HEALTH EQUITY
Table 1 : Pharmacy Accessibility Index Community Focus Group By Age
Under 60 Years of Age : Over 60 Years of Age :
• Need access to pharmacy after work hours .
• Proximity in geographic neighborhood is important , due to time constraints relevant to work and after-hours access .
• Critical access , especially for CII medications , within refill time window while balancing work / time constraints ( children ’ s ADHD medications , etc .).
• Don ’ t like random closures due to staffing shortages ( e . g .: the pharmacy is supposed to be open at 2 p . m . but is not , and the patient takes off work to get to the pharmacy with no results .)
• They value good service : including staffing , efficiency , communication and cleanliness
• Prescriptions are not as important ( they have Medicare Part D mail order services or other lines of obtaining routine prescriptions ). Access to a pharmacy is more important for acute scripts .
• Those with vehicles will drive miles to East Louisville pharmacies .
• Access to the store is important for goods , including food , durable medical goods , over-the-counter medications , etc .
• Access to a pharmacist for consultation is important .
• They value efficiency , lack of chaos , safety and cleanliness . of Urban and Public Affairs have worked on a collaborative study . Termed the Pharmacy Accessibility Index ( PAI ) Study , this work has reviewed access to pharmacies and looked beyond solely geographic access . 5 The study team performed geographic access analytics and found that while the density of pharmacies in West Louisville is like that of the rest of the metro area , the qualitative aspects of those pharmacies and their non-physical environment result in barriers to care . They conducted two focus group luncheon events and discussed pharmacy access and utility with one group of adults under 60 years of age and another group over 60 years of age . Table 1 provides some of the qualitative insights gathered in those focus groups . Of surprising interest to the investigators was that pharmacy accessibility takes on different meanings demarcated by age group .
The results of the multi-faceted PAI study have shown that in Louisville , the use of pharmacy services is not directly tied to distance to pharmacies but to other factors related to Health-Related Social Needs ( HRSN ) and Social Determinants of Health ( SDoH ). 6 Having a vehicle can certainly improve a patient ’ s access to pharmacies . Car ownership does impact the individual ’ s ability to get to appointments , get groceries and fill prescriptions . Not having a car means relying on others . Alternatively , for many the bus routes are critical . The UofL study has found that significant neighborhoods in West Louisville , Newburg and South Louisville have a dearth of open access pharmacies and do not have reasonable public transportation access to pharmacies . The over 60-year-olds focus group revealed that subtle factors which may not be obvious can result in a barrier to transportation . For example , the shelters and benches were removed from most of the bus stops , making it too physically difficult for the over 60 age group to wait for the infrequent buses .
Though West Louisville isn ’ t considered a pharmacy desert by geographical standards , it ’ s clear from the focus group responses that these areas in Louisville have failing service ecosystems , particularly concerning the pharmacy . See Appendix 2 to view a diagram of focus group feedback . The physical structures to support the community are present , but deficiencies in transportation , operating hours and pharmacy services lead to disparities across Louisville . See Appendix 1 to review a geographical example of the impact of transportation from a publication associated with this study . This data analysis of transportation supports the focus group findings . Participants shared that pharmacy hours listed online were often inaccurate . These inconveniences waste valuable time and decrease the quality of health care services offered in the area . The insight gained from this qualitative study emphasizes the importance of community testimony in understanding care gaps . Defining pharmacy deserts exclusively by geographical distance is not sufficient .
The Washington Post has reported that over the past few years , the major pharmacy chains have closed more than 1,500 stores nationally . The chains are feeling the economic pinch of competition from online pharmacies , the billion-dollar lawsuits related to unsafe filling of opioid prescriptions and revenue losses from the COVID-19 epidemic . The chain stores , that have driven out the neighborhood independent drugstore , have also had to face staffing shortages , theft and changing consumer behaviors . To trim costs , the pharmacy chains have focused on closing less profitable stores . 7 These are largely in low-income neighborhoods . That translates into worsening of the disparities in pharmacy access in largely Black , Latinx and rural stores .
Changing Directions for Pharmacies :
In the void there are other options , but these have advantages and significant disadvantages :
1 .) Mail order pharmacies – Under the encouragement of purchasers of health insurance products , the chains have been doing mail order pharmaceuticals for several years . This has the advantage of lower cost and typically delivery of a 3-month supply for a lower co-payment . But the disadvantage can be “ porch piracy .” Unless there is a secure
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