Abstract
ObjectivesLimited studies have investigated geographic accessibility to a nearby community pharmacy for elderly which is an essential determinant of the access to medications and pharmacy services. This research identified pharmacy deserts and investigated availability of different types of community pharmacies and their services for elderly enrolled in a State Pharmaceutical Assistance Program (SPAP).MethodsThe state of Pennsylvania in the US was used as a case to demonstrate the geographic accessibility to community pharmacy and services for elderly enrolled in SPAP. The locations of community pharmacies and households of elderly enrolled in SPAP were derived from Pharmaceutical Assistance Contract for the Elderly programs’ database. The street addresses were geocoded and the distance to a nearby community pharmacy was calculated for study sample using the haversine formula. The demographic and geographic data were aggregated to Census Tracts and pharmacy deserts were identified using the predefined criteria. Descriptive statistical analysis was used to determine whether there are statistical differences in the socio-demographic profiles and distribution of different types of community pharmacies and their services in pharmacy deserts and non-deserts. This research used hot spot analyses at county level to identify clusters of pharmacy deserts, areas with high concentration of different racial/ethnic groups and clusters of high densities of chain and independent pharmacies.ResultsThe Spatial analysis revealed that 39% and 61% Census Tracts in Pennsylvania were pharmacy deserts and non-deserts respectively (p < 0.001). Pharmacy deserts were found to have significantly more females, married and white elderly and fewer blacks and Hispanics compared to pharmacy non-deserts. Pharmacy deserts had significantly fewer chain and independent pharmacies and less delivery and 24-hour services in pharmacies than pharmacy non-deserts. Hot spot analyses showed that clusters of pharmacy deserts were more concentrated in southcentral, northwest and northeast regions of the state which represent rural areas and overlapped with clusters of high concentration of white individuals.ConclusionsThe findings suggest that urban-rural inequality, racial/ethnic disparity and differences in availability of pharmacies and their services exist between pharmacy deserts and non-deserts. The methodological approach and analyses used in this study can also be applied to other public health programs to evaluate the coverage and breadth of public health services.
Highlights
Use prescription medications more than any other age groups as they are more likely to have multiple and/or severe chronic conditions and more frequent seasonal illnesses[1,2]
The findings suggest that urban-rural inequality, racial/ethnic disparity and differences in availability of pharmacies and their services exist between pharmacy deserts and nondeserts
The methodological approach and analyses used in this study can be applied to other public health programs to evaluate the coverage and breadth of public health services
Summary
Use prescription medications more than any other age groups as they are more likely to have multiple and/or severe chronic conditions and more frequent seasonal illnesses[1,2]. The group of patients which received medication management interventions by a community pharmacy had 3% higher medication adherence, 1.8% less hospital admissions, 2.7% less emergency room visits, and 0.53 fewer mean outpatient visits compared to the group of patients which did not receive medication management services from a community pharmacy[14]. Because of this role, the accessibility to community pharmacies is critical to ensure proper utilization of medications and adequate delivery of healthcare services
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