Original Research

Journal of General Internal Medicine

, Volume 26, Issue 12, pp 1396-1402

The Comparative Effectiveness of Mail Order Pharmacy Use vs. Local Pharmacy Use on LDL-C Control in New Statin Users

  • Julie A. SchmittdielAffiliated withDivision of Research, Kaiser Permanente Northern California Email author 
  • , Andrew J. KarterAffiliated withDivision of Research, Kaiser Permanente Northern California
  • , Wendy DyerAffiliated withDivision of Research, Kaiser Permanente Northern California
  • , Melissa ParkerAffiliated withDivision of Research, Kaiser Permanente Northern California
  • , Connie UratsuAffiliated withDivision of Research, Kaiser Permanente Northern California
  • , James ChanAffiliated withPharmacy Outcomes Research Group, Kaiser Permanente Northern California
  • , O. Kenrik DuruAffiliated withDavid Geffen School of Medicine, University of California, Los Angeles

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Abstract

BACKGROUND

Mail order pharmacies are commonly used to deliver CVD risk factor medications. Previous studies have shown that mail order pharmacy use is associated with greater medication adherence; however, no studies have examined whether mail order pharmacy use is related to improved CVD risk factor outcomes.

OBJECTIVE

To examine the comparative effectiveness of mail order pharmacy vs. local pharmacy use on LDL-C control in new statin users.

DESIGN

Observational cohort study.

PATIENTS

100,298 adult Kaiser Permanente Northern California (KPNC) members who were new users of statins between January 1, 2005 and December 31, 2007.

MEASUREMENTS

The main outcome measure was LDL-C control in the 3–15 month period after statin therapy was initiated.

RESULTS

After adjustment for patient, clinical, and census-block characteristics, and for potential unmeasured differences between mail order and local KPNC pharmacy users with instrumental variables analysis, 85.0% of patients who used the mail order pharmacy to deliver their statin at any time achieved target LDL-C levels compared with 74.2% of patients who only used the local KPNC pharmacy to dispense the statin (p < 0.001). Greater adjusted rates of LDL-C control in mail order pharmacy users were seen across all gender and race/ethnicity subgroups.

CONCLUSIONS

Mail order pharmacy use was positively associated with LDL-C control in new statin users. Future research should continue to explore the relationship between mail order pharmacy use and outcomes, and address how to appropriately target mail order services to patients most likely to benefit without compromising patient choice, care, and safety.

KEY WORDS

health services research hyperlipidemia pharmaceutical care