Analysis of Factors Associated with Access to Pharmacy Services and Pharmacy Closures

The scope of pharmacy practices has expanded over the years to include non-dispensing activities such as the provision of vaccinations, diagnostic tests, blood pressure monitoring, and medication therapy management services. It generally is believed that pharmacies are the most available healthcare facility in the United States (US); about 90% of the US population live within five miles of a pharmacy. However, systematic evidence to confirm this is lacking. Furthermore, pharmacy availability and accessibility may not be consistent across various local areas and regions of the country. The goal of this dissertation is to better understand the pharmacy landscape in the United States, with a particular focus on Texas. This research consists of three studies: 1) a systematic literature review that synthesized published evidence on the factors associated with pharmacy availability and pharmacy accessibility in the US; 2) a geospatial secondary data analysis of the sociodemographic factors associated with pharmacy availability and accessibility in Texas at the census tract level; and 3) an analysis that examined the factors associated with pharmacy closures in the state of Texas. The analysis in the systematic review chapter showed that, while pharmacies were generally available, pharmacy access varied within less populous regions in the country, and in areas with low-income or minority populations. The analysis in the chapters focused on pharmacies in Texas found that total census tract population was the most important factor accounting for greater pharmacy availability and pharmacy access, although larger population also was associated with a greater likelihood of a pharmacy closure. Geospatial analysis showed that the mean distance to a pharmacy in a census tract in Texas was 0.9 miles, however the farthest distance was about 15 miles. People living in rural areas traveled further to the pharmacy compared to urban areas. A census tract in Texas was likely to experience pharmacy closure if it had a relatively high total population, high percentage of uninsured and high percentage of bachelor degree holders. Future studies should examine the impact of pharmacy closures on access to pharmacy services such as vaccination and other health services and the effect on population health outcomes