Rural Disparities in Alzheimer's Disease‐Related Community Pharmacy Care in the United States

PURPOSE: To examine the relationship between area population density and community pharmacy-based Alzheimer's Disease (AD)-related services: pharmacists' medication knowledge and counseling, immunizations, and in-stock cognitive enhancers in 3 predominantly rural regions of the United States. METHODS: A standardized interview was administered by telephone to a 100% sample of community pharmacies in 3 areas: Northern California/Southern Oregon (n = 206), North and South Dakota (n = 278), and West Virginia (n = 420). Key study outcomes included: pharmacists' medication knowledge, availability of immunization services, and cognitive enhancers in stock. Respondents were classified by population density (persons/mi2 ) by pharmacy location to evaluate the relationship between rurality and AD-related pharmacy services. Chi-squared and logistic regression analyses were performed using Stata 10.1. FINDINGS: Pharmacies in more rural areas (50.1-100.0, 25.1-50.0, and ≤25.0 persons/mi2 ) were about 50% less likely to offer immunizations (95% CI: 0.32-0.91; 0.32-0.76; 0.28-0.80, respectively) compared to the least rural areas (>100.0 persons/mi2 ). Compared to the least rural areas, pharmacists in the most rural areas (≤25.0 persons/mi2 ) were less likely to name ≥2 gastrointestinal adverse effects of donepezil (OR = 0.50, 95% CI: 0.31-0.82) or have memantine XR 28 mg (OR = 0.61, 95% CI: 0.41-0.89) and other surveyed medications (OR = 0.57, 95% CI: 0.39-0.82) in stock. CONCLUSIONS: We found disparities in AD-related services in community pharmacies located in more rural counties, wherein individuals with AD and their caregivers may face barriers to obtaining quality pharmaceutical care. There is a need to strengthen pharmacists' knowledge and improve pharmacy services to reduce disparities.