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Newswise -- Buying medicine by mail may encourage patients to stick to their doctor-prescribed medication regimen, new research suggests.

Patients with diabetes, high blood pressure and high cholesterol

Researchers from UCLA and Kaiser Permanente's Division of Research in Oakland, Calif., found that patients with diabetes, high blood pressure and high cholesterol who ordered their medications by mail were more likely to take them as prescribed by their physicians than patients who obtained medications from a local pharmacy.

"The field of medication adherence research typically focuses on patient factors for poor adherence, leading to a 'blame the patient' approach for non-adherence," said Dr. O. Kenrik Duru, the study's lead researcher and an assistant professor in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.

Streamline the medication-acquisition process

"Our work helps to place this issue in a larger perspective," Duru said. "Our findings indicate that mail-order pharmacies streamline the medication-acquisition process, which is associated with better medication adherence."

The researchers found that 84.7 percent of patients who received their medications by mail at least two-thirds of the time stuck to their physician-prescribed regimen, compared with 76.9 percent of those who picked up their medications at traditional "brick-and-mortar" Kaiser Permanente pharmacies.

"The results were consistent for all three classes of medication, including medications to control diabetes, high blood pressure and high cholesterol," said co-investigator Julie A. Schmittdiel, Ph.D., a research scientist with the Kaiser Permanente research division.

Other findings include:

• Before adjusting for other variables, white patients were more likely than Hispanics to obtain medications by mail (61.0 percent vs. 37.1 percent) and to be in the highest socioeconomic status quartile (27.5 percent vs. 17.8 percent).

• Mail-order pharmacy users were more likely than local pharmacy users to have a financial incentive to fill their prescriptions (49.6 percent vs. 23.0 percent) and to live a greater distance from a local pharmacy (8.0 miles vs. 6.7 miles). An example of a financial incentive is receiving a three-month supply of medication for the cost of a two-month supply.

• After adjusting for other variables, whites were more likely to use mail-order pharmacies (24.1 percent) than were Asian/Pacific Islanders (8.4 percent), Hispanics (5.2 percent), African Americans (4.0 percent) and individuals of mixed race (8.0 percent).

While other research has examined the association between medication costs and mail-order and local pharmacies, this is the first study to look at the relationship between pharmacy type and medication adherence. Furthermore, it controls for differences in out-of-pocket costs and medication supply (by number of days) between mail-order and local pharmacy users, something other datasets have not included.

"In other words, our study is able to isolate the use of mail-order pharmacies specifically, without the results being affected by differences in cost or in the number of pills provided with each dispensing," Duru said.

The study does have some limitations. For example, the findings need to be confirmed by a randomized controlled trial.

Still, the research suggests that increased mail-order use to obtain medications could improve patients' adherence.

In addition to Duru and Schmittdiel, researchers included Wendy Dyer, Melissa Parker, Connie Uratsu, James Chan and Andrew J. Karter of the research division at Kaiser Permanente Northern California.

Grants from the U.S. Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases funded this study.

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large.

The General Internal Medicine and Health Services Research Division in the department of medicine at the David Geffen School of Medicine at UCLA provides a unique interactive environment for collaborative efforts between health services researchers and clinical experts with experience in evidence-based work.  

Depression often coexists with other long-term health problems, presenting additional complexities. About 60 percent of depressed outpatients have at least one other chronic medical condition as well, such as a heart problem, high blood pressure, or diabetes.

The US Department of Health & Human Services, through the Agency for Healthcare Research and Quality  has funded research to track effective care of depression. 

Heart Attacks and Depression

Research results have shown that patients with a history of heart attacks have 1.8 times more depressive spells in a year and more persistent symptoms than depressed patients without a history of heart attacks.

Chronic Conditions and Depression in Older Persons

The challenge of treating depression as one of multiple chronic conditions is especially an issue in older persons. AHRQ research comparing elderly patients with and without depression in a primary care clinic found that the depressed patients had:

• Nearly $200 more in annual diagnostic test costs.
• Almost 1.5 more ambulatory care visits per year.
• Over 12 percent more annual visits to the emergency department.
• Five percent more hospitalizations each year.

To reduce the cost of care and improve outcomes for older persons with depression, coexisting psychiatric and medical illnesses must be targeted for treatment.

Best Care:  Mental Health Specialists or Medical Care Providers?

The organization of care can affect care delivery for depression. One AHRQ-sponsored study showed that shifting patients away from mental health specialists to general medical providers (as is the practice in some managed care arrangements) may lead to fewer improvements in patient functioning but costs two to three times less.

Other AHRQ-funded research on the effects of changes in health care payment and delivery found that after switching to a prepaid plan, the health status of outpatients with depression did not appear to suffer although they were 12 percent less likely to use antidepressants and made 35 to 40 percent fewer visits to their mental health care providers.

Even where there is substantial agreement about how treatment for depression can be improved, changes to everyday practice have been slow. Past efforts by managed care organizations to improve compliance with guidelines for improving diagnosis and treatment of depression have met with only modest success.

Two AHRQ studies investigating academic detailing and continuous quality improvement interventions in managed care organizations concluded that these approaches were only mildly effective in improving clinicians' adherence to the recommended guidelines for care. However, promising early results from a current study evaluating ways to increase use of antidepressants and psychotherapy in managed primary care practice suggest that depressed patients in the intervention groups were more likely to receive these interventions and exhibit better outcomes.

The National Guideline Clearinghouse™ (NGC) sponsored by AHRQ in partnership with the American Medical Association and the American Association of Health Plans, allows physicians and other Internet users to assess and compare guidelines online at http://www.guideline.gov. The NGC is being used by Georgetown University Medical Center's Mood Disorder Program in the development of clinical practice guidelines on depression for primary care physicians in managed care settings.

Last year pharmaceutical companies spent more than $4 billion urging patients to "ask your doctor" about their drugs. But if you want an effective prescription that is affordable, ask your doctor about drugs you don't see on TV. And ask for generic drug and behavioral options for your health care -- both prevention and cures.

AARP reports that prices for the most popular drugs rose an average of 8.7% last year, more than twice the rate of inflation.

Fortunately there are cheaper alternatives to many popular and well-advertised medications.

For example, AstraZeneca's acid reflux drug Nexium -- the "purple pill" -- was the second best-selling drug in the U.S. last year, with a hefty price tag of about $215 per month. But a drug from the same family, that works the same way, is available over-the-counter for about $20 a month as Prilosec.

Generic drugs already make up nearly 70% of prescriptions in the U.S., and that percentage is expected to rise. Over the next five years products worth $137 billion are expected to go generic.

These generic drugs are older.  But not necessarily less effective.

The FDA does not judge drugs based on how they stack up against older medications. Rather, the FDA weighs each drug's benefits against its risks. If the drug appears more beneficial than harmful, the agency is obligated to approve it.  

Pharmaceutical Advertising to Physicians

Only a licensed health care professional can prescribe a drug, and you'll want to defer to their judgment, but that doesn't mean you can't ask questions and ask for your options. It's important to understand that physicians may not be completely objective when choosing a prescription.

The pharmaceutical industry spends about 90% of its $20 billion annual marketing budget pitching new, proprietary pharmaceuticals to doctors, according to the Journal of the American Medical Association.

The Best Drugs for Less

On the consumer information side of the equation, Consumer Reports is now publishing "Best Drugs for Less". The Consumers Union team analyzes dozens of academic and government studies to make recommendations on the most affordable and effective medications.

More information is coming.  The US federal government has set aside $1.1 billion to study various medical treatments and see which ones work best, in an effort to cut out costly, ineffective treatments. This is part of the Obama administration's effort to reform health care and reduce costs.