Community Pharmacy Density Across Remote, Rural, Regional and Metropolitan Areas of Australia: An Ecological Study

To investigate community pharmacy density (CPD) at national and subnational (i.e., below-national) levels in Australia, and examine area-level factors associated with CPD.

Aggregate, 2024 data on Australia's community pharmacies (CPs) and Statistical Area Level 3 (SA3) populations were sourced. CPD (number of CPs/10 000 population) was calculated nationally and sub-nationally. SA3 characteristics associated with CPD quintiles were examined via partial proportional odds regression. Statistical significance was set at p < 0.05.

There were 6 032 CPs across 336 SA3s. CPD was 2.22, 2.09, and 2.63 CPs/10 000 population for Australia overall, metropolitan Australia, and remote/rural/regional Australia, respectively. SA3-level data revealed CPD tended to be lower for outer- than inner-city metropolitan areas. Clusters of SA3s with lowest-quintile CPD (i.e., 'pharmacy deserts') were observed. Four large, remote SA3s in the Northern Territory (NT) (e.g., Daly-Tiwi-West Arnhem) had lowest-quintile CPD, as did many outer-city (e.g., Manningham East, Victoria) or other remote/rural/regional (e.g., Baw Baw, Victoria) SA3s. SA3 characteristics associated with a one-quintile increase in CPD included remote/rural/regional (relative to metropolitan) areas (adjusted odds ratio [aOR] = 4.68, 95% confidence interval [CI] = 2.24-9.81) and percentage of male residents (aOR = 1.38, 95% CI = 1.16-1.63). Additionally, CPD tended to significantly increase with increasing percentages of residents aged 85+ or 65-84 years, and to significantly decrease with increasing SA3 area (km²).

Correlates of CPD, and particular SA3s with lowest-quintile CPD, could inform legislation, policies, and decisions related to CP premises and workforce Australia-wide (e.g., Australia's Pharmacy Location Rules and state/territory-level CP ownership legislation). Future studies of CPD across Australia should assess the correlation between CPD and general practice density, and incorporate additional subnational area characteristics (e.g., socioeconomic status) and CP accommodations (e.g., opening hours).