Date Published: June 4, 2018
Publisher: Public Library of Science
Author(s): Priti Pednekar, Andrew Peterson, Jaymie Meliker.
Limited 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).
The 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.
The 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. The 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.
Elderly 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]. In the US, elderly use about 25–30% of all prescription medications. An elderly patient takes, on average, four or five prescription drugs and two over-the-counter (OTC) medications. Elderly people are also more likely to have adverse drug reactions, drug-drug interactions and medication errors[5–7]. The accessibility to a pharmacy is therefore an important facilitator of overall health of elderly population.
The results of these analyses identified pharmacy deserts and investigated availability of different types of community pharmacies and their services, that can affect geographic access to medications and other services offered by community pharmacies for elderly even if their economic access was improved by being enrolled in SPAPs. The study findings confirm the presence of spatial heterogeneity in data. The results can be used to inform interventions aimed at improving access to prescription medications and community pharmacies and SPAP program management by targeting specific geographic areas which need more attention, rather than delivering interventions to the entire study area. The results can also be used as a guide for resource allocation decisions, target outreach efforts, and help guide public health policy and program enhancement decisions. The methodological approach and analyses demonstrated here for PACE program can also be applied to other public health programs in the US and globally to evaluate the coverage and breadth of public health services. Several states in countries around the world, such as New Zealand, Brazil, and Canada, are currently experiencing similar problems associated with geographic accessibility to community pharmacies[20,28,50].
To the best of our knowledge, this study is the first to report pharmacy deserts and availability of community pharmacies and their services for elderly enrolled in a SPAP and our methodological approach should be reasonably generalizable to other public health programs globally.