Pharmacy Services in Rural Areas: Is the Problem Geographic Access or Financial Access?

Abstract

Access to pharmacy services is an important rural health policy issue but limited research has been conducted on it. This article describes rural retail pharmacies in Minnesota, North Dakota, and South Dakota, including their organizational characteristics, staffing, services provided, and planned future changes; examines the availability of pharmacy services and pharmacy closures in rural areas of these three states; and briefly discusses policy issues that affect the delivery of pharmacy services in rural areas. Study data came from a phone survey of 537 rural pharmacies, an analysis of pharmacy licensure data, and phone interviews with clinic, public health, and social services staff in rural communities with potential pharmacy access problems. Using a standard of 20 miles to the nearest pharmacy, most rural residents of these three states currently have adequate geographic access to pharmacy services. However, rural pharmacists and clinic, public health, and social services staff rate financial access to pharmacy services for the elderly and the uninsured as a major problem. Key policy issues that will affect future access to pharmacy services in rural areas include pharmacy staffing and relief coverage; alternative methods of providing pharmacy services; thefinancial viability of rural pharmacies; and the potential impact of a Medicare prescription benefit on rural consumers and rural pharmacies.

Current practices and state regulations regarding telepharmacy in rural hospitals

“…Many rural hospitals rely on pharmacists who practice primarily in a community pharmacy setting. 3 As pharmacy service delivery has become increasingly complex, the knowledge and skills of pharmacists have become more specialized with respect to practice setting. It is unlikely that a pharmacist who is focused mostly on community pharmacy practice will be fully up-to-date with respect to the breadth of clinical and pharmacy systems management functions in an acute care setting.…”

“…1,2 In addition, a significant number of pharmacists in small rural hospitals practice primarily in community pharmacy settings, providing parttime pharmacist consultant services in hospitals and nursing homes in addition to their retail responsibilities. 3 Several studies have demonstrated that limited pharmacist hours adversely affect the contributions pharmacists can make to medication safety in rural hospitals. As a result of pharmacist vacancies, rural hospital pharmacists in Illinois reported a reduction in the amount of time available to provide clinical pharmacy services and an increase in pharmacy-related medication errors.…”

Assessing spatial inequalities in accessing community pharmacies: a mixed geographically weighted approach

“…A set of independent variables was chosen on the basis of regional socio-economic features, previous research (Casey et al, 2002;Perez and Decoupigny, 2009;Amstislavski et al, 2012;Norris et al, 2014;Qato et al, 2014) and data availability at the municipal level. This dataset included population (1000s of inhabitants)/population density (inhabitants per km 2 ), mean altitude (100 m units) above the mean sea level (msl), dummy variables of the status of rural according to the Eurostat classification (Istat, 2014), municipality (0=urban), coastal municipality (0=landlocked), proportion of >65-year-olds, <5-yearolds, immigrants, and a proxy of municipal income (mean declared personal income per taxpaper in 1000s of Euro).…”

“…Research has shown that geographical access to pharmacies depends on several factors, such as socio-economic determinants (Casey et al, 2002;Amstislavski et al, 2012;Qato et al, 2014) including levels of deprivation (Ward et al, 2014;Todd et al, 2014), community segregation (Qato et al, 2014), landscape features (Perez and Decoupigny, 2009) and degree of urbanity vis-à-vis remoteness (Lin, 2004;Todd et al, 2014;Norris et al, 2014). Among these, urban-rural inequalities are of particular relevance in Italy, since rural areas account for more than 90% of the surface area and host about 57% of the population.…”

Quality of Handoffs in Community Pharmacies

“…This may be explained by the relatively better pharmacy staffing pattern in urban areas compared to those of rural areas as rural pharmacies are likely to experience staff shortages. 43,44 Consequently, this may limit opportunities for interactions between pharmacists and the conduct of face-to-face, synchronous handoffs during shift changes. After-hours coverage for pharmacy services in rural areas are also likely to be limited and, as a result, patients may be forced to obtain services from other places such as hospitals or pharmacies located in a different community.…”