( continued from page 17 ) drive-through pharmacy pick up was safer ; but this is being dropped by a number of pharmacies as a cost-saving move .
There are implications for patient care because of these pharmacy deserts . Another recent patient , Isaiah *, had just been discharged from the hospital after an amputation of a great toe . Isaiah is 72 and homeless . Currently , he lives in a tent under the expressway downtown . He was discharged on Bactrim to minimize the likelihood of wound infection . But Isaiah had a problem . His Medicare plan covered the Bactrim , but he still had to pay the $ 12 copay — he frankly didn ’ t have it . His Medicare Advantage case manager kept calling stores trying to get him a better deal . She finally put together a plan with a pharmacy in another part of town that would use some government resources to reduce his copay to zero . But , by the time she got that worked out , Isaiah was back in the hospital . For Isaiah , both the difficulty of getting to a new pharmacy and the time it took to plan was more than enough to allow his stump site to get infected , forcing him back to the hospital again . Both the specter of cost and the reality of disease exacerbated the pharmacy desert .
When pharmacies , both independent and chain , move from an area , there is a loss of both proximate access to affordable sources for prescription medications and access to the teaching that pharmacists can perform . As pharmacists are able to be reimbursed for performing immunizations , they are also finding that they can provide valuable teaching and feedback to patients . The loss of neighborhood pharmacies creates a void difficult to fill . The pharmacy desert is more than a barrier in access to filling and refilling prescriptions . It also represents the loss of pharmacist reinforcement of the message of care espoused by their physicians .
What are the options ? If the pharmacy is difficult to access , there are options for mail order or pharmacy drop-off . However , with the rise of porch piracy , the drop-off makes such delivery options somewhat of a gamble . Family Health Centers operated by the Health Department do have a delivery service where the medications are handed off to the patient and not just left on the front porch or in the mailbox . But the Family Health Center pharmacy delivery is only for those individuals who are active patients at one of the Family Health Center sites . Good Brothers RX is a new local medication delivery service , specifically targeting the West Louisville community . A new service of mobile pharmacies is being explored by the University of Louisville . In that option , the store is mobile and visits neighborhoods on a regional basis , in much the same fashion as the old mobile libraries . The hope is to have the mobile pharmacies available to people in West Louisville by next year .
Working together with the support of Deputy Mayor Nicole George , the School of Public Health and J . B . Speed School of Engineering at the University of Louisville , a collaborative group of citizens , pharmacists , physicians and others have come together to tackle this problem . Called the Pharmacy Accessibility Index ( PAI ) Project , funded by the University of Louisville ’ s Humana-Sponsored
Health Equity Innovation Hub , the group has developed a series of heat maps of Jefferson County . When overlaid , these heat maps clearly show similarities in chronic disease incidence , reduced numbers of health facilities and pharmacy deserts . With this new information in hand , the group hopes to start making inroads that will improve the health of our community .
While pharmacy deserts are of real concern , there are newer ways to address the access issue and those deserve our support .
Acknowledgement : Assistance by Demetra ( Dee ) Antimisiaris , PharmD , BCGP , FASCP , Associate Professor , Dept . Health Management & Systems Sciences , University of Louisville ; Director , Frazier Polypharmacy & Medication Management Program ; Assistant Dean , Continuing Medical Education & Professional Development .
Funding Acknowledgment : This research was supported in part by a grant through the Health Equity Innovation Hub at the University of Louisville . Any information presented or conclusions drawn are those of the study team and do not necessarily represent the official position of the Hub .
References
1
Amstislavski , P ., Matthews , A ., Sheffield , S . et al . Medication deserts : survey of neighborhood disparities in availability of prescription medications . Int J Health Geogr 11 , 48 ( 2012 ). https :// doi . org / 10.1186 / 1476-072X-11-48
2
Qato DM , Daviglus ML , Wilder J , Lee T , Qato D , Lambert B . ‘ Pharmacy deserts ’ are prevalent in Chicago ’ s predominantly minority communities , raising medication access concerns . Health Aff ( Millwood ). 2014 Nov ; 33 ( 11 ): 1958-65 . doi : 10.1377 / hlthaff . 2013.1397 . PMID : 25367990 .
3
Guadamuz JS , Wilder JR , Mouslim MC , Zenk SN , Alexander GC , Qato DM . Fewer Pharmacies In Black And Hispanic / Latino Neighborhoods Compared With White Or Diverse Neighborhoods , 2007-15 . Health Aff ( Millwood ). 2021 May ; 40 ( 5 ): 802-811 . doi : 10.1377 / hlthaff . 2020.01699 . PMID : 33939507 .
4
Wisseh C , Hildreth K , Marshall J , Tanner A , Bazargan M , Robinson P . Social Determinants of Pharmacy Deserts in Los Angeles County . J Racial Ethn Health Disparities . 2021 Dec ; 8 ( 6 ): 1424-1434 . doi : 10.1007 / s40615-020-00904-6 . Epub 2020 Oct 27 . PMID : 33111234 ; PMCID : PMC8076330 .
5
Pednekar P , Peterson A . Mapping pharmacy deserts and determining accessibility to community pharmacy services for elderly enrolled in a State Pharmaceutical Assistance Program . PLoS One . 2018 Jun 4 ; 13 ( 6 ): e0198173 . doi : 10.1371 / journal . pone . 0198173 . PMID : 29864159 ; PMCID : PMC5986116 .
Dr . James is the Chief Medical Officer for Passport Health Plan by Molina Healthcare .
* Name and other identifying factors have been changed to maintain patient privacy .
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