The RUPRI Center, in collaboration with the University of North Carolina Rural Health Research & Policy Analysis Center, has investigated reasons for closure of local independently owned pharmacies in rural communities, and the roles those pharmacies had in the local health care delivery system. This project continues the Center's work by exploring the next sequential question: what are the consequences of losing the only local pharmacy? If closures are the result of general decline in the community (loss in population and economic base) local personal pharmacy services may not be sustainable and the policy issues are the more general considerations of sustainability of rural communities. If the only pharmacy service closed despite what appears to be a sufficient population base, the policy issues are more specific: how to sustain essential local services.

The goals of this project are to: 1) measure and analyze potential determinants of pharmacy closure, including those related to community decline, and market factors such as availability of services from other sources, 2) assess potential consequences of pharmacy closure for other health care services in the community; 3) assess changes in use of medications by Medicare beneficiaries that may be related to losing local pharmaceutical services; and 4) understand changes in delivery of pharmacy services in communities after losing the only local retail pharmacy. A mixed methods strategy will be employed, including qualitative data collection through case studies (using telephone interviews), quantitative analysis of factors contributing to closure (using census and Area Resource File data to measure community and health system characteristics), and quantitative analysis of changes in use of medications and Medicare expenditures using the Part D claims file and total Medicare spending. Results will indicate both reasons for the decline in services and subsequent consequences for the community and Medicare beneficiaries. We anticipate publishing two Policy Briefs, one describing the circumstances in communities that may contribute to loss of the local retail pharmacy and one that focuses on actions taken to maintain pharmacy services. A Policy Paper is planned that will describe changes in patterns of prescription drug acquisition and use in communities losing the only local pharmacy. The paper will use multivariate analysis to compare patterns of prescription drug utilization and expenditures in communities losing local retail pharmacies to communities (matched as closely as possible) that retained local retail pharmacy services during the same time period.

Publications

• Causes and Consequences of Rural Pharmacy Closures: A Multi-Case Study
  RUPRI Center for Rural Health Policy Analysis
  Date: 08/2013
  This policy brief identifies factors that contributed to the closing of six rural pharmacies in various states and describes how the affected communities adapted to losing locally based services.
• Demographic and Economic Characteristics Associated With Sole County Pharmacy Closures, 2006-2010
  RUPRI Center for Rural Health Policy Analysis
  Date: 11/2013
  This policy brief describes demographic and economic characteristics associated with counties experiencing closure of their sole pharmacy.
• Rural Pharmacy Closures: Implications for Rural Communities
  RUPRI Center for Rural Health Policy Analysis
  Date: 01/2013
  This study documents the closure of local retail pharmacies in which the pharmacist was the only clinical provider available in the community at the time the pharmacy closed. This brief describes the characteristics of the communities and retail pharmacies in question.