The Cecil G. Sheps Center for Health Services Research.
UNC Gillings School of Global Public Health.
Milbank Q. 2018 Sep;96(3):568-592. doi: 10.1111/1468-0009.12342.
Policy Points: Policymakers in the United States should consider expanding pharmacy practice laws to allow pharmacists to vaccinate adolescents as a way to improve geographic access to adolescent vaccines, particularly for human papillomavirus (HPV) vaccine, which has low uptake. Our state-level analysis showed that pharmacists are more geographically dispersed than primary care physicians in the US state of Texas. Including pharmacists among available adolescent vaccine providers would improve the geographic distribution of vaccine providers, especially in areas with an inadequate number of primary care physicians.
The largest disparities in human papillomavirus (HPV) vaccination in the United States are due to geography. One potential way of addressing these disparities is by improving geographic access to HPV vaccination. Two federal panels have recommended including community pharmacists as HPV vaccine providers as a strategy to improve opportunities for HPV vaccination for adolescents. We sought to evaluate whether community pharmacists can improve the number of vaccine providers in areas with primary care physician shortages in the US state of Texas.
We gathered publicly available physician and pharmacist 2016 workforce data from the Texas Medical Board and Board of Pharmacy. We conducted geospatial analysis of census tracts to analyze the distribution of physicians and pharmacists and how pharmacists change vaccine provider coverage across the state.
Census tracts with high numbers of physicians per capita tended to be located near one another, in 5 of 5 analyses of Moran's I (median = .04). In contrast, pharmacist rates were not spatially dependent on census tract in any of our analyses. If pharmacists were added to primary care physicians as vaccine providers, 35% of urban census tracts that previously had inadequate coverage would be adequately covered, while 18% of inadequately covered rural census tracts would become adequately covered. Overall, when pharmacists were included with primary care physicians as vaccine providers, vaccine providers per capita increased in 2,413 of the 4,508 urban census tracts (54%), while the rate increased in 223 of 746 rural census tracts (30%).
Pharmacists are more geographically dispersed across census tracts than primary care physicians. As a result, adding pharmacists to the workforce would increase the availability of vaccine providers in areas with inadequate primary care provider coverage.
政策制定者应考虑扩大药剂师的执业范围，允许药剂师为青少年接种疫苗，以改善青少年疫苗接种的地理可及性，特别是人乳头瘤病毒（HPV）疫苗的接种可及性，因为这种疫苗的接种率很低。
美国 HPV 疫苗接种最大的差异是由于地理位置造成的。解决这些差异的一种潜在方法是改善 HPV 疫苗接种的地理可及性。两个联邦小组建议将社区药剂师纳入 HPV 疫苗提供者之列，作为增加青少年 HPV 疫苗接种机会的一种策略。我们试图评估在美国德克萨斯州，社区药剂师是否可以改善初级保健医生短缺地区的疫苗提供者数量。
我们从德克萨斯州医学委员会和药剂师委员会收集了公开的医生和药剂师 2016 年劳动力数据。我们对普查区进行了地理空间分析，以分析医生和药剂师的分布情况，以及药剂师如何在全州范围内改变疫苗提供者的覆盖范围。
在我们的 5 项莫兰指数（中位数=0.04）分析中，每平方英里人口中医生数量较高的普查区往往彼此相邻。相比之下，在我们的任何分析中，药剂师的比率都与普查区没有空间依赖性。如果将药剂师作为疫苗提供者加入到初级保健医生中，那么 35%以前疫苗覆盖不足的城市普查区将得到充分覆盖，而 18%的农村普查区疫苗覆盖不足的情况将得到改善。总的来说，当将药剂师与初级保健医生一起作为疫苗提供者时，在 4508 个城市普查区中的 2413 个（54%），以及在 746 个农村普查区中的 223 个（30%），每平方英里的疫苗提供者人数增加。
药剂师在普查区的分布比初级保健医生更为分散。因此，在劳动力中增加药剂师将增加在初级保健提供者覆盖不足地区疫苗提供者的可及性。
