Assessing Risk for Loss of Rural Pharmacy Services in Minnesota
Assessing Risk for Loss of Rural Pharmacy Services in Minnesota
Objective: To quantify rural communities' risks for losing access to local pharmacy services using a newly developed risk-assessment tool.
Design: Cross-sectional study.
Setting: Minnesota in June through August 2003.
Participants: Pharmacy owners and managers in rural communities with populations less than 5,000 residents and only one community pharmacy.
Intervention: Self-administered questionnaire completed by study participants.
Main Outcome Measures: Each answer was given a score based on the related factor's ability to affect risk of pharmacy closure. Scores were summed to give a comparative risk score with a positive score indicating higher risk; these scores could range from -13.5 to +30.75, depending on responses.
Results: From 126 communities outside of the Minneapolis-St. Paul metropolitan area with populations of fewer than 5,000 residents and only one community pharmacy, 81 (64.3%) usable responses were received. The calculated risk scores ranged from -7 to +12.3, with mean (± SD) scores of 1.55 ± 4.17. Factors that contributed most to rural pharmacies' risk index were dramatic decreases in community populations within 5 years, poor community support for the pharmacy, owner's intent to sell pharmacy within 2 years, less than $750,000 in annual prescription revenue, perceived erosion of total market share of prescriptions, difficulties in recruiting full-time pharmacist-employees, lack of access to local primary care, and perceived likelihood that local primary care clinics would not be active in 5 years. Approximately 26% of pharmacy owners responding expressed interest in selling their pharmacy within 3 years, and 62% were interested in selling within 10 years.
Conclusion: The tool developed for this study allows prospective assessment of risk, which can facilitate a greater awareness by local and regional officials and consumers of the possibility of loss of rural pharmacies, assist in targeting resources to areas most in need, and serve as a bridge to collaborative relationships aimed at ensuring local access to both pharmacy services and the knowledge of a pharmacist.
Individuals living in rural communities represent roughly 25% of the U.S. population, with trends suggesting the rural population is increasing. Of note, populations in rural areas typically consist of a greater percentage of older patients compared with urban populations, and this group uses greater amounts of health care resources, including pharmaceuticals. Despite this substantial proportion of our country's population and its age-related demographics, issues surrounding the delivery of health care in rural communities remain underrecognized. Distribution of the pharmacy workforce is one example of a potential health care disparity because only 12% of pharmacists practice in rural areas. Nationally, the ratio of pharmacists in rural areas is 66 per 100,000 population, substantially less than the overall U.S. ratio of 78 pharmacists per 100,000 population.
Rural pharmacy practice, in general, is operating in a fragile environment. Delivery of pharmacy services in rural areas has been challenged by changes in the U.S. health care system, including increased competition from chain, mass-merchandiser, and mail service pharmacies; changes in third-party reimbursement; and the increased application of costly technology. Specific barriers to the delivery of pharmacy services in rural areas include reduced profitability, challenges in hiring staff pharmacists and obtaining assistance from relief pharmacists when needed, decreased personal and professional flexibility of a pharmacist's time, and decreased interest in rural pharmacy ownership.
The cumulative effects of these challenges are being realized in several ways, but potentially the ultimate result is the closure of a pharmacy. In Minnesota, the annual number of nonmetropolitan pharmacy closures has been consistent since 1996. Compared with 87 closures in the seven-county Minneapolis-St. Paul metropolitan area, 102 pharmacies have closed in nonmetropolitan areas. More importantly, new pharmacy openings are less likely in rural areas, compared with urban environments. Of the 38 pharmacy closures in rural Minnesota from 1996 to 1999, 9 resulted in a community no longer having access to a local pharmacy. Because this environment remains tenuous, any unfavorable shift in factors affecting rural pharmacy may cause pharmacy closures to greatly increase, resulting in more rural residents losing access to local pharmacy services.
While previous studies have examined risk factors and trends that may be detrimental to rural pharmacy, researchers have not attempted to prospectively identify or compare a rural community's risk for losing access to local pharmacy services. Identifying this risk is desirable because state leaders and pharmacists would be able to focus efforts on those communities at greatest risk. In addition, identification, comparison, and further investigation of this risk may also facilitate the effective targeting of innovative practice model development for communities in which traditional service delivery may no longer be feasible. Finally, the ability to identify risk for losing access could also help support efforts to maintain existing service delivery in communities in which long-term viability is most likely.
The purpose of this study was to give government, schools of pharmacy, professional associations, or other interested parties a framework to identify and target rural communities at greatest risk for loss of pharmacy services. While a multitude of factors cumulatively affect rural pharmacy, the negative consequences of any one factor, if severe enough, can result in a rural community losing access to local pharmacy services.
Objective: To quantify rural communities' risks for losing access to local pharmacy services using a newly developed risk-assessment tool.
Design: Cross-sectional study.
Setting: Minnesota in June through August 2003.
Participants: Pharmacy owners and managers in rural communities with populations less than 5,000 residents and only one community pharmacy.
Intervention: Self-administered questionnaire completed by study participants.
Main Outcome Measures: Each answer was given a score based on the related factor's ability to affect risk of pharmacy closure. Scores were summed to give a comparative risk score with a positive score indicating higher risk; these scores could range from -13.5 to +30.75, depending on responses.
Results: From 126 communities outside of the Minneapolis-St. Paul metropolitan area with populations of fewer than 5,000 residents and only one community pharmacy, 81 (64.3%) usable responses were received. The calculated risk scores ranged from -7 to +12.3, with mean (± SD) scores of 1.55 ± 4.17. Factors that contributed most to rural pharmacies' risk index were dramatic decreases in community populations within 5 years, poor community support for the pharmacy, owner's intent to sell pharmacy within 2 years, less than $750,000 in annual prescription revenue, perceived erosion of total market share of prescriptions, difficulties in recruiting full-time pharmacist-employees, lack of access to local primary care, and perceived likelihood that local primary care clinics would not be active in 5 years. Approximately 26% of pharmacy owners responding expressed interest in selling their pharmacy within 3 years, and 62% were interested in selling within 10 years.
Conclusion: The tool developed for this study allows prospective assessment of risk, which can facilitate a greater awareness by local and regional officials and consumers of the possibility of loss of rural pharmacies, assist in targeting resources to areas most in need, and serve as a bridge to collaborative relationships aimed at ensuring local access to both pharmacy services and the knowledge of a pharmacist.
Individuals living in rural communities represent roughly 25% of the U.S. population, with trends suggesting the rural population is increasing. Of note, populations in rural areas typically consist of a greater percentage of older patients compared with urban populations, and this group uses greater amounts of health care resources, including pharmaceuticals. Despite this substantial proportion of our country's population and its age-related demographics, issues surrounding the delivery of health care in rural communities remain underrecognized. Distribution of the pharmacy workforce is one example of a potential health care disparity because only 12% of pharmacists practice in rural areas. Nationally, the ratio of pharmacists in rural areas is 66 per 100,000 population, substantially less than the overall U.S. ratio of 78 pharmacists per 100,000 population.
Rural pharmacy practice, in general, is operating in a fragile environment. Delivery of pharmacy services in rural areas has been challenged by changes in the U.S. health care system, including increased competition from chain, mass-merchandiser, and mail service pharmacies; changes in third-party reimbursement; and the increased application of costly technology. Specific barriers to the delivery of pharmacy services in rural areas include reduced profitability, challenges in hiring staff pharmacists and obtaining assistance from relief pharmacists when needed, decreased personal and professional flexibility of a pharmacist's time, and decreased interest in rural pharmacy ownership.
The cumulative effects of these challenges are being realized in several ways, but potentially the ultimate result is the closure of a pharmacy. In Minnesota, the annual number of nonmetropolitan pharmacy closures has been consistent since 1996. Compared with 87 closures in the seven-county Minneapolis-St. Paul metropolitan area, 102 pharmacies have closed in nonmetropolitan areas. More importantly, new pharmacy openings are less likely in rural areas, compared with urban environments. Of the 38 pharmacy closures in rural Minnesota from 1996 to 1999, 9 resulted in a community no longer having access to a local pharmacy. Because this environment remains tenuous, any unfavorable shift in factors affecting rural pharmacy may cause pharmacy closures to greatly increase, resulting in more rural residents losing access to local pharmacy services.
While previous studies have examined risk factors and trends that may be detrimental to rural pharmacy, researchers have not attempted to prospectively identify or compare a rural community's risk for losing access to local pharmacy services. Identifying this risk is desirable because state leaders and pharmacists would be able to focus efforts on those communities at greatest risk. In addition, identification, comparison, and further investigation of this risk may also facilitate the effective targeting of innovative practice model development for communities in which traditional service delivery may no longer be feasible. Finally, the ability to identify risk for losing access could also help support efforts to maintain existing service delivery in communities in which long-term viability is most likely.
The purpose of this study was to give government, schools of pharmacy, professional associations, or other interested parties a framework to identify and target rural communities at greatest risk for loss of pharmacy services. While a multitude of factors cumulatively affect rural pharmacy, the negative consequences of any one factor, if severe enough, can result in a rural community losing access to local pharmacy services.
Source...