Assessing spatial inequalities in accessing community pharmacies: a mixed geographically weighted approach

Abstract

Geographical accessibility is an important determinant for the utilisation of community pharmacies. The present study explored patterns of spatial accessibility with respect to pharmacies in Liguria, Italy, a region with particular geographical and demographic features. Municipal density of pharmacies was proxied as the number of pharmacies per capita and per km 2 , and spatial autocorrelation analysis was performed to identify spatial clusters. Both non-spatial and spatial models were constructed to predict the study outcome. Spatial autocorrelation analysis showed a highly significant clustered pattern in the density of pharmacies per capita (I=0.082) and per km 2 (I=0.295). Potentially under-supplied areas were mostly located in the mountainous hinterland. Ordinary least-squares (OLS) regressions established a significant positive relationship between the density of pharmacies and income among municipalities located at high altitudes, while no such association was observed in lower-lying areas. However, residuals of the OLS models were spatially auto-correlated. The best-fitting mixed geographically weighted regression (GWR) models outperformed the corresponding OLS models. Pharmacies per capita were best predicted by two local predictors (altitude and proportion of immigrants) and two global ones (proportion of elderly residents and income), while the local terms population, mean altitude and rural status and the global term income functioned as independent variables predicting pharmacies per km 2 . The density of pharmacies in Liguria was found to be associated with both socio-economic and landscape factors. Mapping of mixed GWR results would be helpful to policy-makers.

Attitudes and Beliefs on Influenza Vaccination during the COVID-19 Pandemic: Results from a Representative Italian Survey

“…Italy may be considered to be a country of towns and villages [62]. In our study people living in smaller municipalities were generally more prone to refuse the next season's influenza vaccination.…”

“…Regarding pharmacists, in Italy community pharmacies may be seen as the most easily accessible health-related "place" for laypeople: individuals can enter a pharmacy without a previous appointment and receive professional advice (including vaccination counselling) immediately [62,63]. As described previously, in Italy, most vaccine doses are administered in GPs' offices [40].…”

“…Rural parents preferred influenza vaccination outside their provider's office; the authors concluded that alternative venues for influenza vaccination in rural areas should be promoted [74]. Moreover, Italian rural areas are characterized by a relatively high density of the elderly [62], who are the main target population for influenza vaccination [10]. An older adult (especially the so-called "oldest old") living in rural areas may have fewer transport options [62] and thus less probability of receiving a flu shot, as reported by a study conducted on vaccination service organization and accessibility in Italy [75].…”

“…Moreover, Italian rural areas are characterized by a relatively high density of the elderly [62], who are the main target population for influenza vaccination [10]. An older adult (especially the so-called "oldest old") living in rural areas may have fewer transport options [62] and thus less probability of receiving a flu shot, as reported by a study conducted on vaccination service organization and accessibility in Italy [75]. However, we speculate that the observed difference could be also attributed to the different impact of the lockdown measures adopted during the COVID-19 outbreak.…”

Social Determinants of Pharmacy Deserts in Los Angeles County

“…Poor access to medications is often exacerbated in urban, rural, and racially segregated areas and such areas have been identified as pharmacy deserts nationally and internationally. [3][4][5][6][7][8][9]. Pharmacy closure is also a factor that contributes to the formation and existence of pharmacy deserts.…”