William P Neil1, Chrislynn E Shiokari2, Raoul J Burchette3, David Stapleton4, Bruce Ovbiagele5. 1. Kaiser Permanente, San Diego, United States. Electronic address: William.P.Neil@kp.org. 2. Kaiser Permanente, San Diego, United States. 3. Dept of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, United States. 4. Pharmacy Analytical Service, Kaiser Permanente, Downey, CA, United States. 5. Medical University of South Carolina, Charleston, SC, United States.
Abstract
BACKGROUND AND PURPOSE: Mail order pharmacies (MOP) are increasingly being used to deliver medications for chronic disease management. Their use is linked to similar or even greater medication adherence than local pharmacy (LP) use. We are unaware of any studies that have evaluated the association of mail order pharmacy use with drug adherence among stroke patients. METHODS: We conducted cross-sectional analyses of patients discharged with ischemic stroke from 24 hospitals in a managed care network, who received a new anticoagulant, antiplatelet, anti-glycemic, antihypertensive, and/or lipid-lowering medication between January 1, 2007 and June 30, 2015. We defined good adherence as medication availability ≥80% of the time, and compared adherence between mail-order users (≥66% of refills by mail) and local pharmacy users (all refills in person). Relationship between delivery method and adherence was evaluated using multivariate regression models. RESULTS: A total of 44,658 eligible patients refilled an index medication. Of these, 13,295 in the LP and 6801 in MOP groups met inclusion criteria. Patients in the MOP group were more likely to be white, and less likely to have hypertension, diabetes, and smoke tobacco. Continuous Medication Gap (CMG) adherence was 0.28 in the LP group and 0.11 in the MOP group (p < 0.001). At 90-days there were 893 hospital readmissions for the LP group and 375 for the MOP group for a rate of 0.07 vs 0.06 (p < 0.001). In the multivariable analysis, adherence was associated with MOP use, (OR 0.12, 95% CI 0.11-0.14) and decreased readmission at 90 days (OR 0.62, 95% CI 0.55-0.71). CONCLUSIONS: Stroke patients who use MOP vs. LP are more likely to have good medication adherence. Future studies should examine the impact of mail-order pharmacy use on vascular risk marker control and events after stroke.
BACKGROUND AND PURPOSE: Mail order pharmacies (MOP) are increasingly being used to deliver medications for chronic disease management. Their use is linked to similar or even greater medication adherence than local pharmacy (LP) use. We are unaware of any studies that have evaluated the association of mail order pharmacy use with drug adherence among strokepatients. METHODS: We conducted cross-sectional analyses of patients discharged with ischemic stroke from 24 hospitals in a managed care network, who received a new anticoagulant, antiplatelet, anti-glycemic, antihypertensive, and/or lipid-lowering medication between January 1, 2007 and June 30, 2015. We defined good adherence as medication availability ≥80% of the time, and compared adherence between mail-order users (≥66% of refills by mail) and local pharmacy users (all refills in person). Relationship between delivery method and adherence was evaluated using multivariate regression models. RESULTS: A total of 44,658 eligible patients refilled an index medication. Of these, 13,295 in the LP and 6801 in MOP groups met inclusion criteria. Patients in the MOP group were more likely to be white, and less likely to have hypertension, diabetes, and smoke tobacco. Continuous Medication Gap (CMG) adherence was 0.28 in the LP group and 0.11 in the MOP group (p < 0.001). At 90-days there were 893 hospital readmissions for the LP group and 375 for the MOP group for a rate of 0.07 vs 0.06 (p < 0.001). In the multivariable analysis, adherence was associated with MOP use, (OR 0.12, 95% CI 0.11-0.14) and decreased readmission at 90 days (OR 0.62, 95% CI 0.55-0.71). CONCLUSIONS:Strokepatients who use MOP vs. LP are more likely to have good medication adherence. Future studies should examine the impact of mail-order pharmacy use on vascular risk marker control and events after stroke.
Authors: Julie A Schmittdiel; Cassondra J Marshall; Deanne Wiley; Christopher V Chau; Connie M Trinacty; J Frank Wharam; O Kenrik Duru; Andrew J Karter; Susan D Brown Journal: BMC Health Serv Res Date: 2019-06-25 Impact factor: 2.655
Authors: Imama A Naqvi; Ying Kuen Cheung; Kevin Strobino; Hanlin Li; Sarah E Tom; Zehra Husaini; Olajide A Williams; Randolph S Marshall; Adriana Arcia; Ian M Kronish; Mitchell S V Elkind Journal: Pilot Feasibility Stud Date: 2022-04-11