Impact of Pharmacists on Access to Vaccine Providers: A Geospatial Analysis
Impact of Pharmacists on Access to Vaccine Providers: A Geospatial Analysis
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DOI：
10.1111/1468-0009.12342
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发表时间：
2018-09-01
影响因子：
6.6
通讯作者：
Brewer, Noel T.
中科院分区：
文献类型：
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作者：
Shah, Parth D.;Trogdon, Justin G.;Brewer, Noel T.
美国的政策制定者应考虑扩大药房执业法，允许药剂师为青少年接种疫苗，作为改善青少年疫苗地理获取的一种方式，特别是接种率较低的人乳头瘤病毒（HPV）疫苗。我们的州级分析显示，在美国德克萨斯州，药剂师在地理上比初级保健医生更加分散。包括药剂师之间可用的青少年疫苗供应商将改善疫苗供应商的地理分布，特别是在初级保健医生数量不足的地区。ContextThe最大的差距在美国人乳头瘤病毒（HPV）疫苗接种是由于地理。解决这些差异的一个潜在方法是改善HPV疫苗接种的地理可及性。两个联邦小组建议将社区药剂师作为HPV疫苗提供者，作为改善青少年HPV疫苗接种机会的战略。我们试图评估社区药剂师是否可以提高疫苗供应商的数量，在美国德克萨斯州的初级保健医生短缺的地区。MethodsWe收集了公开的医生和药剂师2016年的劳动力数据，从得克萨斯州医学委员会和药学委员会。我们进行了地理空间分析的人口普查区，以分析医生和药剂师的分布，以及药剂师如何改变疫苗供应商的覆盖率在整个国家。FindingsCensus tracts与高数量的医生人均往往位于彼此附近，在5的5个分析莫兰的I（中位数= 0.04）。相比之下，在我们的任何分析中，药剂师的比率在空间上都不依赖于人口普查区。如果药剂师作为疫苗提供者加入到初级保健医生中，35%以前覆盖率不足的城市人口普查区将得到充分覆盖，而18%覆盖率不足的农村人口普查区将得到充分覆盖。总体而言，当药剂师被列入初级保健医生作为疫苗提供者，疫苗提供者人均增加了2,413的4,508个城市人口普查区（54%），而在223的746个农村人口普查区（30%）的速度增加。因此，增加药剂师的劳动力将增加疫苗提供者在初级保健提供者覆盖不足的地区的可用性。
Policymakers in the United States should consider expanding pharmacy practice laws to allow pharmacists to vaccinate adolescents as a way to improve geographic access to adolescent vaccines, particularly for human papillomavirus (HPV) vaccine, which has low uptake. Our state-level analysis showed that pharmacists are more geographically dispersed than primary care physicians in the US state of Texas. Including pharmacists among available adolescent vaccine providers would improve the geographic distribution of vaccine providers, especially in areas with an inadequate number of primary care physicians.ContextThe largest disparities in human papillomavirus (HPV) vaccination in the United States are due to geography. One potential way of addressing these disparities is by improving geographic access to HPV vaccination. Two federal panels have recommended including community pharmacists as HPV vaccine providers as a strategy to improve opportunities for HPV vaccination for adolescents. We sought to evaluate whether community pharmacists can improve the number of vaccine providers in areas with primary care physician shortages in the US state of Texas.MethodsWe gathered publicly available physician and pharmacist 2016 workforce data from the Texas Medical Board and Board of Pharmacy. We conducted geospatial analysis of census tracts to analyze the distribution of physicians and pharmacists and how pharmacists change vaccine provider coverage across the state.FindingsCensus tracts with high numbers of physicians per capita tended to be located near one another, in 5 of 5 analyses of Moran's I (median = .04). In contrast, pharmacist rates were not spatially dependent on census tract in any of our analyses. If pharmacists were added to primary care physicians as vaccine providers, 35% of urban census tracts that previously had inadequate coverage would be adequately covered, while 18% of inadequately covered rural census tracts would become adequately covered. Overall, when pharmacists were included with primary care physicians as vaccine providers, vaccine providers per capita increased in 2,413 of the 4,508 urban census tracts (54%), while the rate increased in 223 of 746 rural census tracts (30%).ConclusionsPharmacists are more geographically dispersed across census tracts than primary care physicians. As a result, adding pharmacists to the workforce would increase the availability of vaccine providers in areas with inadequate primary care provider coverage.