Market factors and the availability of community pharmacies

The purpose of this study was to examine the relationships between the avai lability of community pharmacies and 4 types of market factors. A composite data set was created that linked, at the county level, data on: (1) type a nd number of pharmacies; (2) population characteristics; (3) payer variable s; (4) health care system factors; and (5) competitive factors. In this exp loratory study, secondary data were used to assess the association between the availability of community pharmacies and the influence of market factor s. To assess the market in fluences on availability of community pharmacies , 2 regressions were performed. In 1 model, the number of community pharmac ies per 10,000 population was the dependent variable, whereas the dependent variable in the other regression was the proportion of independently owned community pharmacies. The independent variables in each regression were th e market factors-population characteristics, payer variables, health care s ystem factors, and competitive variables. Squared terms were included for 8 of 15 market factors to account for nonlinearities in the relationships. M ultiple market factors were correlated with both the number of community ph armacies and the proportion of independently owned pharmacies in an area. S everal of the relationships were not linear and changed direction within th e range of data. Counties with either a low or a high percentage of elderly people had fewer pharmacies and a lower proportion of independently owned pharmacies compared with counties with a moderate percentage of elderly peo ple. Counties that were scarcely or highly rural had fewer community pharma cies but a higher proportion of independently owned pharmacies than countie s that were moderately rural. Areas with a greater percentage of the popula tion earning less than the poverty level had more pharmacies, especially in dependently owned ones. Fewer community pharmacies were found in areas with higher health maintenance organization penetration rates. The number of ho spital admissions was positively associated with the number of pharmacies b ut negatively associated with the proportion of independently owned pharmac ies. The availability of community pharmacies varies across the country. In light of the trend toward fewer independently owned pharmacies, potential problems in accessing pharmacy services could develop in certain areas, inc luding those that are highly rural and those with a high percentage of peop le earning less than the poverty level. Future research and policy issues a re identified.