Local Factors for Community Charitable Pharmacy Implementation

With the implementation of the Affordable Healthcare Act, tax exempt hospitals became required to implement a Community Health Needs Assessment(CHNA) every three years. Many of the same assessments are useful in determining where a charitable pharmacy is to be a located based on community need. Factors assessed by CHNA include:

  • Demographic Assessment identifying the community the pharmacy will serve
    • Population by age group, sex, language
    • Income, insurance, poverty level
    • Public transportation, housing status, education status
  • A community health needs assessment survey of perceived healthcare issues
  • Quantitative analysis of actual health care issues
    • Health Behaviors and Outcomes
  • Appraisal of current efforts to address the healthcare issues
    • Access to healthcare providers (hospitals, clinics)
    • Locations of hospitals and FQHCs
  • Formulate a 3-year plan – the community comes together to address those remaining issues collectively, ultimately working towards growing a healthier community
    • Who are potential local collaborators to improve health outcomes through improved medication access?
    • What other agencies exist in the community that are providing similar services (free medication, aid with PAP applications, etc.)?

Geo-mapping allows visualization and analysis of data as it relates to geographical information (zip code, city, county, state). Comparing a possible site for a community charity pharmacy to health disparities provides insights for the population being served. Disparities include lack of insurance, chronic disease states, transportation to health providers and/or pharmacies, language, and poverty level. Data comparisons with location can be a convincing visual for potential partners and funders.

Figure 1

Uninsured population, Percent for Bridgeport, Connecticut with zip code delineations.

This geo-map can help determine need within the city, where that need is greatest and possible locations that would be nearest the population in need. A comparison to number of patients served and prescriptions filled reflects how well the population’s needs are being met. See How Much Did We Do or How Many?and Appendices/ Marketing/Building a Map of Impact

Map of Uninsured Population, Percent by Tract, ACS 2011 – 15, Greater Bridgeport, Connecticut, USA. Community Commons (2012), Retrieved on 07/17/2017, www.communitycommons.org

Some free online sources for this information are the US Census Bureau, Community Commons, City-Data, and City Health Dashboard.

  • Censusbureau.com/ACSoffers a Fact Finder tool, allowing specific data to be accessed from the previous US census (2010) and the American Community Survey (ACS) which is conducted continually and published annually. Training webinars are available online and ongoing to aid in use of the Fact Finder and their many other tools.
  • CommunityCommons.orgis a website offering common use of the census bureau data by communities with tools to “improve communities and inspire change.” Data can be linked to maps (state, county, city, zip code) to relate data to a specific location. This is useful when determining the location of the charitable pharmacy (See: Location)and in assessing impact of the pharmacy on the community (See: Results-Based Accountability). Sample stories and maps are available to view and adapt to your situation as well as creating maps to fit a specific need. Training tools are available.
  • City-Data.comcollects and analyzes data from a variety of government and private sources to create detailed, informative profiles of cities in the United States. Though not healthcare related, data relating to income, transportation, born outside United States, population density, unemployment, and poverty status are factors affecting a charitable pharmacy population.
  • City Health Dashboardis an interactive tool that provides access to health-related statistics –from housing costs to high blood pressure to premature birth rates in 500 cities across the United States. Data can be broken down into a region within a city and allows comparison of statistics to other cities or the national average.

Pharmacy Deserts

A Pharmacy Desert is a low-income census tract or zip code where a substantial number of residents have low access to a community pharmacy. This definition is based on the USDA definition of a food desert. Patients with chronic diseases living within a pharmacy desert face tough challenges with regards to medication access and information. Several methods can be used to determine a pharmacy desert.

An urban pharmacy desert can be defined as a low-income community or neighborhood with no pharmacy within a half-mile for those with limited vehicle access. For low-income communities with adequate vehicle access, the defining radius extends to a mile.

A rural pharmacy desert is defined as any area within a 10-mile radius without ready access to a community pharmacy (for those that have access to transportation).

Another measure used for determining a pharmacy desert is the density of community pharmacies per 10,000 residents in an area with predominately a low-income (or minority) population compared to areas with moderate income (or non-minority) population (See: Evaluation of racial and socioeconomic disparities in medication pricing and pharmacy access and services).

In determining a pharmacy desert, considerations in an urban setting include resident access to individual or public transportation, walking distance to pharmacy from public transportation, and home prescription delivery service. Limited transportation is also a consideration in a rural setting. A survey to evaluate disparities conducted in Shelby County, TN included “out of pocket” costs of three medications, hours of operation, home medication delivery, a generic drug program, immunizations, and MTM services.

A community charitable pharmacy may be able to address the issues seen in a pharmacy desert by improving affordable medication access and medication information. Locating in or near a place already frequented by the population in need reduces transportation barriers. Mail-order charity pharmacies offer home or close to home delivery for rural populations (See: Locationand Models of Community Charitable Pharmacies).