ABSTRACT
INTRODUCTION: Geographic proximity is an important component of access to primary care and the pharmaceutical services of community pharmacies. Variations in access to primary care have been found between rural and urban areas in Canadian and international jurisdictions. We studied access to community pharmacies in the province of Nova Scotia. METHODS: We used information on the locations of 297 community pharmacies operating in Nova Scotia in June 2011. Population estimates at the census block level and network analysis were used to study the number of Nova Scotia residents living within 800 m (walking) and 2 km and 5 km (driving) distances of a pharmacy. We then simulated the impact of pharmacy closures on geographic access in urban and rural areas. RESULTS: We found that 40.3% of Nova Scotia residents lived within walking distance of a pharmacy; 62.6% and 78.8% lived within 2 km and 5 km, respectively. Differences between urban and rural areas were pronounced: 99.2% of urban residents lived within 5 km of a pharmacy compared with 53.3% of rural residents. Simulated pharmacy closures had a greater impact on geographic access to community pharmacies in rural areas than urban areas. CONCLUSION: The majority of Nova Scotia residents lived within walking or short driving distance of at least 1 community pharmacy. While overall geographic access appears to be lower than in the province of Ontario, the difference appears to be largely driven by the higher proportion of rural dwellers in Nova Scotia. Further studies should examine how geographic proximity to pharmacies influences patients' access to traditional and specialized pharmacy services, as well as health outcomes and adherence to therapy. Can Pharm J 2013;146:39-46.
ABSTRACT
BACKGROUND: Proximity is an important component of access to healthcare services. Recent changes in generic pricing in Ontario have caused speculation about pharmacy closures. However, there is little information on the current geographic accessibility of pharmacies. Therefore, we studied geographic access to pharmacies and modelled the impact of possible closures. METHODS: We used location data on the 3,352 accredited community pharmacies from the Ontario College of Pharmacists and population estimates at the census dissemination block level. Using network analysis, we determined the share of Ontario's population who reside in a census dissemination block within three road travel distances of a community pharmacy: 800 m (walking), 2 km and 5 km (driving). We then simulated the effects on these measures of 10% to 50% reductions in the number of community pharmacies in Ontario. RESULTS: Approximately 63.6% of the Ontario population reside in a dissemination block located within walking distance of one or more pharmacies; 84.6% and 90.7% reside within 2-km and 5-km driving distances, respectively. Randomly removing 30% of Ontario's community pharmacies reduces these estimates to 56.0%, 81.4% and 89.0% for each distance, respectively; a 50% reduction results in 48.3%, 77.1% and 87.2%, respectively. CONCLUSIONS: Pharmacies are geographically accessible for a majority of the Ontario population. Moreover, it appears that modest closures would have only a small impact on geographic access to pharmacies. However, closures may have other impacts on access, such as cost, waiting time and reduced patient choice.
