Patients with diabetes who received their heart medications by mail were less likely to visit the emergency room than those who picked up prescriptions in person, a study by Kaiser Permanente found.
The research, published in the American Journal of Managed Care, is the first to examine how the use of mail order pharmacies can affect patient safety and utilization. Past research has suggested that mail order pharmacy use is connected with greater medication adherence and cholesterol control.
This study also explored the concern of patients experiencing adverse outcomes because they do not meet face-to-face with a pharmacist or their physician as often, in order to prevent contraindications to a medication's use, especially when the patient is taking several medications.
Up to about one third of chronic illness medications are now delivered by mail, the report noted.
Kaiser Permanente offers its members the options of using its mail order pharmacy with free shipping or picking up prescriptions at walk-in pharmacies located in its hospitals and outpatient medical buildings. Mail order co-payments are often lower for the same prescription as walk-in pharmacies.
Overall there were no safety concerns, and the use of mail order pharmacies was not associated with adverse outcomes in most patients, according to Julie Schmittdiel, lead author and research scientist with the Kaiser Permanente Division of Research. "For the vast majority of people, mail order pharmacy works well," she said in a KP news release.
The researchers followed 17,217 adult KP members from the diabetes registry and who were first prescribed heart medications in 2006 for three years. It found that those under 65 years old who used mail order pharmacy had significantly fewer emergency room visits for any cause compared with those who picked up their medications: 33.8 percent vs. 40.2 percent respectively.
"Since good medication adherence and cardiovascular disease risk factor control are associated with reduced hospitalizations and better outcomes, mail order use may lead to lower preventable utilization over time," the authors said in the study.
Increasing mail order pharmacy may be an important strategy for improving care processes and outcomes for patients with chronic conditions. However, care should be taken to make sure that system changes to increase mail order pharmacy use a patient-centered approach to accommodate those who may be sensitive to primary and preventive care access, the report said.
The study, which the Centers for Disease Control and Prevention funded, did not drill down into the possible reasons why the use of mail order pharmacies was linked to fewer emergency room visits. Researchers noted that more examination was needed around factors, including patients' disabilities, time constraints or limited transportation access.