Continuous Services in the Absence of Retail Pharmacies in Rural Communities

Research center:
Lead researcher:
Project funded:
September 2020
Anticipated completion date:
August 2021

The aim of this project is to broaden the RUPRI Center's longtime focus on closures of independent pharmacies in rural places by identifying rural communities that lost all retail pharmacies from 2003 through 2019. This work will expand previous Center work beyond a focus on local independent pharmacies by incorporating chain pharmacies, including pharmacies located in larger retail outlets such as grocery stores and merchandising stories (e.g., Shopko, Walmart). First, the Center will identify the number of pharmacy closures over time by the type of pharmacy (independent, chain) and by rurality.

  1. Hypothesis 1: The Center hypothesizes that it will see recent increases in closures of chain pharmacies or pharmacies that are part of a larger retail outlet in rural areas.

    Second, the Center will identify pharmacy deserts (i.e., zero pharmacies) at the Primary Care Service Area (PCSA) level by rurality.
  2. Hypothesis 2: The Center hypothesizes that the number of pharmacy deserts in rural areas is increasing.

    Aim 2 of this project will use multivariate regression techniques to compare the characteristics of communities with no pharmacy (pharmacy deserts) to those with at least one pharmacy. More specifically, the Center will test the following hypotheses using a multivariate regression framework.
  3. Hypothesis 3: Pharmacy deserts are associated with higher rates of poverty, higher percentages of persons insured through Medicare and Medicaid, and higher percentages of uninsured.
  4. Hypothesis 4: Pharmacy deserts are associated with low population density and/or population declines.
  5. Hypothesis 5: Pharmacy deserts are associated with declines in the number of primary care providers in the community.

Design: For Aim 1, Hypothesis 1, the Center will apply an approach previously used by the RUPRI Center to classify and track rural pharmacies. Monthly data will be evaluated to determine if a pharmacy is closed or open. The Center considers a pharmacy closed if the provider identification number ceases to be included in the monthly data set or when a closure date was specified. Care will be taken to assess other pharmacy activity in the geography to account for facility sales or transfers.

For Aim 1, Hypothesis 2, and Aim 2, Hypotheses 1-3, the Center will create a longitudinal data set of pharmacy deserts at the PCSA level from 2003 to 2019 by linking multiple data sources. For each year, the Center will classify a given PCSA as a pharmacy desert if it does not have any pharmacy operating within its boundaries. The Center will merge data on community characteristics, such as poverty level, population count and age distribution, population gain or loss, and insurance status from the American Community Survey using PCSA component ZIP code tabulation areas. Community primary care providers will be tabulated from National Provider Identifier data.