Rural access to clinical pharmacy services |
| |
| Affiliation: | Philadelphia College of Pharmacy, University of the Sciences, Philadelphia; at the time of the research, he was a graduate student, University of Iowa, Iowa City;Veterans Rural Health Resource Center-Central Region;Iowa City Veterans Affairs Health Care System;Iowa City Veterans Affairs Health Care System;Center for Comprehensive Access & Delivery Research and Evaluation, U.S. Department of Veterans Affairs, Iowa City, IA;MCPHS University, Boston, MA. At the time of project completion, he was PGY1 pharmacy resident at MCPHS University/Harvard Vanguard Medical Associates.;MCPHS University, Boston, MA;Cedars-Sinai Medical Center, Los Angeles, CA; at the time of the research, he was a PGY-2 Critical Care Resident, University of Kentucky, Lexington;Department of Anesthesiology, College of Medicine, University of Kentucky, Lexington;College of Pharmacy, University of Kentucky, Lexington;University of New Mexico Hospital, Albuquerque, NM; at the time of this project, Postgraduate Year 1 Resident, Cape Fear Valley Health System, Southern Regional Area Health Education Center of Fayetteville, NC;Center Pharmacy, Cape Fear Valley Health System, Fayetteville, NC;Southern Regional Area Health Education Center; Postgraduate Year 1 Residency Director, Cape Fear Valley Health System/Southern Regional Area Health Education Center, Fayetteville, NC;Eshelman School of Pharmacy, University of North Carolina, Chapel Hill;American Pharmacists Association Foundation, Washington, DC.;Epidemiology and Global Health and Adjunct Professor of Pharmacy, School of Public Health, University of Washington, Box 357965, Seattle, WA 98195-7965;Philadelphia College of Pharmacy, University of the Sciences in Philadelphia;Rite Aid, New Jersey |
| |
| Abstract: | ObjectivesTo examine the impact of rural residence and primary care site on use of clinical pharmacy services (CPS) and to describe the use of clinical telepharmacy within the Veterans Health Administration (VHA) health care system.MethodsUsing 2011 national VHA data, the frequency of patients with CPS encounters was compared across patient residence (urban or rural) and principal site of primary care (medical center, urban clinic, or rural clinic). The likelihood of CPS utilization was estimated with random effects logistic regression. Individual service types (e.g., anticoagulation clinics) and delivery modes (e.g., telehealth) were also examined.ResultsOf 3,040,635 patients, 711,348 (23.4%) received CPS. Service use varied by patient residence (urban: 24.9%; rural: 19.7%) and principal site of primary care (medical center: 25.9%; urban clinic: 22.5%; rural clinic: 17.6%). However, in adjusted analyses, urban–rural differences were explained primarily by primary care site and less so by patient residence. Similar findings were observed for individual CPS types. Telehealth encounters were common, accounting for nearly one-half of patients receiving CPS. Video telehealth was infrequent (<0.2%), but more common among patients of rural clinics than those receiving CPS at medical centers (odds ratio [OR] = 9.7; 95% CI 9.0–10.5).ConclusionWe identified a potential disparity between rural and urban patients’ access to CPS, which was largely explained by greater reliance on community clinics for primary care than on medical centers. Future research is needed to determine if this disparity will be alleviated by emerging organizational changes, including expanding telehealth capacity and integrating pharmacists into primary care teams, and whether lessons learned at VHA translate to other settings. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
