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Mail-order medications help diabetes patients avoid ED visits

Wednesday December 11, 2013
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Patients with diabetes who received prescribed heart medications by mail were less likely to visit the ED than those who picked up prescriptions in person, according to a study.

The study, published on the website of the American Journal of Managed Care, examined 17,217 adult members with diabetes who were members of Kaiser Permanente and first were prescribed heart medications in 2006.

Kaiser Permanente researchers followed the patients for three years and found that diabetes patients under age 65 who used mail-order pharmacy had significantly fewer ED visits for any cause than those who picked up prescriptions (33.8% vs. 40.2%).

Patients using mail order also had fewer preventable ED visits (7.7% vs 9.6%) and serum creatinine laboratory monitoring tests after angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or diuretic initiation (41.2% vs 47.2%).

Among patients ages 65 and older, mail order users had fewer preventable ED visits (13.4% vs 16.3%) but slightly more occurrences of overlapping days of supply of contraindicated medications (1.1% vs 0.7%), according to the study abstract.

The study is described as the first to examine the potential impact of mail-order pharmacy on patient safety and utilization, and explores the concern of patients who experience adverse outcomes because they do not meet face-to-face with a pharmacist.

“Overall, we didn’t see any safety concerns,” Julie A. Schmittdiel, PhD, research scientist with the Kaiser Permanente Division of Research and the study’s lead author, said in a news release. “For the vast majority of people, mail-order pharmacy works well.”

Kaiser Permanente offers members the options of using its mail-order pharmacy or picking up prescriptions at walk-in pharmacies located in Kaiser Permanente hospitals and outpatient medical buildings. Medications can be delivered by mail with free shipping, mail-order requests can be made by phone or online, and mail-order copayments often are lower for the same supply than walk-in pharmacies, according to the news release.

The researchers did not look at possible reasons for the association between use of mail-order pharmacies and fewer ED visits, but noted that further investigation may involve exploring factors such as patient disabilities, time constraints or limited transportation.

Schmittdiel’s previous studies have shown that patients who use mail-order pharmacies have significantly better medication adherence and cholesterol management.

Study: www.ajmc.com/publications/issue/2013/2013-1-vol19-n11/Safety-and-Effectiveness-of-Mail-Order-Pharmacy-Use-in-Diabetes


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