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重新思考医疗服务可及性:美国关闭药店的潜在影响的空间经济分析。

Rethinking access to care: A spatial-economic analysis of the potential impact of pharmacy closures in the United States.

机构信息

University of Houston College of Medicine, Houston, Texas, United States of America.

Humana Integrated Health Systems Sciences Institute, Houston, Texas, United States of America.

出版信息

PLoS One. 2023 Jul 27;18(7):e0289284. doi: 10.1371/journal.pone.0289284. eCollection 2023.

Abstract

Data chronicling the geo-locations of all 61,589 pharmacies in the U.S. (from the Homeland Infrastructure Foundation-Level Data (HIFLD) Open Data interface, updated on April 2018) across 215,836 census block groups were combined with Medically Underserved Areas (MUAs) information, and the Centers for Disease Control and Prevention's Social Vulnerability Index (CDC-SVI). Geospatial techniques were applied to calculate the distance between the center of each census block and the nearest pharmacy. We then modeled the expected additional travel distance if the nearest pharmacy to the center of a census block closed and estimated additional travel costs, CO2 emissions, and lost labor productivity costs associated with the additional travel. Our findings revealed that MUA residents have almost two times greater travel distances to pharmacies than non-MUAs (4,269 m (2.65 mi) vs. 2,388 m (1.48 mi)), and this disparity is exaggerated with pharmacy closures (107% increase in travel distance in MUAs vs. 75% increase in travel distance in non-MUAs). Similarly, individuals living in MUAs experience significantly greater average annual economic costs than non-MUAs ($34,834 ± $668 vs. $22,720 ± $326). Our findings suggest the need for additional regulations to ensure populations are not disproportionately affected by these closures and that there is a significant throughput with community stakeholders before any pharmacy decides to close.

摘要

将全美 61589 家药店的地理位置数据(源自国土基础设施基础级别数据(HIFLD)开放数据接口,数据更新于 2018 年 4 月)与医疗服务不足地区(MUAs)信息和疾病控制与预防中心的社会脆弱性指数(CDC-SVI)相结合。应用地理空间技术计算每个普查块中心与最近药店之间的距离。然后,我们模拟了如果最近的药店关闭,每个普查块中心附近的预计额外旅行距离,并估计了与额外旅行相关的额外旅行成本、二氧化碳排放量和劳动力生产力损失成本。我们的研究结果表明,MUA 居民前往药店的距离比非 MUA 居民长近两倍(4269 米(2.65 英里)与 2388 米(1.48 英里)),并且这种差距随着药店关闭而进一步扩大(MUA 地区的旅行距离增加 107%,而非 MUA 地区的旅行距离增加 75%)。同样,生活在 MUA 地区的个人比非 MUA 地区的人每年平均经济成本更高($34834±$668 与 $22720±$326)。我们的研究结果表明,需要制定额外的法规,以确保这些关闭不会不成比例地影响到人群,并在任何药店决定关闭之前,与社区利益相关者进行大量的沟通。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/06dd/10374066/ace44be497e9/pone.0289284.g001.jpg

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