Is Shelter-in-Place Policy Related to Mail Order Pharmacy Use and Racial/Ethnic Disparities for Patients With Diabetes?

Thomas, Tainayah; Dyer, W. T. Thiselton; Yassin, Maher; Neugebauer, Romain; Karter, Andrew J.; Schmittdiel, Julie A.

doi:10.2337/dc20-2686

Cited by 4 publications

(6 citation statements)

References 4 publications

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“…Among the interviewed applicants, fellowship positions were offered to 26 candidates (34.2%), of whom Association, Society of General Internal Medicine), and many firstauthored fellows' papers were published in leading journals. 19,[24][25][26][27][28][29][30][31][32][33][34][35][36] Four case examples are presented in Table 3 to illustrate typical bar-…”

Section: Resultsmentioning

confidence: 99%

Training the next generation of delivery science researchers: 10‐year experience of a post‐doctoral research fellowship program within an integrated care system

Grant

Schmittdiel

Liu

et al. 2023

Learning Health Systems

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IntroductionLearning health systems require a workforce of researchers trained in the methods of identifying and overcoming barriers to effective, evidence‐based care. Most existing postdoctoral training programs, such as NIH‐funded postdoctoral T32 awards, support basic and epidemiological science with very limited focus on rigorous delivery science methods for improving care. In this report, we present the 10‐year experience of developing and implementing a Delivery Science postdoctoral fellowship embedded within an integrated health care delivery system.MethodsIn 2012, the Kaiser Permanente Northern California Division of Research designed and implemented a 2‐year postdoctoral Delivery Science Fellowship research training program to foster research expertise in identifying and addressing barriers to evidence‐based care within health care delivery systems.ResultsSince 2014, 20 fellows have completed the program. Ten fellows had PhD‐level scientific training, and 10 fellows had clinical doctorates (eg, MD, RN/PhD, PharmD). Fellowship alumni have graduated to faculty research positions at academic institutions (9), and research or clinical organizations (4). Seven alumni now hold positions in Kaiser Permanente's clinical operations or medical group (7).ConclusionsThis delivery science fellowship program has succeeded in training graduates to address delivery science problems from both research and operational perspectives. In the next 10 years, additional goals of the program will be to expand its reach (eg, by developing joint research training models in collaboration with clinical fellowships) and strengthen mechanisms to support transition from fellowship to the workforce, especially for researchers from underrepresented groups.

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Section: Resultsmentioning

confidence: 99%

Training the next generation of delivery science researchers: 10‐year experience of a post‐doctoral research fellowship program within an integrated care system

Grant

Schmittdiel

Liu

et al. 2023

Learning Health Systems

View full text Add to dashboard Cite

show abstract

“… 62 Mail order pharmacy has been suggested as a means to counter pharmacy deserts, but most users tend to be White older adults with higher income and greater education. 63–65 Access to community pharmacies was critical to receive routine care through medication dispensation and provide accessible vaccine disbursement in familiar and convenient locations, 66 particularly important during the COVID-19 pandemic.…”

Section: Resultsmentioning

confidence: 99%

Structural Racism, Place, and COVID-19: A Narrative Review Describing How We Prepare for an Endemic COVID-19 Future

et al. 2022

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Background: Place is a social determinant of health, as recently evidenced by COVID-19. Previous literature surrounding health disparities in the United States often fails to acknowledge the role of structural racism on place-based health disparities for historically marginalized communities (i.e., Black and African American communities, Hispanic/Latinx communities, Indigenous communities [i.e., First Nations, Native American, Alaskan Native, and Native Hawaiian], and Pacific Islanders). This narrative review summarizes the intersection between structural racism and place as contributors to COVID-19 health disparities. Methods: This narrative review accounts for the unique place-based health care experiences influenced by structural racism, including health systems and services and physical environment. We searched online databases for peer-reviewed and governmental sources, published in English between 2000 and 2021, related to place-based U.S. health inequities in historically marginalized communities. We then narrate the link between the historical trajectory of structural racism and current COVID-19 health outcomes for historically marginalized communities. Results: Structural racism has infrequently been named as a contributor to place as a social determinant of health. This narrative review details how place is intricately intertwined with the results of structural racism, focusing on one's access to health systems and services and physical environment, including the outdoor air and drinking water. The role of place, health disparities, and structural racism has been starkly displayed during the COVID-19 pandemic, where historically marginalized communities have been subject to greater rates of COVID-19 incidence and mortality. Conclusion: As COVID-19 becomes endemic, it is crucial to understand how place-based inequities and structural racism contributed to the COVID-19 racial disparities in incidence and mortality. Addressing structurally racist place-based health inequities through anti-racist policy strategies is one way to move the United States toward achieving health equity.

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“…A mail-order alternative to in-person prescription fulfillment has been offered in recent years by retail pharmacies, the VA, and KP with the goal of improving primary and secondary adherence by making medication order fulfillment more convenient than in-person fulfillment. [42][43][44] Mail-order fulfillment is often offered at a reduced cost to the patient (eg, waived or lower copayment than would be required of an in-person refill) and can be initiated by Internet or telephone requests. During the COVID-19 pandemic, the safety and convenience of mail-order medication fulfillment was widely marketed.…”

Section: Prior Mail-order Pharmacy Fulfillmentsmentioning

confidence: 99%

Did Access to Ambulatory Care Moderate the Associations Between Visit Mode and Ancillary Services Utilization Across the COVID-19 Pandemic Period?

et al. 2023

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Background/Objective: In recent years, 2 circumstances changed provider-patient interactions in primary care: the substitution of virtual (eg, video) for in-person visits and the COVID-19 pandemic. We studied whether access to care might affect patient fulfillment of ancillary services orders for ambulatory diagnosis and management of incident neck or back pain (NBP) and incident urinary tract infection (UTI) for virtual versus in-person visits. Methods: Data were extracted from the electronic health records of 3 Kaiser Permanente Regions to identify incident NBP and UTI visits from January 2016 through June 2021. Visit modes were classified as virtual (Internet-mediated synchronous chats, telephone visits, or video visits) or in-person. Periods were classified as prepandemic [before the beginning of the national emergency (April 2020)] or recovery (after June 2020). Percentages of patient fulfillment of ancillary services orders were measured for 5 service classes each for NBP and UTI. Differences in percentages of fulfillments were compared between modes within periods and between periods within the mode to assess the possible impact of 3 moderators: distance from residence to primary care clinic, high deductible health plan (HDHP) enrollment, and prior use of a mail-order pharmacy program. Results: For diagnostic radiology, laboratory, and pharmacy services, percentages of fulfilled orders were generally >70–80%. Given an incident NBP or UTI visit, longer distance to the clinic and higher cost-sharing due to HDHP enrollment did not significantly suppress patients’ fulfillment of ancillary services orders. Prior use of mail-order prescriptions significantly promoted medication order fulfillments on virtual NBP visits compared with in-person NBP visits in the prepandemic period (5.9% vs. 2.0%, P=0.01) and in the recovery period (5.2% vs. 1.6%, P=0.02). Conclusions: Distance to the clinic or HDHP enrollment had minimal impact on the fulfillment of diagnostic or prescribed medication services associated with incident NBP or UTI visits delivered virtually or in-person; however, prior use of mail-order pharmacy option promoted fulfillment of prescribed medication orders associated with NBP visits.

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Is Shelter-in-Place Policy Related to Mail Order Pharmacy Use and Racial/Ethnic Disparities for Patients With Diabetes?

Cited by 4 publications

References 4 publications

Training the next generation of delivery science researchers: 10‐year experience of a post‐doctoral research fellowship program within an integrated care system

Training the next generation of delivery science researchers: 10‐year experience of a post‐doctoral research fellowship program within an integrated care system

Structural Racism, Place, and COVID-19: A Narrative Review Describing How We Prepare for an Endemic COVID-19 Future

Did Access to Ambulatory Care Moderate the Associations Between Visit Mode and Ancillary Services Utilization Across the COVID-19 Pandemic Period?

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