Role of independent versus chain pharmacies in providing pharmacy access: a nationwide, individual-level geographic information systems analysis

Cost and availability of high-dose oral prednisone for management of optic neuritis

OBJECTIVE

This study assesses the cost and availability of 1250 mg of oral prednisone for treatment of optic neuritis across pharmacies in Toronto.

DESIGN

Prospective cross-sectional study PARTICIPANTS: Data collected from 70 pharmacies, across 4 regions in Toronto, Ontario, Canada METHODS: Data were collected from 70 pharmacies on cost and availability for 3- and 5-day courses of prednisone. Pharmacist hesitancy was assessed on the basis of the readiness of the pharmacist to dispense the required dose of medication.

RESULTS

The average cost for a 3-day course of prednisone was $29.10 CAD, and for a 5-day course was $40.40 CAD. Availability was lowest in independent pharmacies (23.8%) and highest in chain pharmacies (47.6%). Although no significant association between availability and pharmacy type was found (χ2 [1; N = 63] = 3.66; p = 0.06), the direction of the effect still shows an indication of chain pharmacies having higher stock. Chain pharmacies also exhibited the highest cost variability. Finally, 40% of pharmacists had some hesitancy or refused to dispense the appropriate dose.

CONCLUSIONS

There is limited availability of high-dose prednisone across Toronto, with chain pharmacies offering the highest availability but at a higher cost. There is significant hesitancy about dispensing this prednisone dose among pharmacists. Clinicians should be aware of these trends when prescribing medication for optic neuritis. Neuro-ophthalmologists should aim to develop relationships with pharmacies to improve timely administration of this medication.

Racial and ethnic inequities in spatial access to pharmacies: A geographic information system analysis

BACKGROUND

Pharmacy accessibility is crucial for equity in health care access because community pharmacists may reach individuals who do not have access to other health care providers.

OBJECTIVE

The objective of this study was to determine whether spatial access to pharmacies differs among racial/ethnic groups across the rural-urban continuum.

METHODS

We obtained a 30% random sample of the Research Triangle Institute synthetic population, sampled at the census block level. For each individual, we defined optimal pharmacy access as having a driving distance ≤2 miles to the closest pharmacy in urban counties, ≤5 miles in suburban counties, and ≤10 miles in rural counties. We used a logistic regression model to measure the association between race/ethnicity and pharmacy access, while controlling for racial/ethnic composition of the census tract, area deprivation index, income, age, gender, and U.S. region. The model included an interaction between race/ethnicity and urbanicity to evaluate whether racial/ethnic inequities differed across the rural-urban continuum.

RESULTS

The sample included 90,749,446 individuals of whom 80.6% had optimal pharmacy access. Racial/ethnic inequities in pharmacy access differed across the rural-urban continuum (P value for interaction= <0.0001). In rural areas, Black (OR 0.87; 95% CI 0.86-0.87), Hispanic (OR 0.80; 95% CI 0.79-0.80), and indigenous (OR 0.47; 95% CI 0.47-0.48) individuals had lower odds of optimal pharmacy access, than White individuals. Hispanic (OR 0.96; 95% CI 0.96-0.97) and Indigenous individuals (OR 0.75; 95% CI 0.75-0.76) had lower odds of optimal pharmacy access compared to White individuals in suburban areas. In Western states, Asian had lower odds of optimal pharmacy access in suburban (OR 0.88; 95% CI 0.86-0.90) and rural areas (OR 0.91; 95% CI 0.87-0.95) compared to White individuals.

CONCLUSIONS

Racial/ethnic inequities in spatial access to community pharmacies vary between urban and rural communities. Underrepresented racial/ethnic groups have significantly lower pharmacy access in rural and some suburban areas, but not in urban areas.

Implementation Documentation and Process Assessment of the PharmNet Intervention: Observational Report

BACKGROUND

The number of overdose deaths in the United States involving opioids continues to exceed 100,000 per year. This has precipitated ongoing declarations of a public health emergency. Harm reduction approaches, such as promoting awareness of, ensuring access to, and fostering willingness to use naloxone to reverse opioid overdose, are a key component of a larger national strategy to address the crisis. In addition, overdose reversal with naloxone directly and immediately saves lives. Because of pharmacies' ubiquity and pharmacists' extensive clinical training, community pharmacies are well-positioned, in principle, to facilitate naloxone access and education.

OBJECTIVE

In 2022, a single-site pilot study of PharmNet, a community pharmacy intervention incorporating naloxone distribution, awareness building, and referral, showed promising outcomes for both naloxone and resource distribution in the community. As a next step, this study was intended to be a pilot randomized controlled trial of PharmNet in 7 pharmacies. However, due to circumstances outside of the study team's control, data collection was unable to be fully completed as planned. In keeping with open research standards, we transparently report all available data from the study and discuss trial barriers and processes. We do so both to provide insights that may inform similar studies and to avoid the "file-drawer" (publication bias) problem, which can skew the aggregated scholarly literature through nonpublication of registered trial results or selective publication of findings affirming authors' hypotheses.

METHODS

This paper reports an in-depth implementation study assessment, provides the available observational data, and discusses implementation considerations for similar studies in independent (eg, nonchain) community pharmacies.

RESULTS

Retrospective assessment of study outcomes and fidelity data provided for robust discussion around how resource differences in independent community pharmacies (vs well-resourced chain pharmacies), as well as high demands on staff, can affect intervention implementation, even when leadership is highly supportive.

CONCLUSIONS

Community pharmacies, particularly independent community pharmacies, may require more support than anticipated to be successful when implementing a new intervention into practice, even if it might affect estimates of real-world effectiveness. Further implementation science research is needed specific to independent community pharmacies. All study elements are outlined in the International Registered Report Identifier (IRRID) PRR1-10.2196/42373. Although this paper reports results associated with that registration, results and conclusions should not be given the weight assigned to findings from a preregistered study.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/42373.