San Diego—Here’s a statistic that will likely concern community pharmacists: Stroke survivors who get medications by mail are more likely to take them as directed than patients who fill their prescriptions at local pharmacies.

That information was presented recently at the American Stroke Association's International Stroke Conference 2016.

Kaiser Permanente San Diego researchers and colleagues reviewed the prescription refill records of patients discharged with ischemic stroke from 24 hospitals who received new anticoagulant and cholesterol-lowering medications between 2006 and 2015.

Stroke-preventive medications were refilled by 48,746 patients, including 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.

The research indicates that, while patients who picked up their medications from local pharmacies were adherent about 47% of the time, patients who had their medications mailed to them were adherent almost 74% of the time.

“Medication adherence is associated with improved outcomes, including reduced cardiovascular events, health care costs, and mortality,” study authors write. “We are unaware of any studies that have evaluated the association of mail order pharmacy use with drug adherence among stroke patients.”

Good adherence was defined as medication availability at least 80% of the time (i.e., a continuous measure of medication gaps value of less than or equal to 20%), and the study 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.

More specifically, patients using only local pharmacies were 56.4% adherent to their statin prescriptions compared to nearly 88% for patients receiving mail-order prescriptions. Adherence among those taking anticoagulants was about 45% for those using their local pharmacies versus 56% for mail order customers.

“Stroke patients who obtain medication by mail are more likely to have good medication adherence than those who obtain them from local pharmacies,” researchers conclude. “Future studies should examine the impact of mail-order pharmacy use on vascular risk marker control and events after stroke.”

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