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Lack of pharmacy services in underserved populations

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Melika H. Fini

on 20 November 2013

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Transcript of Lack of pharmacy services in underserved populations

Population Density of North Carolina by County
Median Income Per Household in North Carolina by County
Provision of pharmacy services to underserved populations

- Rural areas have less healthcare, our focus being on pharmacist. Rural areas are often proven to have higher rates of disease and lower income.
-Incentives have been shown to increase the presence of healthcare in rural areas
-Example: The Asheville project
Problem Statement
A lack of pharmacy services in rural and low-income regions of North Carolina contributes to health disparities between rural and urban areas within the state and higher incidents of disease in these areas.

According to the National Rural Health Association (NRHA), 20% of Americans live in rural regions while only 12% of pharmacists practice in rural areas

Pharmacy Services and Under-served Populations: What is the Pharmacist's Role?
Patient interaction
Medication counseling and review
Education and prevention
The Asheville Project
Began in 1996 for city employees
Education and prevention initiative centered around pharmacists in close collaboration with doctors
Provides cost coverage for patients who undergo counseling, monitoring, and advising.
NC Pharmacist's Association (NCPhA)
NC Center for Pharmaceutical Care (NCCPC)
Mission Hospitals
City of Asheville
Network of chain and independent pharmacies
Population Density of North Carolina
Percentage of Population Over 65 Years Old
Disease States
Service commitment dependent scholarships
Tax incentives for pharmacies that open in underserved areas
Direct financial incentives; higher salaries, larger bonuses, etc
Indirect financial incentives; more vacation time, company car, relocation packages
Targeted education for developing rural pharmacy practice

Direct Financial Incentives
-2004 study looked at state funded programs to assess success rate at enticing/retaining physicians in underserved areas
-93% completed their full obligation
-Obligated physicians remained longer in their practice than non-obligated
-9/10 indicated that they would enroll again
-Retention rates were highest for loan repayment, direct financial incentive (as compared with other incentives for physicians)
Offer loan repayment/forgiveness
Example: forgive/repay one year of loans for every year served
Higher salaries for pharmacists working rural areas
Signing bonuses for pharmacists signing multi-year contracts to work in rural areas

Salary In Metropolitan area
Salary in Non-Metropolitan area
Survey Results
Pharmacists per 10,000 Population North Carolina 2011
Direct Financial Incentives
Target Populations
Low income
Rural residents
Target Population Makeup
A 2000 study by the Department of Health and Human Services on the Pharmacist Workforce described several distinct traits of the rural patient population:
Rural area residents tend to be older than metropolitan residents (2 years older on average)
A greater percentage of rural area populations are over the age of 65 (15% for rural areas, 12.8% for metropolitan)
Chronic disease rates, incidence of injury and age-adjusted mortality rates area all higher in rural areas
Economic depression: In 1998, there was a disparity of over $7000 between rural positions and metropolitan positions of similar job types
Business/Tax Incentives
NC Rural Economic Development Center, Inc. – Rural Hope, offers grants (up to $480,000) to build new health care facilities in rural areas
Append list of approved facilities to include pharmacies
Chiquita Banana’s relocation to Charlotte as large scale model
Company offered over $22 m in incentives to relocate, including a $16.1M grant from the state, brought 417 jobs to NC
Could offer independently owned and chain pharmacies similar credits/grants to open sites in rural areas

UNC Eshelman School of Pharmacy Students Survey
Pathman DE, Konrad TR, King TS, Taylor DH, Koch GG. Outcomes of states' scholarship, loan repayment, and related programs for physicians. Med Care. 2004;42(6):560-8.
Jackson J, Shannon CK, Pathman DE, Mason E, Nemitz JW. A comparative assessment of West Virginia's financial incentive programs for rural physicians. J Rural Health. 2003;19 Suppl:329-39.
Strosberg MA, Mullan F, Winsberg GR. Service-conditional medical student aid programs: The experience of the states. J Med Educ. 1982;57(8):586-92.
Thrasher K, O'connor SK, Joyner PU. Rural health in pharmacy curricula. Am J Pharm Educ. 2012;76(9):180.
US Department of Health and Human Services. The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/pharmaciststudy. Accessed October 29, 2013.
Portillo, Ely. Chiquita relocating headquarters to Charlotte. The Charlotte Observer. 2011.
US Department of Labor. Occupational Employment and Wages, May 2012, 29-1051 Pharmacists. Available at: http://www.bls.gov/oes/current/oes291051.htm. Accessed October 29, 2013.
2010 Census Results – United States and Puerto Rico: Population Density by County or County Equivalent [demographic map]. United States Census Bureau (US); 2010. 1 sheet: color
Pharmacists per 10,000 Population: North Carolina, 2011 [demographic map]. North Carolina Health Professions Data System, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill (US); 2011. 1 sheet: color
65 Years and Older [United States] [demographic map]. United States Census Bureau (US); 2010. 1 sheet: color
Heart Diseases Death Rates by County of Residence, N.C., 2006-2010 [demographic map]. Justus-Warren Heart Disease & Stroke Prevention Task Force (NC); 2012. 1 sheet: color
Stroke Hospital Discharge Rates by County of Residence, N.C., 2006-2010 [demographic map]. Justus-Warren Heart Disease & Stroke Prevention Task Force (NC); 2012. 1 sheet: color
Percentage of North Carolina Adults Who Are Overweight or Obese by Area Health Education Center (AHEC) Regions [demographic map]. NC State Center for Health Statistics (NC); 2009. 1 sheet: color
2010 North Carolina Cancer Mortality Rates by County [demographic map]. NC State Center for Health Statistics (NC); 2010. 1 sheet: color
The Asheville Project [Internet]. Asheville, NC: City of Asheville; No publication date listed [Cited October 26th, 2013]; available from: http://www.theashevilleproject.net/home
American Fact Finder [Internet]. Atlanta: United States Census Bureau; July 01, 2013 [Cited October 20, 2013]; [Database], Available from: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_12_1YR_S1901&prodType=table
Percent Change in Population by County: 2000-2010 [Internet]. Atlanta: United States Census Bureau; July 01, 2013 [Cited October 20, 2013]; [One screen], available from: http://www.census.gov/geo/maps-data/maps/pdfs/2010pop/nc_perchange_2010map.pdf
Population Density by County, 2010 [Internet]. Atlanta: United States Census Bureau; July 01, 2013 [Cited October 20, 2013]; [One screen], available from: http://www.census.gov/geo/maps-data/maps/pdfs/thematic/us_popdensity_2010map.pdf
Census Data Mapper [Internet]. Atlanta: United States Census Bureau; July 01, 2013 [Cited October 20, 2013]; [One screen], available from: http://tigerweb.geo.census.gov/datamapper/map.html
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Sarah Leyden, Adam Dickinson, Melika Fini, Brittney Roberts,
Matt Shepard, Taylor Pasley, Ross Cramer, Brian Bailey

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