Department of Environmental and Occupational Health Sciences, School of Public Health, Downstate Medical Center, State University of New York, Box 43, 450 Clarkson Avenue, Brooklyn, NY 12203, USA.
Int J Health Geogr. 2012 Nov 9;11:48. doi: 10.1186/1476-072X-11-48.
Only a small amount of research has focused on the relationship between socio-economic status (SES) and geographic access to prescription medications at community pharmacies in North America and Europe. To examine the relationship between a community's socio-economic context and its residents' geographic access to common medications in pharmacies, we hypothesized that differences are present in access to pharmacies across communities with different socio-economic environments, and in availability of commonly prescribed medications within pharmacies located in communities with different socio-economic status.
We visited 408 pharmacies located in 168 socio-economically diverse communities to assess the availability of commonly prescribed medications. We collected the following information at each pharmacy visited: hours of operation, pharmacy type, in-store medication availability, and the cash price of the 13 most commonly prescribed medications. We calculated descriptive statistics for the sample and fitted a series of hierarchical linear models to test our hypothesis that the in-stock availability of medications differs by the socio-economic conditions of the community. This was accomplished by modeling medication availability in pharmacies on the socio-economic factors operating at the community level in a socio-economically devise urban area.
Pharmacies in poor communities had significantly higher odds of medications being out of stock, OR=1.24, 95% CI [1.02, 1.52]. There was also a significant difference in density of smaller, independent pharmacies with very limited stock and hours of operation, and larger, chain pharmacies in poor communities as compared to the middle and low-poverty communities.
The findings suggest that geographic access to a neighborhood pharmacy, the type of pharmacy, and availability of commonly prescribed medications varies significantly across communities. In extreme cases, entire communities could be deemed "medication deserts" because geographic access to pharmacies and the availability of the most prescribed medications within them were very poor. To our knowledge, this study is first to report on the relationship between SES and geographic access to medications using small area econometric analysis techniques. Our findings should be reasonably generalizable to other urban areas in North America and Europe and suggest that more research is required to better understand the relationship of socio-economic environments and access to medications to develop strategies to achieve equitable medication access.
仅有少量研究关注了社会经济地位（SES）与北美和欧洲社区药店处方药地理位置获取之间的关系。为了检验社区社会经济背景与其居民在药店获取常见药物的地理位置之间的关系，我们假设在社会经济环境不同的社区中，居民获取药店的便利性存在差异，并且在社会经济地位不同的社区中，药店提供的常用处方药也存在差异。
我们访问了 408 家位于 168 个社会经济多样化社区的药店，以评估常见处方药的可获取性。我们在每家访问的药店收集以下信息：营业时间、药店类型、店内药物供应情况以及 13 种最常开处方药物的现金价格。我们对样本进行了描述性统计，并拟合了一系列层次线性模型，以检验我们的假设，即药物库存的可用性因社区的社会经济条件而异。这是通过在一个社会经济设计的城市地区，在社区层面上运作的社会经济因素对药店的药物供应情况进行建模来实现的。
贫困社区的药店药物缺货的可能性显著更高，OR=1.24，95%CI[1.02，1.52]。与中低收入贫困社区相比，贫困社区的小型独立药店（库存和营业时间非常有限）和大型连锁药店的密度也存在显著差异。
研究结果表明，社区之间的邻里药店地理位置获取、药店类型和常用处方药的可获取性存在显著差异。在极端情况下，整个社区可能被视为“药物荒漠”，因为它们的地理位置获取药店和其中最常开处方药物的可获取性非常差。据我们所知，这是首次使用小区域计量经济学分析技术报告 SES 与药物地理位置获取之间的关系的研究。我们的发现应该可以合理地推广到北美的其他城市和欧洲，这表明需要进行更多的研究来更好地了解社会经济环境和获取药物的关系，以制定实现公平药物获取的策略。
