September 10, 2015

Refilling medications online may improve adherence

Kaiser Permanente study finds tools can help patients take their medications.

OAKLAND, Calif., — Patients from all racial and ethnic minority groups who ordered their prescription refills through an online patient portal had better medication adherences, according to a new study in the Journal of the American Medical Informatics Association.

“Our findings are consistent with other studies that suggest providing tools for health care management, such as online refills, can help improve health behavior such as medication adherence,” said lead author Courtney Lyles, PhD, affiliate investigator at the Kaiser Permanente Division of Research and assistant professor at the University of California, San Francisco. “While the consistent benefit in medication adherence across racial and ethnic groups in this study is promising, we also need to better understand the reasons for differences in use of online portals across groups to help promote a more uniform use of these health technologies and tools.”

Kaiser Permanente’s online patient portal, My Health Manager, provides members access to their health information and tools, including online appointment scheduling, prescription refill and secure email messaging with doctors.

According to a recent federal report, Americans with chronic conditions take their medications as prescribed only about 50 percent to 60 percent of the time. The report estimates that this phenomenon, known as poor adherence, costs the health care system $100 billion to $300 billion each year, and results in about 125,000 deaths. Ensuring patients take their medicines as prescribed can help improve outcomes if the behavior is sustained.

This study examined a cohort of patients with diabetes from Kaiser Permanente Northern California who had been using My Health Manager. Patients in the study were older and were prescribed an average of seven medications. Researchers studied changes in patients’ medication-taking patterns for statins, a cholesterol-lowering drug, once they began using the online medication refill feature. Medication adherence was measured by calculating the percentage of time without statins, based on the number of pills dispensed and the time between refills.

Patients who began consistently refilling their statin prescriptions online showed a 4 percent improvement in adherence, and this improvement did not differ statistically across racial and ethnic groups. Those who used online refilling tended to be younger and were taking a higher number of recurring medications than those not refilling online, and they used the patient portal more frequently at the onset of the study. However, Black portal users were less likely to utilize the online tool to refill their prescriptions, and all racial and ethnic minority groups had lower statin adherence compared to white patients at baseline.

“Improving medication adherence has been a longstanding public health challenge, and racial/ethnic minorities have been particularly vulnerable to the barriers to adherence,” observed senior author Andrew Karter, PhD, research scientist at the Kaiser Permanente Division of Research. "This study suggests that health care systems might experience modest improvements in medication adherence among their patients simply by offering the option of refilling online.”

Additional authors included on the study are Urmimala Sarkar, MD, MPH, and Dean Schillinger, MD, University of California, San Francisco Department of Medicine; James D. Ralston, MD, MPH, Group Health Research Institute; and Jill Y. Allen, PhD, and Robert Nguyen, MA, Kaiser Permanente, National Market Research.

This work was supported by the Agency for Healthcare Research and Quality (K99HS022408) and the National Institutes of Health (P30DK092924, P60MD006902, R01DK080726, and R01DK081796).

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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 500-plus staff is working on more than 400 epidemiological and health services research projects. For more information, visit or follow us @KPDOR.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 10 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.