Characteristics of rural elderly people who bypass local pharmacies

Context: The bypassing of local pharmacies by consumers is an indicator of limited accessibility and, possibly, compromised quality of rural pharmacy services. Purpose: The objective of this study was to identify the characteristics of rural consumers who bypassed local pharmacies for their medication needs. Methods: The sample was derived from the Texas Tech 5000, a longitudinal survey in West Texas, and pharmacy data from the Texas State Board of Pharmacy. The sample included 1062 people aged 65 or older who lived in rural counties and had at least one community pharmacy in town. Bivariate and multivariate analyses were performed to investigate the demographic, financial, nonfinancial, prescription and over-the-counter drug use, and health characteristics that were associated with the probabilities of the subjects' using local community pharmacies, nonlocal community pharmacies, and mail-order pharmacies. Findings: In the sample, 70.8%, 13.7%, and 15.5% of elderly people primarily used local pharmacies, nonlocal pharmacies, and mail-order pharmacies, respectively. The oldest subjects, women subjects, subjects with no employer-provided or other federal insurance, subjects who had a regular doctor, and subjects living within city limits and in areas with a higher density of community pharmacies had lower probabilities of choosing nonlocal pharmacies over local pharmacies. Insurance coverage for prescriptions was one of the most important determinants in choosing mail-order pharmacies over local community pharmacies. Conclusions: Additional research is warranted to further understand the choices made by older people, as well as by younger people who use medications. In particular, further investigation of the potential differences between services provided by rural-community, urban-community, and mail-order pharmacies is needed to identify other reasons for bypassing local pharmacies.