Integrated Health Care Delivery System and Electronic Health Records Support Medication Adherence

Kaiser Permanente Study Finds Electronic Prescribing Makes It Easier to Identify Patients Who Are Not Getting Their Prescriptions Filled

DENVER - People who receive medical care in an integrated health care system with electronic health records linked to its own pharmacy more often collect their new prescriptions for diabetes, cholesterol and high blood pressure medications than do people who receive care in a non-integrated system, according to a Kaiser Permanente study published online in the Journal of General Internal Medicine.

The study of 12,061 men and women in Kaiser Permanente Colorado with newly ordered medications for diabetes, blood pressure and cholesterol found that only 7 percent of the people did not get their new prescriptions for blood pressure medication filled, 11 percent failed to pick up new prescriptions for diabetes medication, and 13 percent failed to collect new prescriptions for cholesterol-reducing medication.

Previous research of patients in health systems that are not integrated found that primary non-adherence, when new prescriptions are not filled, to be as high as 22 percent. However, primary non-adherence research conducted in non-integrated systems likely overestimates the percentage of patients who do not have their prescriptions filled. This is because, in a non-integrated system, medication orders from one organization must be linked with pharmacy claims from a different organization. Pharmacy claims databases do not include information on patients who never pick up their first prescription, nor do they contain information on patients who paid cash for their prescription, researchers said.

In contrast, within an integrated health system such as Kaiser Permanente, medication orders can be directly linked to prescriptions filled within the same system, thus including information on patients who do not pick up their first prescription.

"Given that adherence to medications is directly associated with improved clinical outcomes, higher quality of life, and lower health care costs across many chronic conditions, it is important to examine why some people never start the medications their doctors prescribe," said study lead author Marsha Raebel, PharmD, an investigator in pharmacotherapy with the Kaiser Permanente Colorado Institute for Health Research and with the University of Colorado School of Pharmacy.

"Having electronic health record medication order entry linked to pharmacy dispensing information makes it much easier for clinicians and researchers to identify patients who are not getting their new prescriptions filled," she said. "The next step is to better understand what the barriers are to people picking up the medications their doctors have prescribed to help them manage diabetes and heart disease."

This retrospective, observational study examined pharmacy dispensing records of 12,061 men and women whose average age was 59 for 18 months in 2007 and 2008 to see whether they picked up newly initiated medications for high blood pressure, diabetes and high cholesterol.

"This group of people has historically been ignored because prescriptions were written on a piece of paper. But now that we have electronic health records with electronic order entry, we can find out patients that did not pick up their first prescription for medications they need," Dr. Raebel said. "Now we need to look at how we can reduce the number of people who do not get their medications."

This study is part of ongoing research at Kaiser Permanente to understand and improve medication adherence:

  • A Kaiser Permanente study last month in the same journal found Kaiser Permanente Northern California patients who obtained new statin prescriptions via a mail-order pharmacy achieved better cholesterol control in the first 3-15 months following the initiation of therapy - compared to those patients who only obtained their statin prescription from their local Kaiser Permanente Northern California pharmacy.

  • A Kaiser Permanente study published last year in the American Journal of Managed Care found that patients with diabetes, high blood pressure or high cholesterol who ordered their medications by mail were more likely to take them as prescribed by their doctors than did patients who obtained them from a local pharmacy.

At Kaiser Permanente, members have 24/7 access to My Health Manager, the world's most actively used personal health record. Members can access an online pharmacy and get pharmacy refills at using My Health Manager, which can be mailed to them free of shipping charges or made available for pick-up at any Kaiser Permanente pharmacy.

Other authors of the paper include: Jennifer L. Ellis, MBA, MSPH, Nikki M. Carroll, MS, Elizabeth A. Bayliss, MD, MSPH, Emily B. Schroeder, MD, PhD, Susan Shetterly, MS, Stan Xu, PhD, John F. Steiner, MD, MPH, of the Kaiser Permanente Institute for Health Research and the University of Colorado Schools of Pharmacy and Medicine; Brandy McGinnis, PharmD, of the Kaiser Permanente Colorado Department of Pharmacy and the University of Colorado School of Pharmacy.

About Kaiser Permanente Colorado
Kaiser Permanente Colorado is the state's largest nonprofit health plan, proudly working to improve the lives and health of Denver, Boulder, and southern Colorado area residents for 40 years. Kaiser Permanente Colorado provides comprehensive health care services to more than 522,000 members through 20 medical offices and a network of affiliated hospitals and physicians. The health plan was recently named "Highest in Member Satisfaction" among Commercial Health Plans by J.D. Power and Associates for the third straight year. Kaiser Permanente was also named the top-ranked private health plan in Colorado and #9 in the nation for quality and member satisfaction by NCQA. In 2009, Kaiser Permanente proudly directed more than $82 million to community benefit programs to improve the health of all Coloradans. For more Kaiser Permanente news, visit or follow us on twitter @kpcolorado or

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, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.8 million members in nine 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. For more information, go to: