Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA.
J Gen Intern Med. 2011 Dec;26(12):1396-402. doi: 10.1007/s11606-011-1805-7. Epub 2011 Jul 20.
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.
To examine the comparative effectiveness of mail order pharmacy vs. local pharmacy use on LDL-C control in new statin users.
Observational cohort study.
100,298 adult Kaiser Permanente Northern California (KPNC) members who were new users of statins between January 1, 2005 and December 31, 2007.
The main outcome measure was LDL-C control in the 3-15 month period after statin therapy was initiated.
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.
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.
邮购药房常用于配送 CVD 风险因素药物。先前的研究表明，使用邮购药房与更高的药物依从性相关；然而，尚无研究检验使用邮购药房是否与改善 CVD 风险因素结局相关。
检验新使用他汀类药物患者中，邮购药房与当地药房使用对 LDL-C 控制的比较效果。
观察性队列研究。
100298 名 2005 年 1 月 1 日至 2007 年 12 月 31 日期间，新使用他汀类药物的 Kaiser Permanente Northern California（KPNC）成年会员。
主要结局指标为他汀类药物治疗开始后 3-15 个月期间的 LDL-C 控制情况。
经患者、临床和普查街区特征调整后，以及通过工具变量分析对邮购和当地 KPNC 药房使用者之间潜在的未测量差异进行调整，与仅使用当地 KPNC 药房配药的患者相比，任何时候使用邮购药房配送其他汀类药物的患者中有 85.0%达到 LDL-C 目标水平（p<0.001）。在所有性别和种族/民族亚组中，邮购药房使用者的 LDL-C 控制率更高。
新使用他汀类药物患者中，使用邮购药房与 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局之间的关系，并解决如何将邮购服务有针对性地提供给最有可能受益的患者，同时又不损害患者的选择、护理和安全的问题。
