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The US Health Care System Needs Independent Pharmacies
Since 2003, about 16% of independent rural pharmacies–roughly 1230 stores–have closed, with fewer than 6400 remaining, according to figures released in July 2019. In concert with the closers of independent rural pharmacies, approximately 110 rural hospitals have closed between 2013-2020.2 As a result of these significant site closures, rural residents in many places over the US now have to travel further for health care services. This affects an estimated 18.7% of the US population.3 The Government Accountability Office (GAO) found that rural residents had to travel an additional 39 miles for health care services, up from 3.4 miles in 2012.3 Whether this number relates to community pharmacy closures has not been determined, but a good guess says that it is similar.
What are other important consequence of these closures? The GAO study found that residents’ health declined because of the hospital closures. Medicare beneficiaries had a higher prevalence of the 10 most common conditions in their communities. Ambulance drive times are lengthened putting critical lives at stake. General, surgical, and emergent services all dropped from about 81% in 2012 to ~40% in 2017. Along with these services, when independent rural pharmacies close important and sometimes critically needed drugs are not available, putting lives at risk. In addition, other health care needs are lost including health care information, vaccinations, value-based services, and community service. This may place older adults at the highest risk for morbidity and mortality.
A missing component of independent rural pharmacy closures is the loss of “emotional intelligence” or emotional quotient (EQ)—a person’s ability to emotionally process the world around them to a point of accuracy or inaccuracy to make quality decisions “such as can I ration my medications.” It is estimated that 90% of our success comes from our EQ (over intelligence quotient [IQ]).
Social distancing affects how the brain works—humans have an evolutionary need to socialize and this is critical to survival. When hospitals or independent rural pharmacies close and the community is without healthcare social homeostasis or the right balance of social connections is lost. These lost connections means increased anxiety and stress for many. In most situations, independent rural pharmacy in small towns (<10,000 persons) are not replaced.2
Another component of EQ is the power of touch, or the practice of health care in the presence of the patient.8-9 Independent rural pharmacies are set up to provide patient contact, and when they close, persons are adversely affected–they have lost part of their social foundation. From disposing of medication, providing advice to help patients understand their health and medicines and giving appropriate advice, triaging patients for health care services, administering vaccines and discussion of community issues, community pharmacies are an important EQ to the community.
Independent rural pharmacies are an essential part of the rural community. Their loss leads to poor health outcomes in many rural communities throughout the US, especially related to older adult care. US health care needs to focus on the loss of these services, which when present, are a safety network for the rural community.
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