Research compiled by a Medical University of South Carolina expert shows that using mail-order pharmacies may help stroke patients adhere to their medication regimens.
After analyzing data from Kaiser Permanente, Dr. Bruce Ovbiagele of the Medical University of South Carolina in Charleston and the International Stroke Conference found that 73.9 percent of prescriptions for statins and anticoagulants were refilled when patients used mail-order pharmacies compared to 46.5 percent through local pharmacies.
“What we sought out to do was take a look at the link between the use of mail-order pharmacies and medication adherence in people who had suffered an ischemic stroke, or a stroke that is caused by a blood clot,” Ovbiagele told Palmetto Business Daily. “We had known that there were already a few published studies looking at mail-order pharmacies in patients who had diabetes, but nobody had looked at stroke patients specifically.”
Ovbiagele said although diabetic patients are important to review, the study focused on stroke patients because patients who have suffered stokes have a high risk of having a subsequent stroke. Based on the knowledge that taking medication can reduce the risk of a second stroke, the research sought to discover whether there was a link between the convenience of mail-order pharmacies and increased drug adherence.
“Kaiser has used mail-order pharmacies for quite a while," Ovbiagele said. "So we decided to use their system to explore this research question. What they have with their mail-order pharmacies (is) kind of a central pharmacy, which automatically refills medications — those for which doctors have written prescriptions — every 90 days."
The study looked at two medication classes known to prevent the risk of future strokes in patients — anticoagulants (blood thinners) and statins (medications used to treat cholesterol) — using data from 24 hospitals in the Southern Kaiser Permanente Medical system, and defining medication adherence as “utilizing medication for at least 80 percent of the time you are supposed to use it for,” Ovbiagele said.
The research team only looked at people who had experienced a first-time stroke, and excluded patients who had received aspirin orders after their stroke because, being an over-the-counter drug, aspirin is difficult to track.
The team looked at approximately 50,000 eligible patients who had medications following a stroke. There were 205,000 prescriptions for statins and 50,000 prescriptions for anticoagulants. The analysis showed that there was a big difference in adherence between people who drove up to local pharmacies to get their medications versus those who received them from the mail-order pharmacy.
“With mail-order pharmacy, almost 90 percent of them were at least adherent to the medication 80 percent (of) the time while (with) local pharmacy statin medications, about 50 percent of them were adherent to the medication 80 percent of the time,” Ovbiagele said. “With the blood thinners, the anticoagulants, it was much lower. It was 56 percent for the mail-order pharmacy (and) 44.9 percent for the local pharmacy.”
Ovbiagele said the differences between the mail-order and local pharmacy statistics for both medication classes were very significant and that the research team is planning to continue the study to look at mail-order versus local pharmacy on actual events such as a stroke or a heart attack, because no study has looked into whether using mail-order pharmacy versus a local pharmacy actually reduces a patient’s risk for future events, which the study seems to suggest.
According to Ovbiagele, such a finding could potentially change the way health systems and insurance companies view mail-order pharmacies.
“I think that will be huge and would encourage more health systems across the country to encourage their patients to utilize mail-order pharmacies and encourage insurance companies to get patients, or incentivize patients, to utilize mail-order pharmacies if it can be shown it really reduces the risk of strokes, heart attacks and reduces the risk of death,” Ovbiagele said.
The neurologist explained that stroke patients are more likely to skip medication doses than diabetes patients because a stroke often leaves a patient with some form of physical or cognitive disability.
“Unless they have family members who are willing and available to make sure they consistently pick up their medications by themselves, many (patients) may not be as compliant in making sure they go to their local pharmacy to get the medication,” Ovbiagele said.
Ovbiagele believes patients who are able to go to a pharmacy to pick up their prescribed medications should feel free to do so. But those who are unable to should consider using mail-order pharmacies.
Charles Cote, vice president of strategic communications at the Pharmaceutical Care Management Association, said Dr. Ovbiagele's research underscores why his organization has long been a proponent of the mail-order pharmacy option.
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