Online Refills Improve Statin Adherence

Patients who consistently used an online portal to refill their statin prescriptions had significantly increased medication adherence and improved LDL cholesterol control.

Patients with diabetes who refilled their prescriptions through an online patient portal improved their adherence to statins and their cholesterol levels, according to the results of a study published online on December 26, 2013, in Medical Care.

Online patient portals, sometimes called shared medical records or personal health records, allow patients to schedule appointments, review lab results, and request medication refills through the Internet. Since use of these portals has become more widespread in recent years, the researchers aimed to assess their impact on medication adherence. The observational study included patients from the diabetes registry at Kaiser Permanente Northern California who were taking statins and were registered for Kaiser Permanente’s online patient portal by the end of 2010.

Adherence to statins was measured at baseline and during follow-up periods. Patients were considered non-adherent if they were missing a medication supply for more than 20% of the observation time. Low-density lipoprotein (LDL) cholesterol levels were also assessed for patients with poor adherence at baseline. Patients who frequently or occasionally refilled their prescriptions online were matched with patients who never used the online refill portal.

The results indicated that adherence improved among those who exclusively or occasionally refilled their prescriptions online and was unchanged among patients who did not use the portal to refill their prescriptions. Non-adherence decreased from 22% to 15% in those who always used the portal for refills and from 26% to 24% in patients who sometimes used it for refills. After adjusting for confounding factors, non-adherence decreased in patients who always used the portal by an absolute 6%, while non-adherence did not change significantly in occasional users. In a subsample of the study, in which the researchers were able to account for health literacy, education, English proficiency, marital status, and other additional confounders, non-adherence dropped by an absolute 9% in exclusive users compared with those who never refilled their prescriptions online.

Improved adherence from the portal also appeared to improve cholesterol control. The prevalence of poor LDL control decreased by an absolute 6% in patients who had poor adherence at baseline and who began to use the portal to refill their medications.

The study authors suggest that the convenience of refilling prescriptions online may have led to improved adherence. They note that online patient portals may help facilitate patient self-management. “To spread patient portal use widely among chronic disease populations, portals should be implemented across multiple health systems, and designed to be usable for the diverse chronic disease populations most in need of support,” the authors conclude.