title: The comparative effectiveness of mail order pharmacy use vs. local pharmacy use on LDL-C control in new statin users.
abstract: 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.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  100,298 adult Kaiser Permanente Northern California (KPNC) members who were new users of statins between January 1, 2005 and December 31, 2007.
  
  
  METHODS
  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.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA. Julie.A.Schmittdiel@kp.org
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Wendy
authors.initials: W
authors.lastname: Dyer
authors.forename: Melissa
authors.initials: M
authors.lastname: Parker
authors.forename: Connie
authors.initials: C
authors.lastname: Uratsu
authors.forename: James
authors.initials: J
authors.lastname: Chan
authors.forename: O Kenrik
authors.initials: OK
authors.lastname: Duru
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000187:drug effects*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000453:epidemiology; D007356:Insurance, Pharmaceutical Services / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010594:Pharmacies / Q000592:standards*; D011177:Postal Service / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors