Urban-rural disparities in spatiotemporal accessibility of pharmacy care: a case study of Vermont, USA.

BACKGROUND: Pharmacies are more accessible than other health care services, providing frontline primary and preventative health care. Recent research has underscored the importance of pharmacy access for reaching underserved and rural populations. However, minimal attention has been given to the spatial and temporal dimensions of access to pharmacy care despite evidence that geographic accessibility impacts the utilization of healthcare services. METHODS: This study measured spatiotemporal variation in access to pharmacy care across Vermont using the enhanced two-step floating catchment area (E2SFCA) method. We surveyed 102 (87%) Vermont pharmacy locations for data on hours of operation and staffing levels during Fall 2023, and we completed data for an additional 15 in-state and 75 out-of-state locations with public data and imputation. Population data was sourced from the Census and road data from OpenStreetMap. We computed hourly spatial accessibility scores by county subdivision for weekdays, Saturdays, and Sundays, and compared results for metropolitan, micropolitan, and rural areas, testing for significance using the Kruskal-Wallis H Test. RESULTS: Our findings reveal significant disparities in pharmacy access between rural and urban areas. Access also dropped significantly on Saturdays and Sundays compared to weekdays. We found proportionately greater reductions in access on weekends for rural areas than for urban areas. Virtually all Vermonters lack access to community pharmacies at night, while the daily cycles of access are similar across urban and rural areas. CONCLUSIONS: Our study revealed important urban-rural differences in the spatial accessibility of pharmacies across Vermont and highlighted how temporal accessibility compounds with spatial accessibility in rural areas. The results are useful for informing public health policy and the provision of health services. We have also demonstrated the importance of data on pharmacy operating hours and service levels for modeling spatiotemporal pharmacy accessibility, highlighting the need for further research and improving centralized databases to facilitate research in this field.