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

  • Quantitative Research
  • Published:
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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.

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.

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References

  • Agomo, C. O. (2012). The role of community pharmacists in public health: a scoping review of the literature. J Pharm Health Serv Res, 3(1), 25–33.

    Article  Google Scholar 

  • Arcury, T. A., Gesler, W. M., Preisser, J. S., Sherman, J., Spencer, J., & Perin, J. (2005). The effects of geography and spatial behavior on health care utilization among the residents of a rural region. Health Services Research, 40(1), 135–155.

    Article  Google Scholar 

  • Bath, B., Gabrush, J., Fritzler, R., Dickson, N., Bisaro, D., Bryan, K., & Shah, T. I. (2015). Mapping the physiotherapy profession in Saskatchewan: examining rural versus urban practice patterns. Physiotherapy Canada, 67(3), 221–231.

    Article  Google Scholar 

  • Bell, N., & Hayes, M. V. (2012). Use of area-based socio-economic measures. Canadian Journal of Public Health, Suppl Contemporary; Ottawa, 103, S28–S32A.

    Google Scholar 

  • Billi, J. E., Pai, C., & Spahlinger, D. A. (2007). The effect of distance to primary care physician on health care utilization and disease burden. Health Care Management Review, 32(1), 22.

    Article  Google Scholar 

  • Buchan, S. A., Rosella, L. C., Finkelstein, M., Juurlink, D., Isenor, J., Marra, F., … Kwong, J. C. (2017). Impact of pharmacist administration of influenza vaccines on uptake in Canada. CMAJ: Canadian Medical Association Journal, 189(4), E146-E152.

  • Canadian Pharmacist Association. (2013). Summary of pharmacists’ expanded scope of practice activities across Canada. Accessed in July 2017 https://www.pharmacists.ca/pharmacy-in-canada/scope-of-practice-canada/.

  • Cao, Y., Stewart, K., & Kalil, R. (2016). Geographic patterns of end-stage renal disease and kidney transplants in the Midwestern United States. Applied Geography, 71, 133–143.

    Article  Google Scholar 

  • Casey, M., Kligner, J., & Moscovice, I. (2008). Pharmacy services in rural areas: is the problem geographic access or financial access? The Journal of Rural Health, 18(3), 467–477.

    Article  Google Scholar 

  • Chateau, D., Metge, C., Prior, H., & Soodeen, R. A. (2012). Contemporary use of area-based socio-economic measures. Canadian Journal of Public Health, 103, S23–S27A.

    PubMed  Google Scholar 

  • Dai, D., & Wang, F. (2011). Geographic disparities in accessibility to food stores in southwest Mississippi. Environment and Planning. B, Planning & Design, 38(4), 659–677.

    Article  Google Scholar 

  • Denny, K., & Davidson, M. (2012). Area-based socio-economic measures as tools for health disparities research, policy and planning. Canadian Journal of Public Health / Revue Canadienne De Sante'e Publique, 103, S4–S6.

    Google Scholar 

  • Donohoe, J., Marshall, V., Tan, X., Camacho, F. T., Anderson, R., & Balkrishnan, R. (2016). Evaluating and comparing methods for measuring spatial access to mammography centers in Appalachia. Health Services & Outcomes Research Methodology, 6, 22–40.

    Article  Google Scholar 

  • Emami, E., Khiyani, M., Habra, C., Chassé, V., & Rompré, P. H. (2016). Mapping the Quebec dental workforce: ranking rural oral health disparities. Rural Remote Health, 16(1), 3630.

    PubMed  Google Scholar 

  • Frank, L. D., Sallis, J. F., Saelens, B. E., Leary, L., Cain, K., Conway, T. L., & Hess, P. M. (2009). The development of a walkability index: application to the neighborhood quality of life study. British Journal of Sports Medicine, 44, 924–933.

    Article  Google Scholar 

  • Fransen, K., Neutens, T., Farber, S., De Maeyer, P., Deruyter, G., & Witlox, F. (2015). Identifying public transport gaps using time-dependent accessibility levels. Journal of Transport Geography, 48, 176–187.

    Article  Google Scholar 

  • Goad, J. A., Taitel, M. S., Fensterheim, L. E., & Cannon, A. E. (2013). Vaccinations administered during off-clinic hours at a national community pharmacy: implications for increasing patient access and convenience. Annals of Family Medicine, 11(5), 429.

    Article  Google Scholar 

  • Health Canada. (2001). Health expenditures by age and sex, 1980–81 to 2000–01. Ottawa: Health Policy and Communications Branch, Health Canada.

    Google Scholar 

  • Hiscock, R., Pearce, J., Blakely, T., & Witten, K. (2008). Is neighborhood access to health care provision associated with individual-level utilization and satisfaction? Health Services Research, 43(6), 2183–2200.

    Article  Google Scholar 

  • Horsfield, E., Sheridan, J., Kelly, F., Robinson, E., Clark, T., & Ameratunga, S. (2014). Filling the gaps: opportunities for community pharmacies to help increase healthcare access for young people in New Zealand: could pharmacies increase youth healthcare access? International Journal of Pharmacy Practice, 22(3), 169–177.

    Article  Google Scholar 

  • Hughes, C. A., Breault, R. R., Hicks, D., & Schindel, T. J. (2017). Positioning pharmacists’ roles in primary health care: a discourse analysis of the compensation plan in Alberta, Canada. BMC Health Services Research, 17(1), 770.

    Article  Google Scholar 

  • Hulchanski, J. D. (2010). The three cities within Toronto: Income polarization among Toronto's neighbourhoods, 1970–2005. Toronto: Cities Centre, University of Toronto.

    Google Scholar 

  • Hussainy, S. Y., Ghosh, A., Taft, A., Mazza, D., Black, K. I., Clifford, R., … Jackson, J. K. (2015). Protocol for ACCESS: a qualitative study exploring barriers and facilitators to accessing the emergency contraceptive pill from community pharmacies in Australia. BMJ Open, 5(12), e010009.

  • Ikram, S. Z., Hu, Y., & Wang, F. (2015). Disparities in spatial accessibility of pharmacies in Baton Rouge, Louisiana. Geographical Review, 105(4), 492–510.

    Article  Google Scholar 

  • Kennie-Kaulbach, N., Farrell, B., Ward, N., Johnston, S., Gubbels, A., Eguale, T., … & Winslade, N. (2012). Pharmacist provision of primary health care: a modified Delphi validation of pharmacists’ competencies. BMC Family Practice, 13(1), 27.

  • Lee, G., & Hong, I. (2013). Measuring spatial accessibility in the context of spatial disparity between demand and supply of urban park service. Landscape and Urban Planning, 119, 85–90.

    Article  Google Scholar 

  • Lin, S. J. (2004). Access to community pharmacies by the elderly in Illinois: a geographic information systems analysis. Journal of Medical Systems, 28(3), 301–309.

    Article  Google Scholar 

  • Lluch, M., & Kanavos, P. (2010). Impact of regulation of community pharmacies on efficiency, access and equity. Evidence from the UK and Spain. Health Policy, 95(2), 245–254.

    Article  Google Scholar 

  • Lo, L., Preston, V., Anisef, P., Basu, R., & Wang, S. (2015). Social infrastructure and vulnerability in the suburbs. Toronto: University of Toronto Press.

    Google Scholar 

  • Luo, W., & Qi, Y. (2009). An enhanced two-step floating catchment area (E2SFCA) method for measuring spatial accessibility to primary care physicians. Health & Place, 15, 1100–1107.

    Article  Google Scholar 

  • Luo, W., & Wang, F. (2003). Measures of spatial accessibility to health care in a GIS environment: synthesis and a case study in the Chicago region. Environment and Planning. B, Planning & Design, 30, 865–884.

    Article  Google Scholar 

  • Matheson, F., Dunn, J., Smith, K., Moineddin, R., & Glazier, R. (2012). Development of the Canadian marginalization index: a new tool for the study of inequality. Canadian Journal of Public Health / Revue Canadienne De Sante'e Publique, 103, S12–S16.

    Google Scholar 

  • McGrail, M. R. (2012). Spatial accessibility of primary health care utilising the two step floating catchment area method: an assessment of recent improvements. International Journal of Health Geographics, 11, 50–50.

    Article  Google Scholar 

  • Ngui, A. N., & Vanasse, A. (2012). Assessing spatial accessibility to mental health facilities in an urban environment. Spatial and Spatio-temporal Epidemiology, 3(3), 195–203.

    Article  Google Scholar 

  • Norris, P., Horsburgh, S., Sides, G., Ram, S., & Fraser, J. (2014). Geographical access to community pharmacies in New Zealand. Health & Place, 29, 140–145.

    Article  Google Scholar 

  • Papastergiou, J., Folkins, C., Li, W., & Young, L. (2016). Community pharmacy rapid influenza A and B screening: a novel approach to expedite patient access to care and improve clinical outcomes. Canadian Pharmacists Journal / Revue Des Pharmaciens Du Canada, 149(2), 83–89.

    Article  Google Scholar 

  • Parker, R. M., Bell, A., Currie, M. J., Deeks, L. S., Cooper, G., Martin, S. J., … Bowden, F. J. (2015). ‘Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people. Australian Journal of Primary Health, 21(1), 79.

  • Qato, D., & Lambert, B. (2014). ‘Pharmacy deserts’ are prevalent in Chicago’s predominantly minority communities, raising medication access concerns. Health Affairs (Project Hope), 33(11), 1958–1965.

    Article  Google Scholar 

  • Rushworth, G. F., Cunningham, S., Pfleger, S., Hall, J., & Stewart, D. (2017). A cross-sectional survey of the access of older people in the Scottish highlands to general medical practices, community pharmacies and prescription medicines. Research in Social and Administrative Pharmacy. https://doi.org/10.1016/j.sapharm.2017.01.002.

  • Schuurman, N., Berube, M., & Crooks, V. A. (2010). Measuring potential spatial access to primary health care physicians using a modified gravity model. The Canadian Geographer/Le Geographe Canadien, 54(1), 29–45.

    Article  Google Scholar 

  • Shah, A. (2010). Pharmacy intervention in the medication-use process: the role of pharmacies in improving patient safety (pp. 1–50). Winnipeg: University of Manitoba.

    Google Scholar 

  • Tannenbaum, C., & Tsuyuki, R. (2013). The expanding scope of pharmacists’ practice: implications for physicians. Canadian Medical Association Journal, 185(14), 1228–1232.

    Article  Google Scholar 

  • Toronto Public Health. The unequal city 2015: income and health inequities in Toronto. April 2015.

  • Wang, L. (2007). Immigration, ethnicity, and accessibility to culturally diverse family physicians. Health & Place, 13, 656–671.

    Article  Google Scholar 

  • Wang, L. (2014). Immigrant health, socioeconomic factors and residential neighbourhood characteristics: A comparison of multiple ethnic groups in Canada. Applied Geography, 51, 90–98.

  • Wang, L. (2018). Unequal spatial accessibility of integration-promoting resources and immigrant health: a mixed-methods approach. Applied Geography, 92, 140–149.

    Article  Google Scholar 

  • Wang, L., & Tormala, T. (2014). Integrating spatial and aspatial factors in measuring accessibility to primary health care physicians: a case study of Aboriginal population in Sudbury, Canada. Journal of Community Medicine and Health Education, 4, 3.

    Google Scholar 

  • Williams, S., & Wang, F. (2014). Disparities in accessibility of public high schools, in metropolitan Baton Rouge, Louisiana 1990-2010. Urban Geography, 35, 1066–1083.

    Article  Google Scholar 

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Authors and Affiliations

  1. Ryerson University, Department of Geography, 305 Victoria Street, Toronto, Ontario, M5B 2K3, Canada

    Lu Wang & Sasha Ramroop

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  1. Lu Wang
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  2. Sasha Ramroop
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Correspondence to Lu Wang.

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Wang, L., Ramroop, S. Geographic disparities in accessing community pharmacies among vulnerable populations in the Greater Toronto Area. Can J Public Health 109, 821–832 (2018). https://doi.org/10.17269/s41997-018-0110-1

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