J Am Pharm Assoc (2003). 2022 Nov-Dec;62(6):1875-1879. doi: 10.1016/j.japh.2022.06.016. Epub 2022 Jul 5.
In the United States, geographic access is a major driver of health care disparities. Studies have shown that pharmacy deserts are prevalent in the United States, even in major metropolitan areas. However, one limitation often cited by these studies is the use of distance rather than travel time to define pharmacy deserts.
The aim of this study was to assess pharmacy deserts using travel time and to provide a more holistic approach by incorporating analysis of private vehicles and public transportation.
Pharmacy details were collected from the National Provider Identifier database and neighborhood characteristics from collected census data for the four largest U.S. cities. Pharmacy access was evaluated using open-source routing engines. We determined neighborhoods in pharmacy deserts using both distance and travel time analyses. Sensitivity analysis was performed to determine changes to pharmacy deserts based on small changes in travel time.
Of 4654 neighborhoods identified in the four cities of interest, 670 (14.4%) neighborhoods were in pharmacy deserts based on distance. Despite accounting for 28.9% of all neighborhoods, predominantly white neighborhoods only accounted for 4.3% of pharmacy deserts. When evaluating pharmacy deserts by car and public transportation, predominantly white neighborhoods accounted for 2.3% and 1.7% of total pharmacy deserts, respectively. Finally, by reducing travel time from 15 minutes to 10 minutes, pharmacy deserts by car and public transportation increased by 105% and 199%, respectively. All but 3 of the new pharmacy deserts found in the sensitivity analysis were found in nonpredominantly white neighborhoods.
Using travel time and incorporating modes of transportation, we found that disparities in pharmacy access are more than just where pharmacies are located geographically. There are additional layers of disparities, such as access to public transportation, that need to be addressed to reduce the number of pharmacy deserts.
在美国，地理可达性是医疗保健差异的主要驱动因素。研究表明，即使在美国主要大都市区，药店也普遍存在。然而，这些研究经常引用的一个限制因素是使用距离而不是旅行时间来定义药店荒漠。
本研究旨在使用旅行时间评估药店荒漠，并通过整合私人车辆和公共交通分析提供更全面的方法。
从国家提供者标识符数据库中收集药店详细信息，并从四个最大的美国城市收集的人口普查数据中收集邻里特征。使用开源路由引擎评估药店的可达性。我们使用距离和旅行时间分析来确定药店荒漠中的社区。进行敏感性分析，以确定旅行时间的微小变化对药店荒漠的影响。
在所研究的四个城市中，确定了 4654 个社区，其中 670 个（14.4％）社区是根据距离确定的药店荒漠。尽管占所有社区的 28.9％，但以白人为主的社区仅占药店荒漠的 4.3％。当按汽车和公共交通评估药店荒漠时，以白人为主的社区分别占药店荒漠的 2.3％和 1.7％。最后，将旅行时间从 15 分钟减少到 10 分钟，通过汽车和公共交通的药店荒漠分别增加了 105％和 199％。在敏感性分析中发现的除 3 个之外的所有新药店荒漠都位于非以白人为主的社区中。
通过使用旅行时间并整合交通方式，我们发现，药店可达性的差异不仅仅是药店地理位置上的差异。还存在其他层面的差异，例如获得公共交通的机会，需要解决这些差异以减少药店荒漠的数量。
