A recent study, Safety and Effectiveness of Mail Order Pharmacy Use in Diabetes, showed that people with diabetes (PWD) have fewer emergency department visits if they use mail-order pharmacies, rather than using local pharmacies.
The study was done in a large managed-care organization (Kaiser Permanente Northern California), which has its own mail-order pharmacies as well as local walk-in pharmacies located within their outpatient clinics and hospitals. Their mail-order and local pharmacies “do not differ in the standard days of supply of pills issued; and mail order pharmacy does not require physician enrollment of the prescription.” 17,217 PWD were evaluated; 34.2% used a mail-order pharmacy at least once. Mail order pharmacy users were more likely to be white (56.7% vs 37.1%) and to live in areas with higher socioeconomic status.
The authors found that in PWD younger than 65, the use of a mail order pharmacy was associated with fewer overall emergency department visits (33.8% versus 40.2%), and fewer preventable emergency department visits (7.7% versus 9.6%) compared with using the local pharmacy. And in PWD who were 65 or older, mail order pharmacy use was associated with fewer preventable emergency department visits (13.4% versus 16.3%).
The study did not look at possible reasons why the use of mail order pharmacies was associated with fewer emergency department visits and the authors admitted they don’t know why this would be the case. They speculated that it could be related to patients' disability status, time constraints, or access to transportation. Also, they didn’t measure use of non-Kaiser pharmacies which could somehow warp the reported outcomes.
I have no idea why PWD who use mail-order pharmacies would have fewer ER visits. Is it a quirk of the Kaiser managed care organization, or would it occur in any setting? Is it a local phenomenon in California? Does anyone have any idea? If you do, let us know!