Pharmacists are often the most accessible health care professionals, which is why a lack of access to pharmacies can have a detrimental effect on patients, especially those with chronic conditions.
A pharmacy desert is defined as an area where limited access to pharmacies is acute. A 2014 study in Health Affairs found that segregated black and Hispanic communities in Chicago, Illinois are more likely to be host to pharmacy deserts and that 1 million people in the city were living in these pharmacy deserts. Fifty-three percent of those individuals were living in segregated black communities.
In addition to dispensing prescription medications, local pharmacies have a role to play in the sale of OTC products and, increasingly, the provision of diagnostic, preventive, and urgent-care services, wrote the study coauthors.
Pharmacists, in particular those practicing in retail environments, are often the most accessible health care professionals, said Sean Nordt, MD, PharmD, associate dean of academic affairs, chief medical officer, and professor of pharmacy at Chapman University School of Pharmacy in Irvine, California. Whereas a patient needs to register at the hospital to see a physician, all they need to do is walk into their local pharmacy to ask questions, he explained.
That’s why lack of access to pharmacies can have a detrimental effect on patients, in particular those with chronic conditions, said Stephanie Kiser, PharmD, clinical assistant professor at The University of North Carolina Eshelman School of Pharmacy in Chapel Hill. A pharmacist for more than 25 years, Kiser grew up in a rural area and witnessed firsthand that accessing care often requires driving far distances.
She cited the example of a patient who needs to be monitored in person twice weekly until their body adjusts to an anticoagulant. Although that involves 4 inconvenient 10-minute car rides for someone in a suburban area, it could require a 90-minute drive twice a week for the person who lives in a rural area, she explained.
According to a 2018 study in Rural Policy Brief, 16.1% of independently owned rural pharmacies closed between 2003 and 2018. A 2019 study3 in JAMA Network Open found that pharmacy closures “are associated with persistent, clinically significant declines in adherence to cardiovascular medications among older adults in the United States.”
Engaging Homeless Populations in Accessing Care
Skid Row is a 53-block area east of downtown Los Angeles, California where approximately 2700 members of the homeless community live.
To encourage members of Skid Row’s homeless population to seek health care, Jemal Hussein, a PharmD student at Keck Graduate Institute’s School of Pharmacy and Health Sciences in Claremont, partners with students at local health sciences graduate schools, such as the Univiersity of California, Los Angeles, School of Dentistry and the Marshall B. Ketchum University School of Physician Assistant Studies in Fullerton.
One tangible impact of their work is the care kit, which includes items such as a toothbrush, toothpaste, sanitary pads, articles of clothing (such as a T-shirt, socks, or a sweater), and a hand-written note from one of the student volunteers. The idea behind the note is to tell the person that “you’re loved and thought about,” said Hussein, who leads the graduate school’s Community. Advocacy. Resources. Education. organization. Volunteers use the interaction to spark a conversation, which can help get members of the homeless population access to the medication, dental, and health care services they need, he explained.
Connecting to Patients Through Shared Language and Culture
Samantha Garcia, who is also pursuing a PharmD degree at Keck Graduate Institute, said that speaking the same language as the person you’re treating makes a difference. In particular, patients need to understand that taking their blood pressure medication can keep them out of the hospital, she noted. “It’s difficult if your pharmacist or doctor can’t speak your language and you need to take this medication to prevent [you from] having a stroke or a heart attack,” said Garcia.
According to Garcia, her proficiency in Tagalog, the primary language spoken in the Philippines, came in handy last semester at a clinic held for members of the homeless community in nearby Pomona. Services at the clinic included blood pressure checks and education about the signs and symptoms of stroke. As soon as her patient heard her speak in Tagalog, she “perked up,” Garcia said, despite the fact that she was counseling the patient against eating fried pig, a popular Filipino dish, which isn’t good for her health.
It’s important for providers to make that connection with patients and close that gap in a culturally aware manner, said Garcia, who leads the Student National Pharmaceutical Association chapter at the graduate school.
Diagnosing and Treating Asthma in Children
More than 22% of schoolchildren in Pittsburgh, Pennsylvania, have asthma, according to a Journal of Allergy and Clinical Immunology study published in 2018.4 That’s more than double the state’s asthma prevalence rate of 10.2%5 among children and significantly higher than 7.5% for children across the country.
Patients with persistent asthma need access to their daily medications for the condition to be well controlled, explained Jennifer Padden Elliott, PharmD, associate professor at Duquesne University’s School of Pharmacy in Pittsburgh. If their asthma isn’t well controlled, children end up in the emergency room and miss school days, she added.
In 2014, Elliott developed a community-based screening model to diagnose asthma in children and connect them with the care they need. The free service is available in schools throughout Allegheny County, which is home to Duquesne University. The screening model starts with a health questionnaire sent to parents at the start of the school year. Students in Duquesne University’s pharmacy program help tabulate the results and reach out to parents.
In addition, Elliott launched school-based asthma clinics in partnership with federally qualified health centers in the surrounding neighborhoods in 2017. For clinical pharmacists from Duquesne University’s pharmacy, schoolwork takes place at the asthma clinics, where the condition is managed during the school day and medication changes and other updates are communicated to the student’s primary care physician. For example, students can have their lung function assessed using a spirometer at the asthma clinics.
Students in Duquesne University’s pharmacy program can participate in rotations with the asthma clinics, said Elliott. They shadow pharmacists who staff the program and help counsel children and their families on topics such as inhaler techniques and adherence with treatment plans.
Exposing Pharmacy Students to Urban and Rural Experiences
Patients struggle to manage chronic conditions such as diabetes in rural and urban areas, explained Estela Lajthia, PharmD, clinical assistant professor at Howard University in Washington, DC.
The same challenges associated with drug prices and lack of access to preventive care also plague people in rural and urban settings, she said.
To expose its students to the experi- ence of serving as pharmacists in a rural environment, Howard University has partnered with the University of Wyoming School of Pharmacy in Laramie on an exchange program, with 4 students from both schools traveling to the other school since fall 2018.
Students from Wyoming School of Pharmacy learn about health care systems in inner-city Washington, DC, and meet congressional leaders, and Howard University students are exposed to critical-access hospitals and health care systems in rural settings, said Lajthia, an ambulatory care pharmacist.
Lack of convenient access to health care services and increasing closures of independent pharmacies contribute to gaps in patient care in both rural and urban settings. Exposing pharmacy students to these work experiences in pharmacy desert neighborhoods can prepare the next generation of pharmacists to close these gaps.