol," explained co-investigator Julie A. Schmittdiel, PhD, a research scientist with the Kaiser Permanente Division of Research.
"Our findings suggest that there is a lot that health care systems can do to provide support that makes it easier for patients to take care of themselves and do the right thing."
Other findings include:
After adjusting for other variables, whites were more likely to use mail-order more than 2/3 of the time (24.1 percent) than were Asian/Pacific Islanders (8.4 percent), Hispanics (5.2 percent), blacks (4.0 percent), and people of mixed race (8.0 percent).
Mail-order pharmacy users were more likely than local pharmacy users to have a financial incentive to fill their prescriptions by mail (49.6 percent vs. 23.0 percent), and to live a greater distance away from a local pharmacy (8.0 miles vs. 6.7 miles). An example of a financial incentive is receiving a three-month supply of medications for the cost of a two-month supply.
While other research has examined the association between mail-order vs. local pharmacy types and medication cost, this is the first to look at the relationship between pharmacy type and adherence. Furthermore, it controls for differences in medication days' supply and out-of-pocket costs between mail-order and local pharmacy users, something other datasets don't include.
"In other words, our study is able to isolate the use of mail-order pharmacies specifically without the results being affected by differences in cost or in the number of pills provided with each dispensing," Duru said.
The study does have some limitations. For example, these findings need to be confirmed by a randomized controlled trial.
Still, this research suggests that increased mail-order use to obtain medications could improve patients' adherence.
Other researchers in addition to Duru and Schmittdiel are Wendy Dyer, Melissa Parker, Connie Uratsu, James Chan and Andrew J. Karter of the division of research at Kaiser Permanente Northern California.
Grants from the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases funded this study.
General Internal Medicine and Health Services Research is a division within the Department of Medicine at the David Geffen School of Medicine at UCLA. It provides a unique interactive environment for collaborative efforts between health services researchers and clinical experts with experience in evidence-based work. The division's 100-plus clinicians and researchers are engaged in a wide variety of projects that examine issues related to access to care, quality of care, health measurement, physician education, clinical ethics and doctor/patient communication. The division's researchers have close working relationships with economists, statisticians, social scientists and other specialists throughout UCLA and frequently collaborate with their counterparts at the RAND Corp and Charles Drew University. Visit http://gim.med.ucla.edu/ for more information.
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR's 500-plus staff is working on more than 250 epidemiological and health services research projects. For more information, visit http://www.dor.kaiser.org.
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.