title: Examination of the Link Between Medication Adherence and Use of Mail-Order Pharmacies in Chronic Disease States.
abstract: BACKGROUND
  Higher medication adherence is associated with positive health outcomes, including reduction in hospitalizations and costs, and many interventions have been implemented to increase patient adherence.
  
  
  OBJECTIVE
  To determine whether patients experience higher medication adherence by using mail-order or retail pharmacies.
  
  
  METHODS
  Articles pertaining to retail and mail-order pharmacies and medication adherence were collected from 3 literature databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and International Pharmaceutical Abstracts (IPA). Searches were created for each database and articles were compiled. Articles were screened for exclusion factors, and final articles (n=15) comparing medication adherence in patients utilizing mail and retail pharmacies were analyzed. For each study, various factors were identified including days supply, patients' out-of-pocket costs, prior adherence behavior, therapeutic class, measure of adherence, limitations, and results. Studies were then categorized by disease state, and relevant information from each study was compared and contrasted.
  
  
  RESULTS
  The majority of studies-14 out of the 15 reviewed-supported higher adherence through the mail-order dispensing channel rather than through retail pharmacies. There are a number of reasons for the differences in adherence between the channels. Study patients who used mail-order pharmacies were more likely to have substantially higher prior adherence behavior, socioeconomic status, and days supply of medicines received and were likely to be offered financial incentives to use mail-order. The few studies that attempted to statistically control for these factors also found that patients using mail-order services were more adherent but the size of the differences was smaller. The extent to which these results indicate an inherent adherence advantage of mail-order pharmacy (as distinct from adherence benefits due to greater days supply, lower copays, or more adherent patients selecting mail-order pharmacies) depends on how well the statistical controls adjusted for the substantial differences between the mail and retail samples.
  
  
  CONCLUSIONS
  While the research strongly indicates that consumers who use mail-order pharmacies are more likely to be adherent, more research is needed before it can be conclusively determined that use of mail-order pharmacies causes higher adherence.
  
  
  BACKGROUND
  No outside funding supported this study. Fernandez was partially funded by a Virginia Commonwealth University School of Pharmacy PharmD/PhD Summer Fellowship for work on this project. The authors declare no other potential conflicts of interest. Study concept and design were contributed by Carroll and Fernandez. Fernandez took the lead in data collection, along with Carroll and McDaniel, and data interpretation was performed by Carroll and Fernandez. The manuscript was written and revised by Carroll and Fernandez, with assistance from McDaniel.
authors: 1 Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.
authors: Elena V
authors: EV
authors: Fernandez
authors: 2 Tompkins-McCaw Library for the Health Sciences, Virginia Commonwealth University, Richmond, Virginia.
authors: Jennifer A
authors: JA
authors: McDaniel
authors: 3 Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.
authors: Norman V
authors: NV
authors: Carroll
mesh_terms: D002908:Chronic Disease / Q000188:drug therapy / Q000453:epidemiology; D016208:Databases, Factual; D006801:Humans; D055118:Medication Adherence; D010593:Pharmaceutical Services / Q000706:statistics & numerical data*; D010594:Pharmacies / Q000706:statistics & numerical data*; D011177:Postal Service / Q000379:methods / Q000706:statistics & numerical data*