J. A. Whitley1,2, K. Kieran1 1Seattle Children’s Hospital,Urology,Seattle, WA, USA 2Rice University,Houston, TX, USA
Introduction: Failure to obtain medications in a timely fashion is often cited as a contributor to poor clinical outcomes. Socioeconomic and geographic factors that may underlie failure to fill prescriptions promptly are not well described. We describe variations in pharmacy accessibility and medication availability in Washington state.
Methods: We queried 1058 pharmacies on opening hours, availability of 10 commonly prescribed pediatric medications (CPPM), compounding ability, and interpreter services. We evaluated differences in medication availability and pharmacy characteristics by county population density and household income (HI).
Results: 1057 (99.9%) pharmacies participated, representing all counties and 538 (36.9%) census tracts. Counties had a median 9 (range: 1-305) pharmacies. Pharmacy density and population density were strongly correlated (r2=0.98, p<0.001). More high (HPD) than low population density (LPD) (62.5% vs 0%, p<0.001) and high HI than low HI counties (62.5% vs. 0%, p=0.30) had 24-hour pharmacies. A larger proportion of pharmacies were open 7-days in HPD than LPD (75.6% vs 56.2%, p<0.0001) counties and in high HI than low HI counties (100% vs. 62.5%, p=0.30). Compounding pharmacy availability was similar in HPD and LPD counties (100% vs. 73.9%, p=0.48) and high and low HI counties (100% vs 62.5%, p=0.30). CPPM availability was widespread: all pharmacies had same-day availability (SDA) of liquid acetaminophen, ibuprofen, amoxicillin, and trimethoprim-sulfamethoxazole; 99.9% and 98.3% had SDA of hydrocodone and oxycodone elixirs respectively. Nitrofurantoin suspension and capsules were SDA in 92.5% and 80.9% of pharmacies, respectively. Fewer pharmacies stocked oxybutynin elixir (14.3%) and ciprofloxacin suspension (10%) for SDA. CPPM availability was similar across counties, except for nitrofurantoin suspension (Figure). Medications not SDA were stocked in 1-3 days in all pharmacies. 65.9% of pharmacies offered interpretation services (median: 14 [range: 1-150] languages). Using these data, we have created a living document database, available to department members, to help patients locate local pharmacies, especially during off hours.
Conclusion: CPPM availability by pharmacy is similar statewide. However, HPD and high HI counties have increased access to 7-day and 24-hour pharmacies, making filling prescriptions easier than for families in LPD and low HI counties. Limited ability to promptly fill prescriptions owing to restricted pharmacy business hours in poorer and more rural areas may explain some of the observed variation in outcomes in selected patient subgroups. The creation of an updated, editable database of statewide pharmacies enables clinicians to aid patients in efficiently obtaining medications.
