Background: Mail order pharmacies are increasingly being used to deliver medications for chronic disease management. Their use is linked to similar or even greater medication adherence than local pharmacy use. Medication adherence is associated with improved outcomes, including reduced cardiovascular events, health care costs, and mortality. We are unaware of any studies that have evaluated the association of mail order pharmacy use with drug adherence among stroke patients.
Objective: To investigate whether stroke patients who use mail-order pharmacies were more likely to have good medication adherence than those who used local pharmacies.
Methods: We conducted cross-sectional analyses of patients discharged with ischemic stroke from 24 hospitals who received a new anticoagulant and/or lipid-lowering medication between 31/DEC/2006 and 26/JUN/2015. We defined good adherence as medication availability at least 80% of the time (i.e, a continuous measure of medication gaps value of less than or = 20%) and compared adherence between mail-order users (at least 66% of refills by mail) and local pharmacy users (all refills in person). Adherence was calculated from the initial dispensing based on the average percentage adherence and days between fills.
Results: A total of 48,746 eligible patients refilled an index medication. There were 205,085 prescriptions for statins (136,722 by pharmacy and 68,363 by mail), and 50,483 prescriptions for anticoagulants (34,682 by pharmacy and 15,801 by mail). Overall, patients were adherent 46.48% of the time if they picked up their prescriptions from the pharmacy versus 73.87% of the time if they had their prescriptions mailed to them (p <.0001). Compared with those who only used local pharmacies, patients who received medications by mail were more likely to have good adherence to lipid modifiers (87.61% vs. 56.4%, OR 5.43, 95% CI = 5.3 - 5.57, p < .0001) and anticoagulants (44.88% vs. 56.16%, OR 1.57 95% CI 1.52 - 1.63, p < .0001).
Conclusions: Stroke patients who obtain medication by mail are more likely to have good medication adherence than those who obtain them from local pharmacies. Future studies should examine the impact of mail-order pharmacy use on vascular risk marker control and events after stroke.