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Canadian Journal of Public Health

, Volume 109, Issue 5–6, pp 821–832 | Cite as

Geographic disparities in accessing community pharmacies among vulnerable populations in the Greater Toronto Area

  • Lu WangEmail author
  • Sasha Ramroop
Quantitative Research

Abstract

Objectives

Geographic accessibility to community pharmacies (CPs) plays an increasingly important role for the well-being of a community. This study examines the geographic distribution of CPs within the Greater Toronto Area (GTA) relative to the residential patterns of vulnerable populations, including older adults (65+ years), infants and children (0–9 years), and low-income households.

Methods

The study develops a geographic accessibility index at a dissemination area (DA) level by employing the enhanced two-step floating catchment area (E2SFCA) method to measure geographic accessibility to pharmacies. A vulnerability index is also developed to assess and visualize the residential patterns of vulnerable groups. A combined vulnerability-accessibility index is then constructed to identify low-access areas associated with high levels of socio-economic vulnerability. A range of geo-referenced datasets are analyzed within a geographical information system.

Results

The study reveals geographical disparities in accessing pharmacies between urban and suburban areas and across different neighbourhoods, while accounting for population density and distance decay. About 19% of the population (or 15% of DAs) are under-serviced, with very poor geographic access to CPs (1.7 CPs per 10,000 persons), compared to 29.6% of the DAs that are well-/over-serviced, with an average score of 2.8 CPs per 10,000 persons.

Conclusion

The spatial-quantitative analysis at a small geography (DA) allows for improved accuracy for identifying specific neighbourhoods that are in need of greater access to pharmacies by vulnerable residents and areas that have an excessive supply of pharmacies. It provides implications for addressing barriers to accessing pharmacies among high-needs groups, including the rapidly growing older adult population in the GTA.

Keywords

Community pharmacy Geographic accessibility Vulnerable populations Greater Toronto Area 

Résumé

Objectifs

L’accessibilité géographique aux pharmacies communautaires (PC) joue un rôle de plus en plus important pour le bien-être d’un quartier. Notre étude porte sur la distribution géographique des PC dans la région du Grand Toronto par rapport à la répartition par quartiers des populations vulnérables, soit les personnes âgées (65 ans et plus), les nourrissons et les enfants (0 à 9 ans) et les ménages à faible revenu.

Méthode

Un « indice d’accessibilité géographique » est élaboré au niveau de l’aire de diffusion (AD) en employant la méthode améliorée des aires d’attraction flottantes à deux étapes (E2SFCA) pour mesurer l’accessibilité géographique aux pharmacies. Un « indice de vulnérabilité » est également élaboré pour évaluer et visualiser la répartition des groupes vulnérables par quartiers. Un « indice combiné de vulnérabilité et d’accessibilité » est ensuite construit pour cerner les aires à faible accès associées à des niveaux élevés de vulnérabilité socioéconomique. Des jeux de données géoréférencés sont analysés au moyen d’un système d’information géographique.

Résultats

L’étude révèle des disparités géographiques entre les aires urbaines et suburbaines et entre différents quartiers dans l’accès aux pharmacies, tout en tenant compte de la densité de population et de la courbe de fréquentation en fonction de la distance. Environ 19 % des habitants (ou 15 % des AD) sont mal desservis et ont un accès géographique très limité aux PC (1,7 PC pour 10 000 personnes), alors que 29,6 % des AD sont très/excessivement bien desservies, avec un indice moyen de 2,8 PC pour 10 000 personnes.

Conclusion

L’analyse spatio-quantitative à petite échelle géographique (celle des AD) permet une précision améliorée dans le repérage des quartiers où les résidents vulnérables auraient besoin d’un meilleur accès aux pharmacies, et des aires où l’offre de pharmacies est surabondante. Nous en tirons des conséquences pour aborder les obstacles à l’accès aux pharmacies chez les groupes aux besoins élevés, notamment la population en croissance rapide des personnes âgées dans la région du Grand Toronto.

Mots-clés

Pharmacie communautaire Accessibilité géographique Populations vulnérables Région du Grand Toronto 

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Copyright information

© The Canadian Public Health Association 2018

Authors and Affiliations

  1. 1.Ryerson UniversityDepartment of GeographyTorontoCanada

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