Does rural and urban community pharmacy practice differ? A narrative systematic review

Objectives: Anecdotal comparisons between rural and urban community pharmacy practice have been frequently reported. Therefore, a narrative systematic review was conducted to examine the published international evidence comparing the nature of services provided from community pharmacies in both settings. A comprehensive literature search was undertaken across four databases. The key criterion for inclusion was a comparison of practice, excluding dispensing and associated counselling. Definitions of ‘rural’ were specific to the country and publication year. Key findings: The search yielded 3830 titles, from which 17 publications met the inclusion criteria. The studies investigated current or proposed services and included the provision of pharmaceutical care, public health activities and prescribing. Rural customers were more willing to seek advice and talked longer to the pharmacist, but not always. There was limited evidence that rural pharmacists provided more professional services and they appeared to have better working relationships with prescribers. Many of the authors challenged the validity of their own results, suggesting that other confounding factors accounted for the observed differences. In general, the statistical analyses reported were basic, with multivariate analyses being uncommon. There was some evidence that rural pharmacists were seemingly more willing to take on new professional roles and deliver a higher level of service. However, this conclusion is based on a small number of studies, often with a limited number of respondents and simplistic data analyses. Further high-quality research is required to ascertain and characterise any real differences between rural and urban settings in community pharmacy practice.