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Social Determinants of Health: Pharmacy Deserts in the Pacific West

Thursday, August 8, 2019   (0 Comments)
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Medication adherence is a large and costly problem in the United States. Studies estimate that about 125,000 people die each year in the U.S. because they don’t take their medications as prescribed. It’s a problem that costs our health care system around $300 billion annually. Policymakers have long focused on trying to keep medications affordable as a means of improving adherence, but there is a growing amount of research indicating that a lack of access to pharmacy services also shares the blame.

 

What is a Pharmacy Desert?

Research on Pharmacy Deserts, which are neighborhoods with limited access to retail pharmacy locations, is still somewhat limited. A large portion of the information available, to date, has been conducted by the University of Illinois in Chicago and focuses on the pharmacy access issue experienced by Chicago communities. Pharmacy accessibility is typically measured on three criteria: 

 

  1. The number of, and distance to, stores in the area. 
  2. Individual-level resources that may affect accessibility, such as family income or vehicle availability
  3. Neighborhood-level indicators of resources, such as the average income of the neighborhood and the availability of public transportation.

Pharmacy Deserts and Food Deserts

In order to most accurately identify Pharmacy Deserts and understand their impact on affected communities, researchers often draw parallels to the U.S. Department of Agriculture’s (USDA) study of Food Deserts 1 . Food Deserts are neighborhoods that lack healthy food sources. With respect to food accessibility, the USDA examines those neighborhoods it defines as Low Income and Low Access.

  • Low Income neighborhoods are census tracts where:
    • The poverty rate is 20 percent or greater, or
    • The tract’s median family income is less than or equal to 80 percent of the statewide median family income; or
    • The tract is in a metropolitan area and has a median family income less than or equal to 80 percent of the metropolitan area's median family income.
  • Low Access neighborhoods are census tracts where:
    • A significant portion of the population (500 people or more or at least 33 percent) live far from access to the nearest supercenter or grocery store. Distances vary by community type:
      • Greater than half a mile in urban areas
      • Greater than 10 miles in rural areas
    • Using this measure, about 54 million people, or about 17.7 percent of the population, in the U.S. live in census tracts that are defined as Low Income and Low Access.

 

Pharmacy Access and the Pacific West

In regards to limited pharmacy services and access, there is some data on how communities in the Pacific West are being affected, more specifically rural communities.

 

Oregon State University conducted research2 to analyze readmission rates in rural and urban communities and how access to a pharmacy may play a role. All hospitals in the state of Oregon participated.

 

The study found that readmission rates are higher in rural areas, averaging 15.3% compared to 14.7% in urban areas which may seem negligible, but when hospital readmission rates are a national problem costing $17 billion, that .06% difference is significant. In addition, the study found that communities near urban hospitals were more likely to have access to a pharmacy compared to communities near a rural hospital.

 

David Lee, an assistant professor in the Oregon Health & Science University College of Pharmacy said, “This research shows that pharmacy access can help people from going back to the hospital. For older populations who often find hospital experiences quite exhausting, that's extremely important to their overall health.”

 

One study3 found that the number of pharmacies in the U.S. is actually increasing. However, there is substantial variation across counties. Counties in the highest quintile had nearly three-fold more pharmacies than counties in the lowest quintile and “counties in the lowest quintile appear to cluster in the Pacific West, Southwest and Great Lakes regions…”

 

The same study also found that chain pharmacies predominate in the Northeast and Western regions. While chain pharmacies had a higher proportion than any other pharmacy type open for 24 hours (10.7%) or offering a drive-up window (23.9%), chain pharmacies were significantly less likely than independent pharmacies to report offering home delivery, or multilingual staff (6.2% vs. 64.2%). These findings indicate that although there is a large portion of chain pharmacies in these regions, chain pharmacies are lacking in service offerings that can be particularly important to rural and lower socioeconomic communities.

 

Addressing the Pharmacy Access Problem

With a growing aging population, pharmacy access and Pharmacy Deserts are a concern. The United States Census Bureau found:

  • Nearly 40% of people 65 and older have at least one realized disability.
  • Two-thirds of the 15.7 million people that were identified as having at least one disability, reported having trouble walking or climbing.
  • Difficulty with independent living, such as visiting a doctor’s office, was the second most cited disability.

For many, the ability to drive and even access reliable or public transportation has been cited as a barrier to accessing care. In order to better accommodate people experiencing pharmacy access issues, alternative methods such as home delivery of medications will become increasingly important to help combat this national issue.

 

 

Companies like PillPack, an Amazon company have developed new ways to simplify the process of getting medicine to patients in a way that suits their needs. With convenient dose packaging and home delivery, patients in both rural and urban communities can get their medications in a convenient system without having to leave prescriptions unfilled or worry about how they will get to the pharmacy.

 

For more information on Pharmacy Deserts, download a free booklet at www.equiscript.com/desert.

 

How Equiscript helps reach remote and underserved patients

Equiscript is the only non-pharmacy in 340B that uses patient outreach to help improve patient adherence and outcomes. This means that they are a company designed to help you give patients the support they need to be more adherent and have better health outcomes.

 

 

Equiscript’s brand of patient outreach and support is especially important for patients living in Pharmacy Deserts and others whose transportation, mobility, or health issues make getting service from a retail pharmacy prohibitive. Jaunel Martin, Registered Nurse at Heritage Health, an FQHC in Coeur d'Alene, Idaho said, “We have a large population of patients that are elderly, disabled or live rurally. Home delivery is valuable for these patients for consistent medication compliance.” We find that for most patients, it’s important to:

  1. Check in with them - to proactively ask how they are doing
  2. Offer pharmacy options that suit each patient’s preferences

Not every patient benefits from delivery of their medications, just like not every patient has the wherewithal to get to a brick-and-mortar pharmacy multiple times a month. For patients who need to-, or prefer to- have their medications delivered, Equiscript offers a supportive, systematic approach. From personalized calls by a team of patient care advocates to pharmacy systems that cover all major PBMs, to monthly invoices for copays instead of the patient having to pay their copays upfront, Equiscript has a comprehensive system to help you give patients options that support adherence.

 

If you have patients who go to your health center for care, but who get their prescriptions sent outside your contract pharmacy network, Equiscript can help you by reaching out to those patients. The program generates new savings for 340B covered entities while also providing patients with a new service that keeps them healthier and happier. Learn more at www.equiscript.com.

 

 

Sources

  1. Food Access Definitions, United States Department of Agriculture Economic Research Service, Retrieved 6/27/18 from https://www.ers.usda.gov/data-products/food-access-research-a tlas/documentation/#definitions
  2. Lack of pharmacy access sends some patients back to the hospital. (2016, August 01). Retrieved July 01, 2019, from https://today.oregonstate.edu/archives/2016/aug/lack-pharmacy-access-sends-some-pat ients-back-hospital
  3. “Mobility is Most Common Disability Among Older Americans, Census Bureau Reports,” The United States Census Bureau, retrieved July 1, 2019 from https://www.census.gov/newsroom/press-releases/2014/cb14-218.html
  4. Qato, D. M., Zenk, S., Wilder, J., Harrington, R., Gaskin, D., & Alexander, G. C. (2017). The availability of pharmacies in the United States: 2007-2015. PloS one, 12(8), e0183172. doi:10.1371/journal.pone.0183172

 

 

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