The Comparative Effectiveness of Mail Order Pharmacy Use vs. Local Pharmacy Use on LDL-C Control in New Statin Users
The Comparative Effectiveness of Mail Order Pharmacy Use vs. Local Pharmacy Use on LDL-C Control in New Statin Users
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DOI：
10.1007/s11606-011-1805-7
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发表时间：
2011-12-01
影响因子：
5.7
通讯作者：
Duru, O. Kenrik
中科院分区：
文献类型：
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作者：
Schmittdiel, Julie A.;Karter, Andrew J.;Duru, O. Kenrik
背景：邮购药房通常用于提供 CVD 危险因素药物。先前的研究表明，邮购药房的使用与较高的服药依从性有关。然而，没有研究检验邮购药房的使用是否与改善 CVD 危险因素结果相关。目的：研究邮购药房与当地药房使用对新他汀类药物使用者 LDL-C 控制的比较效果。设计：观察性队列研究。测量：2005 年 1 月 1 日至 12 月期间新使用他汀类药物的 100,298 名成年北加州凯撒医疗机构 (KPNC) 会员2007 年 3 月 31 日。结果：主要结果指标是开始他汀类药物治疗后 3-15 个月内的 LDL-C 控制。结果：在对患者、临床和人口普查区特征以及通过工具变量分析邮购和当地 KPNC 药房用户之间潜在的未测量差异进行调整后，与使用邮购药房递送他汀类药物的患者相比，在任何时间使用邮购药房递送他汀类药物的患者中有 85.0% 达到了目标 LDL-C 水平。 74.2% 的患者仅使用当地 KPNC 药房配发他汀类药物 (p < 0.001)。在所有性别和种族/族裔亚组中，邮购药房用户的 LDL-C 控制调整率均较高。结论：邮购药房的使用与新他汀类药物使用者的 LDL-C 控制呈正相关。未来的研究应继续探索邮购药房使用与结果之间的关系，并解决如何在不影响患者选择、护理和安全的情况下，将邮购服务适当地瞄准最有可能受益的患者。
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.MEASUREMENTS: 100,298 adult Kaiser Permanente Northern California (KPNC) members who were new users of statins between January 1, 2005 and December 31, 2007.RESULTS: 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.