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Release: Sept. 21, 1999

UI study looks at pharmacy availability

IOWA CITY, Iowa -- Independently owned pharmacies are more prevalent in rural areas and areas with large populations under the poverty line. But the recent trend of independent pharmacies closing and chain store pharmacies expanding may result in shortages and less access to health care for some segments of the population, according to a University of Iowa study.

William R. Doucette, Ph.D., assistant professor in the UI College of Pharmacy and lead author of the study, said the availability of pharmacies in the United States is an area often overlooked by other researchers.

"There has been a lot of research interest in access to health care, but the majority focuses on hospital and physician availability," he said. "Not much has been done on access to pharmacies."

The study analyzed approximately 3,000 counties in the United States for the number of community (non-hospital) pharmacies per 10,000 people, as well as the proportion of these pharmacies that are independently owned. The researchers also looked at potential factors influencing the number and kinds of pharmacies found, including location (rural or urban), income, age and competition.

The researchers found evidence of small numbers of pharmacies in areas that have large elderly populations, areas that are either highly rural or largely urban, regions with high percentages of people below the poverty line, and areas with a large HMO presence. The researchers also pinpointed areas with large numbers of independent pharmacies, including highly rural or highly urban areas as well as those with large numbers of people below the poverty line and/or receiving public assistance.

The article noted the increasing number of prescription drugs and the reliance upon prescriptions as a form of health care as the reason that pharmacy access is important.

"As the older population increases, drug use is also up," Doucette said. "Prescriptions are a more cost-effective method of health care than hospitals and, proportionally, more is spent on them. Thus, pharmacy availability becomes essential."

The dominance of independently owned pharmacies in highly rural areas and where there are many people under the poverty level can give pharmacists especially important roles in their communities' health care. Often these pharmacies are managed and owned by actual pharmacists, who are more in tune with innovations and willing to try new practices, Doucette said. Pharmacy managers in retail chain stores must often concentrate on the business aspects of running many stores.

An increasing number of independent pharmacies, however, have been closing. This might suggest the expansion of retail store pharmacies, but these outlets are reluctant to expand to areas where it might be difficult to maintain their business.

Doucette acknowledged this as an area in need of future research.

"There is a lot of interest right now in the rural situation with pharmacies and health care. Many people are concerned that 10 years from now the remaining independent pharmacies, owned by those in retirement age, will close down. Then shortages may be severe," he said.

Doucette plans to follow up on some of the lingering questions from his research with updated statistics. He suggested possible study of the shortages of pharmacists as well as pharmacies.

Before joining the UI faculty and conducting other research, Doucette co-owned an independent pharmacy in Evansville, Wis.

The study was published in the July 1999 issue of the Journal of Clinical Therapeutics.