Telepharmacy and medication adherence in urban areas

Abstract

Background: Telepharmacies, which dispense medications on-site under the supervision of an off-site pharmacist using telecommunication technologies, have been proposed as a means to ameliorate the impact of pharmacy closures and improve access to medications.

Objectives: To examine whether adherence varies among individuals filling prescription medications through a telepharmacy versus a traditional pharmacy in an urban neighborhood.

Methods: We conducted a retrospective cohort study using dispensing records of a traditional pharmacy and a telepharmacy, located in the same low-income Chicago neighborhood, from January 2016 to December 2018. We focused on individuals using statins (n = 1044), angiotensin-converting enzyme inhibitors (ACEs)/angiotensin II receptor blockers (ARBs) (n = 1003), or noninsulin diabetes medications (NIDMs) (n = 692). We defined adherence as a proportion of days covered greater than 80% over 12-months. We examined the association between telepharmacy use and medication adherence using logistic regressions adjusted for demographics (age and sex) and index prescription characteristics (method of payment, e-prescription, 90-day supply).

Results: Telepharmacy users were less adherent to statins (37.6% vs. 54.3%, adjusted odds ratio 0.54 [95% CI 0.38-0.76], P < 0.01) and ACEs/ARBs (41.4% vs, 56.5%, 0.61 [0.44-0.84], P < 0.01) than users of the traditional pharmacy. However, adherence to NIDMs was similar among users of the tele- and traditional pharmacies (65.5% vs. 60.1%, 1.47 [0.92-2.35], P = 0.11). Our findings were similar when we conducted a series of sensitivity analyses, including restricting our cohorts to those who only used their index pharmacy and analyzing cohorts of new rather than continuing users of these medications.

Conclusion: In this analysis, medication adherence was lower among users of telepharmacy than users of a traditional pharmacy in some but not all drug classes examined. Further research is needed to identify whether other interventions to improve adherence, such as longer hours of operation, at-home delivery, or 90-day supply, may be coupled with telepharmacies to increase their use in urban areas.