The Inverse Care Law might not apply to preventative health services in community pharmacy

The Inverse Care Law states that healthcare availability is inversely related to the needs of the population served. Increasing the provision of community pharmacy (CP) services for cardiovascular disease has been suggested to improve equity of healthcare access, particularly for screening, but few studies examine this. The aim of this study was to determine how the availability and uptake of cardiovascular disease (CVD) prevention services in CPs varies according to practice and local population characteristics.

Pharmacists at all Victorian CPs were invited by phone to participate in a survey. The survey examined pharmacy characteristics, CVD-relevant service characteristics, and resources for service provision. Pharmacists who declined were asked if they would instead briefly provide key information. Area-level socioeconomic (SES) data for each pharmacy was included in the analyses. Binary logistic regression was used to determine the association of pharmacy attributes with service delivery.

Of 1238 CPs identified, 519 (42%) pharmacists completed the full questionnaire and 414 (33%) provided brief information. In general, services were more frequently available from pharmacies in lower SES and rural communities, with quality accreditation and with private counselling facilities. Factors predicting the likelihood of pharmacies receiving reimbursement for services that were not government-funded included having a private room or counselling area, and more than one pharmacist on duty. Factors predicting service delivery volume in the top quartile included script volume and private counselling facilities, and lower SES community profile. Only script volume predicted volume of government-funded medication reviews (MedsChecks).

Our finding that the Inverse Care Law may not apply to preventative service provision in CPs is highly notable and contrary to multiple findings in other settings. An understanding of the context and drivers of increased CP service provision in more vulnerable communities may inform the delivery of more equitable health services generally.