Qato Dima M, Daviglus Martha L, Wilder Jocelyn, Lee Todd, Qato Danya, Lambert Bruce
Dima M. Qato (
Martha L. Daviglus is a professor of medicine and executive director of the Institute for Minority Health Research at the University of Illinois, in Chicago.
Health Aff (Millwood). 2014 Nov;33(11):1958-65. doi: 10.1377/hlthaff.2013.1397.
Attempts to explain and address disparities in the use of prescription medications have focused almost exclusively on their affordability. However, the segregation of residential neighborhoods by race or ethnicity also may influence access to the pharmacies that, in turn, provide access to prescription medications within a community. We examined whether trends in the availability of pharmacies varied across communities in Chicago with different racial or ethnic compositions. We also examined the geographic accessibility of pharmacies to determine whether "pharmacy deserts," or low-access neighborhoods, were more common in segregated black and Hispanic communities than elsewhere. We found that throughout the period 2000-2012 the number of pharmacies was lower in segregated minority communities than in segregated white communities and integrated communities. In 2012 there were disproportionately more pharmacy deserts in segregated black communities, as well as in low-income communities and federally designated Medically Underserved Areas. Our findings suggest that public policies aimed at improving access to prescription medications may need to address factors beyond insurance coverage and medication affordability. Such policies could include financial incentives to locate pharmacies in pharmacy deserts or the incorporation of pharmacies into community health centers in Medically Underserved Areas.
解释和解决处方药使用差异的尝试几乎完全集中在其可负担性上。然而,按种族或族裔划分的居住社区隔离也可能影响到获取药店的机会,而药店又反过来影响社区内获取处方药的机会。我们研究了在芝加哥不同种族或族裔构成的社区中,药店可及性的趋势是否存在差异。我们还研究了药店的地理可达性,以确定“药店荒漠”(即低可达性社区)在隔离的黑人和西班牙裔社区是否比其他地方更常见。我们发现,在2000年至2012年期间,隔离的少数族裔社区的药店数量低于隔离的白人社区和融合社区。2012年,在隔离的黑人社区以及低收入社区和联邦指定的医疗服务不足地区,药店荒漠的比例过高。我们的研究结果表明,旨在改善处方药获取机会的公共政策可能需要解决保险覆盖范围和药品可负担性之外的因素。此类政策可包括在药店荒漠地区开设药店的经济激励措施,或将药店纳入医疗服务不足地区的社区健康中心。