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Fewer ER visits for diabetes patients who use mail order


Diabetes patients under 65 had significantly fewer emergency room visits when using mail order pharmacy.


Patients with diabetes who received prescribed heart medications by mail were less likely to visit the emergency room than those who picked up prescriptions in person, according to a new Kaiser Permanente study.

The observational study examined 17,217 adult Kaiser Permanente members with diabetes who were first prescribed heart medications in 2006 and followed them for three years. It found that diabetes patients under age 65 who used mail order pharmacy had significantly fewer emergency room visits for any cause than those who picked up prescriptions (33.8% vs. 40.2%, respectively).

“We used multivariate logistic regressions to compare safety and utilization outcomes between those patients who used mail order pharmacy vs. those that did not,” Julie A. Schmittdiel, PhD, a research scientist at the Kaiser Permanente Northern California Division of Research, says.

“We found that patients with diabetes who used mail order pharmacy were less likely to visit the emergency room than those who did not use mail order pharmacy during a three-year follow-up period. We also did not see safety concerns associated with mail order pharmacy for most diabetes patients.”

Mail order pharmacies are widely used to deliver medications in the United States, but few studies have examined the potential effects of mail order pharmacy use on healthcare outcomes, according to Schmittdiel.

“Mail order pharmacy use may help improve outcomes for patients with diabetes, potentially by increasing their ease of access to heart medications shown to improve patient health,” she says. “Healthcare operational leaders should consider how to best encourage patients and their clinicians to leverage the mail order option for delivering diabetes medication management in ways that preserve patient choice for type of pharmacy use.”

Very little research has been done that carefully studies the impact of mail order pharmacy use, and this work helps to fill this void, according to Schmittdiel.

“Our study is the first to show that mail order pharmacy use is associated with lower healthcare utilization,” she says. “This finding, plus other findings by our research group showing mail order pharmacy use is associated with higher levels of medication adherence and LDL-cholesterol control, suggest mail order pharmacy use may be a tool for improving care delivery for diabetes patients.

“Our team would like to continue to work in this area, and conduct more research on understanding the barriers and facilitators of mail order pharmacy use for both patients and their clinicians,” she adds.


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