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      Mapping pharmacy deserts and determining accessibility to community pharmacy services for elderly enrolled in a State Pharmaceutical Assistance Program

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          Abstract

          Objectives

          Limited studies have investigated geographic accessibility to a nearby community pharmacy for elderly which is an essential determinant of the access to medications and pharmacy services. This research identified pharmacy deserts and investigated availability of different types of community pharmacies and their services for elderly enrolled in a State Pharmaceutical Assistance Program (SPAP).

          Methods

          The state of Pennsylvania in the US was used as a case to demonstrate the geographic accessibility to community pharmacy and services for elderly enrolled in SPAP. The locations of community pharmacies and households of elderly enrolled in SPAP were derived from Pharmaceutical Assistance Contract for the Elderly programs’ database. The street addresses were geocoded and the distance to a nearby community pharmacy was calculated for study sample using the haversine formula. The demographic and geographic data were aggregated to Census Tracts and pharmacy deserts were identified using the predefined criteria. Descriptive statistical analysis was used to determine whether there are statistical differences in the socio-demographic profiles and distribution of different types of community pharmacies and their services in pharmacy deserts and non-deserts. This research used hot spot analyses at county level to identify clusters of pharmacy deserts, areas with high concentration of different racial/ethnic groups and clusters of high densities of chain and independent pharmacies.

          Results

          The Spatial analysis revealed that 39% and 61% Census Tracts in Pennsylvania were pharmacy deserts and non-deserts respectively (p < 0.001). Pharmacy deserts were found to have significantly more females, married and white elderly and fewer blacks and Hispanics compared to pharmacy non-deserts. Pharmacy deserts had significantly fewer chain and independent pharmacies and less delivery and 24-hour services in pharmacies than pharmacy non-deserts. Hot spot analyses showed that clusters of pharmacy deserts were more concentrated in southcentral, northwest and northeast regions of the state which represent rural areas and overlapped with clusters of high concentration of white individuals.

          Conclusions

          The findings suggest that urban-rural inequality, racial/ethnic disparity and differences in availability of pharmacies and their services exist between pharmacy deserts and non-deserts. The methodological approach and analyses used in this study can also be applied to other public health programs to evaluate the coverage and breadth of public health services.

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          Most cited references 34

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          Use of medications and polypharmacy are increasing among the elderly.

          To assess changes in medicine use and polypharmacy, two cross-sectional surveys were carried out among community-dwelling persons aged 64 years or over in 1990-91 (n = 1,131) and 1998-99 (n = 1,197) in the municipality of Lieto in southwestern Finland. In addition to drug use, the questionnaire included items on social background, quality of life, and home nursing services. Among those surveyed, 78% in 1990-1991 and 88% in 1998-1999 (P =.001) used prescription drugs during 7 days prior to the interview. The most commonly used medications were for the cardiovascular and central nervous systems. The number of medications per person increased from 3.1 (SD 2.8) to 3.8 (SD 3.1) (P =.0001), and polypharmacy (concominant use of over five medications) increased from 19 to 25% (P =.006). These changes were most prominent among persons aged 85 years or over, especially among women. Polypharmacy is a complex and worrying phenomenon that merits more research.
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            Potentially harmful drug-drug interactions in the elderly: a review.

            Elderly patients are vulnerable to drug interactions because of age-related physiologic changes, an increased risk for disease associated with aging, and the consequent increase in medication use. The purpose of this narrative review was to describe findings from rigorously designed observational cohort and case-control studies that have assessed specific drug interactions in elderly patients. The PubMed and International Pharmaceutical Abstracts databases were searched for studies published in English over the past 10 years (December 2000-December 2010) using relevant Medical Subject Headings terms (aged; aged, 80 and over; and drug interactions) and search terms (drug interaction and elderly). Search strategies were saved and repeated through September 2011 to ensure that the most recent relevant published articles were identified. Additional articles were found using a search of review articles and reference lists of the identified studies. Studies were included if they were observational cohort or case-control studies that reported specific adverse drug interactions, included patients aged ≥65 years, and evaluated clinically meaningful end points. Studies were excluded if they used less rigorous observational designs, assessed pharmacokinetic/pharmacodynamic properties, evaluated drug-nutrient or drug-disease interactions or interactions of drug combinations used for therapeutic benefit (eg, dual antiplatelet therapy), or had inconclusive evidence. Seventeen studies met the inclusion criteria. Sixteen studies reported an elevated risk for hospitalization in older adults associated with adverse drug interactions. The drug interactions included: angiotensin-converting enzyme (ACE) inhibitors and potassium-sparing diuretics, ACE inhibitors or angiotensin receptor blockers and sulfamethoxazole/trimethoprim, benzodiazepines or zolpidem and interacting medications, calcium channel blockers and macrolide antibiotics, digoxin and macrolide antibiotics, lithium and loop diuretics or ACE inhibitors, phenytoin and sulfamethoxazole/trimethoprim, sulfonylureas and antimicrobial agents, theophylline and ciprofloxacin, and warfarin and antimicrobial agents or nonsteroidal anti-inflammatory drugs. One study reported the risk for breast cancer-related death as a function of paroxetine exposure among women treated with tamoxifen. Several population-based studies have reported significant harm associated drug interactions in elderly patients. Increased awareness and interventions aimed at reducing exposure and minimizing the risks associated with potentially harmful drug combinations are needed. Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.
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              Pharmacist consultations in general practice clinics: the Pharmacists in Practice Study (PIPS).

              Medication-related problems (MRPs) are a concern in primary care settings. Pharmacists based in the community or community pharmacies are able to identify, resolve and prevent MRPs; however, the lack of a formal partnership with physicians and poor access to patients' medical records are limitations. In Australia, delivery of pharmacist services within general practice clinics is rare.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SoftwareRole: VisualizationRole: Writing – original draft
                Role: ConceptualizationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                4 June 2018
                2018
                : 13
                : 6
                Affiliations
                [001]Department of Health Policy, University of the Sciences, Philadelphia, Pennsylvania, United States of America
                Stony Brook University, Graduate Program in Public Health, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-18-03513
                10.1371/journal.pone.0198173
                5986116
                29864159
                e129b19e-73b8-40f1-a613-9b2699eeb63c
                © 2018 Pednekar, Peterson

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 7, Tables: 3, Pages: 19
                Product
                Funding
                PP and purchasing of the ArcGIS software was supported by the John Wyeth Dean Fund of Mayes College of Healthcare Business and Policy.
                Categories
                Research Article
                Biology and Life Sciences
                Ecology
                Ecosystems
                Deserts
                Ecology and Environmental Sciences
                Ecology
                Ecosystems
                Deserts
                Ecology and Environmental Sciences
                Terrestrial Environments
                Deserts
                Medicine and Health Sciences
                Geriatrics
                People and Places
                Population Groupings
                Age Groups
                Elderly
                People and places
                Geographical locations
                North America
                United States
                Pennsylvania
                Research and Analysis Methods
                Research Design
                Survey Research
                Census
                Earth Sciences
                Geography
                Geographic Areas
                Urban Areas
                Earth Sciences
                Geography
                Geographic Areas
                Rural Areas
                Earth Sciences
                Geography
                Human Geography
                Urban Geography
                Social Sciences
                Human Geography
                Urban Geography
                Custom metadata
                The dataset analyzed during the current study are not shared publicly because they contain sensitive health-related data of the study population and must be securely protected to ensure their confidentiality and privacy. The dataset is owned by a third-party organization named 'Pharmaceutical Assistance Contract for elderly (PACE)'. The dataset was obtained by authors from PACE after signing the data use agreement. Data requests can be sent to following contact: Debra Heller, Sr. Health Outcomes Scientist, Magellan Rx Management/PACE, 4000 Crums Mill Road, Suite 301, Harrisburg, PA 17112 (phone: 717.651.3629 / email: DAHeller@ 123456magellanhealth.com ). The study was approved by Institutional Review Board of University of the Sciences, which can be contacted at: Greg Thielman, IRB Chair (phone: 215-596-8680 / email: irb@ 123456usciences.edu ). The authors did not have any special access to the data that other researchers would not have.

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