Mail order pharmacy use and adherence to secondary prevention drugs among stroke patients

Background: Mail order pharmacies (MOP) are increasingly being used to deliver medications for chronic disease management. Their use is linked to similar or greater medication adherence than local pharmacy (LP) use. Medication adherence is associated with improved outcomes, including reduced cardiovascular events, health care costs, and mortality. We are unaware of any studies that have evaluated the association of MOP use with medication adherence among stroke patients. Objective: To investigate whether stroke patients who use MOPs were more likely to have good medication adherence than those who used LPs and whether adherence was associated with 90 day hospital re-admission after stroke. Methods: We conducted cross-sectional analyses of patients discharged with ischemic stroke from 24 hospitals who received a new anticoagulant, antiplatelet, antiglycemic, antihypertensive, and/or lipid-lowering medication between 01/JAN/2007 and 30/JUL/2016. We compared adherence between MOP users (at least 66% of refills by mail) and LP users (all refills in person). Adherence was calculated by using the Continuous Medication Gap (CMG) methodology, which determines the cumulative period that no medication was available to the patient. The number of days for which the patient did not have the medication is divided by the number of days in the study window for that patient. A CMG adherence score of 0 meant that the patient had no overall gaps in their medications (perfect adherence), a negative number meant that the patient had more medication than days, and a positive number meant that the patient did not have enough medication for the days they should be taking their medication (poor adherence). Results: A total of 44,658 eligible patients refilled an index medication. Of these, 13,676 in the LP and 6,907 in MOP group met inclusion criteria. CMG adherence was 0.28 in the LP group and 0.11 in the MOP group ( p < 0.001). At 90-days there were 893 hospital readmissions for the LP group and 375 for the MOP group for a rate of 0.073 vs. 0.058 (p < 0.001). Conclusions: Stroke patients who obtain medication by mail are more likely to have good adherence, and less likely to be readmitted than those who obtain medications from their local pharmacies.

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Opportunities to Encourage Mail Order Pharmacy Use in Diabetes—A Qualitative Study

Diabetes ◽

10.2337/db18-2322-pub ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 2322-PUB ◽

Cited By ~ 1

Author(s):

JULIE SCHMITTDIEL ◽

CASSONDRA MARSHALL ◽

DEANNE WILEY ◽

CHRISTOPHER V. CHAU ◽

CONNIE M. TRINACTY ◽

...

Keyword(s):

Qualitative Study ◽

Mail Order ◽

Mail Order Pharmacy

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Mail-Order Pharmacy

American Pharmacy ◽

10.1016/s0160-3450(15)31713-x ◽

1989 ◽

Vol 29 (8) ◽

pp. 22-25

Author(s):

Martin J. Jinks ◽

Lynette M. Evenson ◽

R. Keith Campbell ◽

Stan Bye

Keyword(s):

Mail Order ◽

Mail Order Pharmacy

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Use of medications for secondary prevention in stroke patients at hospital discharge in Australia

International Journal of Clinical Pharmacy ◽

10.1007/s11096-013-9908-3 ◽

2014 ◽

Vol 36 (2) ◽

pp. 384-393 ◽

Cited By ~ 8

Author(s):

Ashraf Eissa ◽

Ines Krass ◽

Beata V. Bajorek

Keyword(s):

Secondary Prevention ◽

Hospital Discharge ◽

Stroke Patients

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Development and Local Contextualization of Mobile Health Messages for Enhancing Disease Management Among Community-Dwelling Stroke Patients in Rural China: Multimethod Study

JMIR mhealth and uhealth ◽

10.2196/15758 ◽

2019 ◽

Vol 7 (12) ◽

pp. e15758

Author(s):

Enying Gong ◽

Wanbing Gu ◽

Erdan Luo ◽

Liwei Tan ◽

Julian Donovan ◽

...

Keyword(s):

Pilot Study ◽

Secondary Prevention ◽

Mobile Phone ◽

Rural China ◽

Text Messages ◽

Community Dwelling ◽

Self Management ◽

Stroke Patients ◽

Dispatching Algorithm ◽

Depth Interviews

Background Rural China has experienced an increasing health burden because of stroke. Stroke patients in rural communities have relatively poor awareness of and adherence to evidence-based secondary prevention and self-management of stroke. Mobile technology represents an innovative way to influence patient behaviors and improve their self-management. Objective This study is part of the System-Integrated Technology-Enabled Model of Care (the SINEMA trial) to improve the health of stroke patients in resource-poor settings in China. This study aimed to develop and pilot-test a mobile phone message–based package, as a component of the SINEMA intervention. Methods The SINEMA trial was conducted in Nanhe County, Hebei Province, China. A total of 4 villages were selected for pretrial contextual research and pilot study. The 5 stages for developing the mobile phone messages were as follows: (1) conducting literature review on existing message banks and analyzing the characteristics of these banks; (2) interviewing stroke patients and caregivers to identify their needs; (3) drafting message contents and designing dispatching algorithms for a 3-month pilot testing; (4) collecting feedback from pilot participants through questionnaire survey and in-depth interviews on facilitators and barriers related to their acceptance and understanding of messages; and (5) finalizing the message-based intervention based on participants’ feedback for the SINEMA trial. Results On the basis of 5 existing message banks screened out of 120 papers and patients’ needs identified from 32 in-depth interviews among stroke patients and caregivers, we developed a message bank containing 224 messages for a pilot study among 54 community-dwelling stroke patients from 4 villages. Of 54 participants, 51 (response rate: 94.4%) completed the feedback survey after receiving daily messages for 3 months. Participants’ mean age was 68 years (SD 9.2), and about half had never been to school. We observed a higher proportion of participants who were in favor of voice messages (23/42, 54%) than text messages (14/40, 35%). Among participants who received voice messages (n=43) and text messages (n=40), 41 and 30, respectively, self-reported a full or partial understanding of the contents, and 39 (39/43, 91%) and 32 (32/40, 80%), respectively, rated the messages as helpful. Analyses of the 32 interviews further revealed that voice messages containing simple and single-theme content, in plain language, with a repeated structure, a slow playback speed, and recorded in local dialect, were preferred by rural stroke patients. In addition, the dispatching algorithm and tools may also influence the acceptance of message-based interventions. Conclusions By applying multiple methodologies and conducting a pilot study, we designed and fine-tuned a voice message–based intervention package for promoting secondary prevention among community-dwelling stroke patients in rural China. Design of the content and dispatching algorithm should engage both experts and end users and adequately consider the needs and preferences of recipients.

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Problems of Cardioembolic Stroke Primary and Secondary Prevention in the Latvian Population / Kardioemboliska Cerebrāla Infarkta Primārās un Sekundārās Profilakses Problēmas Latvijā

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.1515/prolas-2015-0029 ◽

2015 ◽

Vol 69 (5) ◽

pp. 199-204

Author(s):

Kristaps Jurjāns ◽

Santa Sabeļnikova ◽

Evija Miglāne ◽

Baiba Luriņa ◽

Oskars Kalējs ◽

...

Keyword(s):

Atrial Fibrillation ◽

Secondary Prevention ◽

Patient Group ◽

Oral Anticoagulants ◽

Antiplatelet Agents ◽

Cardioembolic Stroke ◽

University Hospital ◽

Primary And Secondary Prevention ◽

Stroke Patients ◽

Very High

Abstract Atrial fibrillation is one of major risk factors of cerebral infarction. The use of oral anticoagulants is the only evidence-based method of reducing the risk of cardioembolic accidents. The guidelines of oral anticoagulant admission and usage have been available since 2012. The results of this study show that of 550 stroke patients that were admitted to Pauls Stradiņš Clinical University Hospital, Rīga, Latvia, from 1 January 2014 until 1 July 2014, atrial fibrillation was diagnosed in 247 (45%) cases, and of these patients, only 8.5% used oral anticoagulants before the onset of stroke. Six months after discharge of 111 (44.9%) stroke survivors, five (4.5%) used no secondary prevention medication, 27 (24.3%) used antiplatelet agents, 54 (48.6%) warfarin, and 25 (22.5%) used target specific oral anticoagulants (TSOACs). The mortality rate was significantly higher in the patient group that used no secondary prevention medication or antiplatelet agents compared to the patient group that used oral anticoagulants. The use of oral anticoagulants for primary stroke prevention in Latvia is insufficient. The mortality of cardioembolic stroke in 180 days is very high - 40.4%. Secondary prevention is essential to prevent recurrent cardioembolic accidents.

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Duplicate Prescriptions of Inhaled Medications for Obstructive Lung Diseases

Pneumologie ◽

10.1055/a-1083-7961 ◽

2020 ◽

Vol 74 (03) ◽

pp. 149-158

Author(s):

P. Kardos ◽

F. Geiss ◽

J. Simon ◽

C. Franken ◽

U. Butt ◽

...

Keyword(s):

Lung Diseases ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Dry Powder Inhalers ◽

Mail Order ◽

Inhaled Corticosteroid ◽

German Market ◽

Metered Dose ◽

Mail Order Pharmacy ◽

Dose Combination

Abstract Introduction Inhalative treatments with metered dose aerosols and dry powder inhalers are the backbone of the pharmacotherapy for asthma and COPD. In the last decade many new and generic inhalative bronchodilators were launched at the German market, both monotherapies and fixed dose double bronchodilator (LABA/LAMA, beta adrenergic and antimuscarinic) or LABA and inhaled corticosteroid (ICS) and triple (LABA/LAMA/ICS) combinations. According to two surveys in 2015 among respiratory physicians we expected a high proportion of patients receiving duplicate prescriptions, e. g. a fixed dose new LABA/LAMA combination in addition to an existing ICS/LABA fixed dose combination. Methodology We searched the database of a large mail order pharmacy (DocMorris) to identify duplicate prescriptions of inhalative drugs for a patient by the same or by two or more different physicians during a 3 months period. Results Unexpectedly, we found as little as around 1 % duplicate prescriptions for the same patient. Duplicate prescriptions involving combination products were found to be much more common than duplicate prescriptions of different mono-products. Irrespective the low percentage number of all prescriptions we saw in just one large mail order pharmacy several thousands of erroneous prescriptions. Conclusion At least in the setting of this mail order pharmacy duplicate (i. e. contraindicated and potentially dangerous) prescriptions are relatively rare. Prescribers and pharmacists should be aware of the issue of duplicates – especially when prescribing or filling prescriptions with combination products.

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Fixed-Dose Combination Treatment After Stroke for Secondary Prevention in China

Stroke ◽

10.1161/strokeaha.114.007384 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1295-1300 ◽

Cited By ~ 29

Author(s):

Wang Longde ◽

Yin Ling ◽

Hua Yang ◽

Zuo Yi ◽

Wang Yongjun ◽

...

Keyword(s):

Cardiovascular Disease ◽

Secondary Prevention ◽

Antiplatelet Agent ◽

Preventive Therapy ◽

Current Treatment ◽

Fixed Dose ◽

Population Census ◽

Treatment Rate ◽

Stroke Patients ◽

International Consensus

Background and Purpose— There is evidence and international consensus on the advantages and potential of a polypill for established cardiovascular disease patients to improve adherence in the secondary prevention of cardiovascular disease. This study aimed to estimate the numbers of stroke patients who would be eligible for the polypill strategy in China, and the suitable composition of a polypill, based on data of the China National Stroke Prevention Project. Methods— A total of 717 620 residents aged ≥40 years from 6 Chinese representative provinces were screened for prevalent stroke from 2011 to 2012 with an 84.4% response rate. Participants with a history of stroke received further investigation of risk factors and treatments. The potential need for treatment was classified according to the guidelines. Rates were standardized using the population composition of the Sixth National Population Census of China. Results— The standardized prevalence rate of stroke was 1.9%. Up to 93.1% of stroke patients were eligible for a polypill containing at least 2 types of medications, with 75.3% eligible for a statin and antiplatelet agent and 70.6% for antihypertensive and antiplatelet medications. Considering 3 therapies, 54% were eligible for antihypertensive, statin, and antiplatelet medications. The current treatment rate with all required combinations of separate pills was only 6.9%. Conclusions— A huge number of stroke patients in China require preventive therapy and would be eligible for a polypill. This study indicates that it would be reasonable to consider and assess the value of a polypill strategy to improve secondary prevention of stroke in China.

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Model Regulations for Mail-Order Pharmacy

American Pharmacy ◽

10.1016/s0160-3450(15)31714-1 ◽

1989 ◽

Vol 29 (8) ◽

pp. 26-27

Author(s):

Sara Martin

Keyword(s):

Mail Order ◽

Mail Order Pharmacy

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Karakteristik dan Periode Kekambuhan Stroke pada Pasien dengan Stroke Berulang di Rumah Sakit Margono Soekardjo Purwokerto Kabupaten Banyumas

Jurnal Keperawatan Muhammadiyah ◽

10.30651/jkm.v3i1.1586 ◽

2018 ◽

Vol 3 (1) ◽

Author(s):

Meida Laely Ramdani

Keyword(s):

Ischemic Stroke ◽

Secondary Prevention ◽

Low Income ◽

Recurrent Stroke ◽

Sampling Technique ◽

Stroke Recurrence ◽

Stroke Patients ◽

Cross Sectional ◽

Post Stroke ◽

Duration Of Illness

Background: Patients who had stroke recurrence after the first stroke have a high risk of disability as well as high rates of morbidity and mortality. Incidence of stroke recurrence can be prevented by controlling risk factors and secondary prevention among post stroke patient, and also tent of the duration of the occurrence of recurrent stroke after the first attack. Objective: The purpose of this study was to determine the characteristics and stroke recurrence periods of post stroke patients.Methods: Cross sectional study design was used in this study. Total 73 recurrent stroke patients age 18-60 years old were selected using consecutive sampling technique. This study was conducted on patients during their follow up in the outpatient department of unit neurology, Margono Soekardjo Purwokerto Hospital during November-December 2015. The characteristics of the recurrent stroke patients include sex, age, education, occupation, and income. This study also describes type of stroke and duration of illness. The periods of recurrent stroke patients divided in to three time periods (≤ 6-month, 7-12 month, >12 month). Results: 73 recurrent stroke patients showed 56% were female, age group 39-60 years old was 97,5%, 60,3% have low education (below senior high school), 64,7% work as public and private employees. Income of respondents were low income 53,4%. Ischemic stroke was the majority (87,7%), no history family of stroke 64,4%, 1-5 years duration of illness and periods of stroke recurrence >12 month was 45,20%.Conclusion: Ischemic stroke is the biggest case of recurrent stroke, so that we need to emphasize the importance of secondary prevention including medication and treatment. Background: Patients who had stroke recurrence after the first stroke have a high risk of disability as well as high rates of morbidity and mortality. Incidence of stroke recurrence can be prevented by controlling risk factors and secondary prevention among post stroke patient, and also tent of the duration of the occurrence of recurrent stroke after the first attack. Objective: The purpose of this study was to determine the characteristics and stroke recurrence periods of post stroke patients.Methods: Cross sectional study design was used in this study. Total 73 recurrent stroke patients age 18-60 years old were selected using consecutive sampling technique. This study was conducted on patients during their follow up in the outpatient department of unit neurology, Margono Soekardjo Purwokerto Hospital during November-December 2015. The characteristics of the recurrent stroke patients include sex, age, education, occupation, and income. This study also describes type of stroke and duration of illness. The periods of recurrent stroke patients divided in to three time periods (≤ 6-month, 7-12 month, >12 month). Results: 73 recurrent stroke patients showed 56% were female, age group 39-60 years old was 97,5%, 60,3% have low education (below senior high school), 64,7% work as public and private employees. Income of respondents were low income 53,4%. Ischemic stroke was the majority (87,7%), no history family of stroke 64,4%, 1-5 years duration of illness and periods of stroke recurrence >12 month was 45,20%.Conclusion: Ischemic stroke is the biggest case of recurrent stroke, so that we need to emphasize the importance of secondary prevention including medication and treatment.

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