Pandemic increased mail order pharmacy use by people with diabetes, but racial disparities persist
Kaiser Permanente study finds less use among Black, Hispanic, and Hawaiian/Pacific Islander patients
By Sue Rochman
Mail order pharmacy use increased during the COVID-19 pandemic among adults with type 2 diabetes, but use continued to differ by race and ethnicity, new Kaiser Permanente research shows.
The study, published in Diabetes Care, analyzed the mail order pharmacy use of 36,871 racially diverse Kaiser Permanente Northern California patients with diabetes during 2 time periods: January 2019 through February 2020 and March 2020 through September 2020. During the 13-month time period before the pandemic started in March 2020, 8.4% of the study participants had a prescription filled through the mail order pharmacy. Over the following 6 months, the number rose to 31.8%.
“Our study showed a very clear jump in mail order pharmacy use by our patients after shelter-in-place was implemented,” said the study’s lead author Tainayah W. Thomas, PhD, a research fellow at the Kaiser Permanente Northern California Division of Research. “This is great, because it means more patients are getting the medications they need while staying safely home. But we still see disparities persisting.”
People with type 2 diabetes and certain other pre-existing conditions have been shown to be at increased risk of severe infection from COVID-19. The Centers for Disease Control and Prevention guidelines have recommended throughout the pandemic that doctors and pharmacists encourage these patients to avoid going to medical facilities to pick up medication and to use mail order pharmacies and other alternative services.
In January 2019, nearly 10% of the white patients studied had used the mail order pharmacy compared with about 8% of the Asian population and 5% of the Black, Hispanic, and Hawaiian/Pacific Islander patients. After the pandemic started, mail order pharmacy use increased overall, but a disparity between the white and Black, Hispanic, and Hawaiian/Pacific Islander patients remained. For example, at peak mail order pharmacy use in July 2020, about 40% of the white and Asian patients had used the mail order pharmacy compared to about 26% of the Black, Hispanic, and Hawaiian/Pacific Islander patients.
“These findings suggest there is still some hesitancy or lack of knowledge that is keeping some of our patients from using the mail order pharmacy,” said Thomas. “It is important for us to learn more from these patients about why they are not using this option and to think about what strategies we can use to encourage them to use this service.”
Many people with type 2 diabetes do not take their medication regularly and do not have their diabetes under control, increasing their risk for heart disease, nerve damage, vision loss, kidney failure, and other health problems. A previous Division of Research study conducted in 2017 to 2018, called Encouraging Mail Order Pharmacy Use to Improve Outcomes and Reduce Disparities, or EMPOWER, showed that mail order pharmacy use can improve medication adherence. All of the patients in the new study had taken part in the EMPOWER trial. Both studies were overseen by Julie Schmittdiel, PhD, a research scientist at the Division of Research.
“This new study and other studies from the Division of Research show that patient interest and engagement in telemedicine and telehealth has changed a lot in this past year,” said Schmittdiel. “Within this new context, we need to learn more about how patients see this service and build on the promising momentum of mail order pharmacy use to reduce disparities.”
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.
Co-authors include Wendy T. Dyer, MS, Maher Yassin, MPH, Romain Neugebauer, PhD, and Andrew J. Karter, PhD, of the Division of Research.
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About the Kaiser Permanente Division of Research
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. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.
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