Evaluation of urban-rural differences in pharmacy practice needs in Maine with the MaPPNA
Background: Maine is a rural state with an aging population located in the northeastern United States. Pharmacists play an important role in serving the public’s health as they are often the most available point-of-contact within a community.
Objective: To assess the current pharmacy practice needs as viewed by licensed pharmacists across our rural state, and to distinguish issues that are unique to rural pharmacy practice.
Methods: An online survey was sent to all licensed pharmacists in the state in the fall of 2014 (n=1,262) to assess their pharmacy practice needs, and specify an rural-specific needs, within the categories of (1) opioid misuse, abuse, and diversion, (2) challenges associated with access to healthcare, (3) poly-pharmacy use, (4) meeting the needs of special populations, (5) lack of antibiotic stewardship, and (6) resources, such as staffing.
Results: The response rate was 22.1 % (n=279). We found the most agreed upon issue facing pharmacists’ in Maine is opioid use, misuse and diversion, followed closely by shortages in staffing. We also learned that pharmacists’ view pharmaceutical care for older adults, those with low health literacy, and those with mental disabilities more time-consuming. Some urban-rural differences were discovered in with regard to the pharmacists’ views; such as the magnitude of the distance barrier, and limited transportation options available to rural residents. Issues related to polypharmacy were viewed as more problematic by pharmacists practicing in urban versus rural sites.
Conclusions: Pharmaceutical care in Maine must focus on meeting the needs of the elderly, those with disabilities, and those with limited health literacy. As with the rest of the nation, opioids challenge pharmacy practice in a variety of ways. These findings clarify areas that present opportunities for pharmacists to focus more specifically on Maine’s largely rural population.
2. Spleen AM, Lengerich EJ, Camacho FT, Vanderpool RC. Health care avoidance among rural populations: Results from a nationally representative survey. J Rural Health. 2014;30(1):79-88. doi: 10.1111/jrh.12032
3. Rural Healthy People 2020. Available at: http://sph.tamhsc.edu/srhrc/docs/rhp2020.pdf (accessed June 11, 2015).
4. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev. 2013;3:CD002213. doi: 10.1002/14651858.CD002213.pub3
5. Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2009;(3):CD000072. doi: 10.1002/14651858.CD000072.pub2
6. American Society of Health-System Pharmacists (ASPH). ASPH statement on the role of health-system pharmacists in public health. Am J Health-Syst Pharm. 2008; 65(5):462-467. doi:10.2146/ajhp070399
7. American Public Health Association (APHA); The role of pharmacist in public health. Available at: www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/07/13/05/the-role-of-the-pharmacist-in-public-health (accessed March 12, 2015).
8. Meyerson BE, Ryder PT, Richey-Smith, C. Achieving pharmacy–based public health: A call of public health engagement. Public Health Rep. 2013;128(3):140-143.
9. Thrasher K, O'Connor SK, Joyner PU. Rural health in pharmacy curricula. Am J Pharm Educ. 2012;76(9):180. doi: 10.5688/ajpe769180
10. Straub LA, Straub SA. Consumer and provider evaluation of rural pharmacyservices. J Rural Health. 1999;15(4):403-412.
11. Bono JD, Crawford SY. Impact of Medicare Part D on independent and chain community pharmacies in rural Illinois--A qualitative study. Res Social Adm Pharm. 2010;6(2):110-120. doi: 10.1016/j.sapharm.2009.11.007
12. Rural Health Care Challenges. Available at: http://www.c-span.org/video/?314225-1/rural-america-challenges-affordable-care-act (accessed June 12, 2015).
13. Ullrich F, Mueller KJ; Rural Health Research & Policy Centers; RUPRI Center for Rural Health Policy Analysis, University of Iowa College of Public Health, Department of Health Management and Policy. Update: independently owned pharmacy closures in rural America, 2003-2013. Rural Policy Brief. 2014;(2014 7):1-4.
14. U.S. Census quick facts. Available at http://quickfacts.census.gov/qfd/states/23000.html (accessed May 28, 2015).
15. Casey MM, Klingner J, Moscovice I. Pharmacy services in rural areas: is the problem geographic access or financial access? J Rural Health. 2002;18(3):467-477.
16. USDA Economic Research Service, Rural-Urban Commuting Area 2010 codes. Available at: http://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx (accessed Jun 18, 2015) .
17. Using RUCA Data. http://depts.washington.edu/uwruca/ruca-uses.php (accessed November 16, 2015).
18. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951;16(3):297-334.
19. Opioid Painkiller Prescribing. Available at: http://www.cdc.gov/vitalsigns/pdf/2014-07-vitalsigns.pdf (accessed June 19, 2015).
20. Hagemeier NE, Murawski MM, Lopez NC, Alamian A, Pack RP. Theoretical exploration of Tennessee community pharmacists’ perceptions regarding opioid pain reliever abuse communication. Res Social Adm Pharm. 2014;10(3):562-75. doi: 10.1016/j.sapharm.2013.07.004
21. Golchin N, Frank SH, Vince A, Isham L, Meropol SB. Polypharmacy in the elderly. J Res Pharm Pract. 2015;4(2):85-8. doi: 10.4103/2279-042X.155755
22. Maher J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65. doi: 10.1517/14740338.2013.827660
23. Think Culture Health. Available at: https://www.thinkculturalhealth.hhs.gov/ (accessed, May 21, 2015).
24. Xu KT, Rojas‐Fernandez CH. Ancillary community pharmacy services provided to older people in a largely rural and ethnically diverse region: a survey of consumers in West Texas. J Rural Health. 2003;19(1):79-86.
25. Per Capita Income by State. Available at: https://bber.unm.edu/econ/us-pci.htm (accessed May 21, 2015).
26. Patterson BJ, Kaboli PJ, Tubbs T, Alexander B, Lund BC. Rural access to clinical pharmacy services. J Am Pharm Assoc (2003). 2014;54(5):518-525. doi: 10.1331/JAPhA.2014.13248
27. Keeys C, Kalejaiye B, Skinner M, Eimen M, Neufer J, Sidbury G, Buster N, Vincent J. Pharmacist-managed inpatient discharge medication reconciliation: a combined onsite and telepharmacy model. Am J Health Syst Pharm. 2014;71(24):2159-66. doi: 10.2146/ajhp130650
28. Margolis A, Young H, Lis J, Schuna A, Sorkness CA. A telepharmacy intervention to improve inhaler adherence in veterans with chronic obstructive pulmonary disease. Am J Health Syst Pharm. 2013;70(21):1875-6. doi: 10.2146/ajhp120241
29. Alfaar AS, Kamal S, Abouelnaga S, Greene WL, Quintana Y, Ribeiro RC, Qaddoumi IA. International telepharmacy education: another venue to improve cancer care in the developing world. Telemed J E Health. 2012;18(6):470-474. doi: 10.1089/tmj.2011.0182
30. Maine Broadband Service Ranks 49th out of 50 States. Available at: http://www.pressherald.com/2014/01/08/maine_broadband_going_nowhere_fast__service_ranks_49th_out_of_50_states (accessed June 18, 2015).
31. USM Partners with Camden Company on Broadband Expansion. Available at: http://news.mpbn.net/post/ums-partners-camden-company-broadband-expansion (accessed June 11, 2015).
32. Klepser ME, Adams AJ, Klepser DG. Antimicrobial stewardship in outpatient settings: leveraging innovative physician-pharmacist collaborations to reduce antibiotic resistance. Health Secur. 2015;13(3):166-173. doi: 10.1089/hs.2014.0083
33. Executive Office of the President. President’s Council of Advisors on Science and Technology. Report to the President on Combating Antibiotic Resistance. September 2014. Available at: http://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_carb_report_sept2014.pdf (accessed June 10, 2015).
34. Gadkari AS, Mott DA, Kreling DH, Bonnarens JK. Pharmacy characteristics associated with the provision of drug therapy services in nonmetropolitan community pharmacies. J Rural Health. 2009;25(3):290-295. doi: 10.1111/j.1748-0361.2009.00232.x
35. Scott DM. Assessment of pharmacists perception of patient care competence and need for training in rural and urban areas in North Dakota. J Rural Health. 2010;26(1):90-96. doi: 10.1111/j.1748-0361.2009.00270.x
36. Piper BJ, Desrosiers C, Rodney MA, Baker RP, McCall KL, Nichols SD, Martin SL. Use and abuse of opioids in Maine: Results from pharmacists, the Prescription Monitoring and the Diversion Alert Programs. Pharmacoepidemiology and Drug Safety. (in review).
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