USC’s Dima M. Qato spent more than a decade working as a community pharmacist and public health advocate in Chicago’s underserved refugee and immigrant communities.
Through her experience and public health training, Qato — the daughter of a pharmacist and now an associate professor in medical school. USC School of Pharmacy — have come to regard access to pharmacies as a human rights issue. Pharmacies are an often overlooked part of the puzzle of access to healthcare.
As a pharmacist, she noticed that people in low-income areas took time off from work just to pick up their medication. Also, in some cases, she did not receive any medicine at all when the medicine was not in stock and the prescription had to be made at another pharmacy far away. According to Cato, patients in high-income, mostly white communities did not really experience these access barriers.
“For decades, the World Health Organization has considered geographic access to pharmacies to be one of the key determinants of access to essential medicines,” it said. Associate Professor Kato He is a Hygeia Centennial Chair in the School of Pharmacy and a Senior Fellow at the USC Leonard D. Schaefer Center for Health Policy and Economics.
“Despite the important role of pharmacy in providing essential medicines to the community, when I completed my PhD 15 years ago, no one took pharmacy access seriously. It wasn’t even people investigating gender or medication adherence imbalances,” she added. “It wasn’t part of the conversation. So I started asking questions.”
Designing a map to identify the “pharmacy desert”
Her latest project is an interactive national mapping tool that shows the location of all pharmacies in the United States and which areas fall into the “pharmacy desert” or pharmacy scarcity categories.of Pharmacy Access Initiative School of Pharmacy, USC Schaefer Center, Spatial Science Laboratory at the USC Dornsife College of Letters, Arts and Sciences, and the National Community Pharmacists Association, which represents independent pharmacies across the country.
The map identifies nearly a quarter of the areas representing millions of Americans as pharmacy shortage areas.
By working together, we were able to tackle the problem on a national scale.
Robert VossUSC Dornsife Institute for Spatial Sciences
“Dr. Qato has spent several years pondering the various barriers to access to pharmacy and how they affect health care equity. Robert Voss, Associate Professor of Spatial Science (Education), who helped build the tool. “We combined her insight into pharmacy access with spatial thinking and computing. We were able to better understand geographic contexts such as urban versus rural.”
This tool can serve multiple purposes to influence policy and improve public health.
Mapping the pharmacy desert
First, the map defines pharmacy shortage areas as areas where the distance to a pharmacy is 10 miles or more in rural areas, 2 miles or more in suburban areas, 1 mile or more in urban areas, and 0.5 miles or more in low-income areas. I’m here. Low car ownership.
In previous research by Qato, one-third of the region In large US cities, including Los Angeles, it’s a pharmacy desert. The areas most affected are the segregated Black or Hispanic/Latino communities within these cities.
“If you don’t have a car, have trouble walking, bad bus connections, bad weather, and a child who needed that antibiotic yesterday because of a raging infection, miles It may not be possible. “When you consider time and effort, 0.5 miles can turn into 30 miles.”
Mapping the need for better policies
Qato hopes the mapping tool will inform federal and state policy changes that improve health equity.
For example, Medicare Part D and Medicaid health plans have pharmacy networks that often exclude independent (and some chain) pharmacies that primarily serve Black and Hispanic/Latino populations. I have. Kurt said such policies are a form of structural racism, forcing historically marginalized people to travel far and wide to the nearest pharmacy to restock their medications.
Removing pharmacies from the network will lead to underutilization and, in many cases, closure of pharmacies in these areas, Qato said.
Maps help address unfair enforcement of policies and pharmacy reimbursement
Not only can this map reveal the country’s pharmacy desert, but it can also provide a framework for promoting accountability. This includes regulation of pharmacy benefit managers, which play an important role in low and unfair pharmacy reimbursement and pharmacy closures.
It is important to verify that your local pharmacy actually stocks essential medicines and provides the essential services they are authorized to provide.
Dima M. KatoUSC Schaefer Center
“In terms of the impartial implementation of federal and state policies, it is important to ensure that local pharmacies stock the medicines they actually need and provide the essential services they are authorized to provide. is,” said Qato.
For example, pharmacists in California and some other states can prescribe and dispense contraceptives and pre-exposure prophylaxis (PrEP) for HIV prevention, Qato said. All state pharmacies are also permitted to dispense buprenorphine or naloxone, an opioid overdose antidote, for the treatment of opioid use disorders.
Although pharmacists are licensed for these services, Qato explained that access remains a problem for those who do not receive them.
Mapping risks for people not taking drugs
Finally, mapping tools can also provide important insights into areas at risk of pharmacy desertification.
“My work in Chicago and elsewhere, including Los Angeles, has found that predominantly Black and Hispanic neighborhoods have fewer pharmacies and are more likely to experience closures. We give,” said Qato. “We found that people who filled prescriptions at pharmacies that were subsequently closed were more likely to discontinue their prescriptions.”
Vos said the mapping tool was developed with an easy-to-use Web GIS software design. The tool will be rolled out through training webinars for interested parties in the coming months.
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