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

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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.

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Acknowledgements

This study was jointly funded by Program Announcement number 04005 from the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases, Contract no. U58/CCU923527-04-1. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding organizations. Dr. Schmittdiel had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the analysis.

Conflicts of Interest

Dr. Schmittdiel serves as an unpaid advisor to the American Diabetes Association and Medco joint medication adherence research collaboration. The authors have no other conflicts of interest to report.

Author information

Authors and Affiliations

  1. Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA

    Julie A. Schmittdiel PhD, Andrew J. Karter PhD, Wendy Dyer MS, Melissa Parker MS & Connie Uratsu BA

  2. Pharmacy Outcomes Research Group, Kaiser Permanente Northern California, Oakland, CA, USA

    James Chan PharmD, PhD

  3. David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    O. Kenrik Duru MD, MSHS

Authors
  1. Julie A. Schmittdiel PhD
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  2. Andrew J. Karter PhD
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  3. Wendy Dyer MS
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  4. Melissa Parker MS
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  5. Connie Uratsu BA
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  6. James Chan PharmD, PhD
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  7. O. Kenrik Duru MD, MSHS
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Corresponding author

Correspondence to Julie A. Schmittdiel PhD.

Appendix

Appendix

The results in Table 3 support our use of instrumental variables to estimate our model and in using financial incentive as the instrument for mail order pharmacy use.

Table 3 Instrumental Variables Tests†
Full size table

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Schmittdiel, J.A., Karter, A.J., Dyer, W. et al. The Comparative Effectiveness of Mail Order Pharmacy Use vs. Local Pharmacy Use on LDL-C Control in New Statin Users. J GEN INTERN MED 26, 1396–1402 (2011). https://doi.org/10.1007/s11606-011-1805-7

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  • DOI: https://doi.org/10.1007/s11606-011-1805-7

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