Rural access to clinical pharmacy services

Area of Science:

• Health Services Research
• Pharmacy Practice
• Rural Health

Background:

• Clinical pharmacy services (CPS) are vital for patient care.
• Understanding disparities in CPS access is crucial for equitable healthcare delivery.
• The Veterans Health Administration (VHA) provides a large-scale system to study healthcare utilization patterns.

Purpose of the Study:

• To investigate how rural versus urban residence and primary care site influence the utilization of clinical pharmacy services (CPS).
• To describe the adoption and patterns of clinical telepharmacy within the VHA.
• To identify potential disparities in CPS access based on patient location and care setting.

Main Methods:

• Analysis of 2011 national VHA data for over 3 million patients.
• Comparison of CPS encounter frequency based on patient residence (urban/rural) and primary care site (medical center, urban clinic, rural clinic).
• Logistic regression modeling to estimate the likelihood of CPS utilization, examining individual service types and telehealth delivery modes.

Main Results:

• 23.4% of patients received CPS; utilization varied by residence (urban 24.9%, rural 19.7%) and primary care site (medical center 25.9%, urban clinic 22.5%, rural clinic 17.6%).
• Adjusted analyses indicated primary care site, not patient residence, was the main driver of urban-rural differences in CPS use.
• Telehealth accounted for nearly half of CPS encounters; video telehealth was infrequent but more common in rural clinics compared to medical centers.

Conclusions:

• A disparity in CPS access exists between rural and urban patients, primarily linked to reliance on community clinics over medical centers for primary care.
• Emerging strategies like telehealth expansion and primary care integration of pharmacists may address these disparities.
• Further research is needed to confirm the impact of these changes and their applicability to other healthcare systems.