Community Pharmacies Fill Critical Healthcare Gaps in Rural Areas — Here’s How We Can Empower and Support Them

Rural Americans have long experienced poorer health outcomes compared to their urban counterparts. New evidence shows that the divide is widening, with rural adults aged 25 to 54 significantly more likely to die of chronic diseases and cancer than individuals living in cities. 

While there are multiple contributing factors, these disparities are largely tied to the fact that there simply aren’t enough healthcare providers to serve rural communities. Around two-thirds of rural areas don’t have enough primary care physicians (PCPs). The Association of American Medical Colleges predicts that the nation could suffer a shortage of up to 100,000 PCPs in the next decade, with rural areas disproportionately affected. 

This creates a self-perpetuating cycle, where communities get sicker, placing additional strain on already under-resourced healthcare systems, which further reduces the quality of care and results in even poorer health outcomes for the community.

In recent months, this crisis has been further exacerbated by a series of clinic closures. Walmart’s decision to shut down 51 healthcare clinics, primarily located in rural areas, both reflects and adds to the strain felt by healthcare providers in some of the country’s most vulnerable and underserved communities. It should also serve as a wake up call that something desperately needs to change to ensure that rural patients receive the care they need.

One compelling solution lies in leveraging the local pharmacy, especially since medication-related problems account for 50% of preventable harm in medical care and cause an estimated 275,000 deaths annually. 

Rural pharmacies as de facto frontline providers

While primary care physicians are becoming increasingly scarce in rural areas, studies show that 90% of Americans live within five miles of a pharmacy. For patients with greater health needs, their community pharmacy is often a lifeline – especially if they’re among the 15 million individuals who rely on independent pharmacies in areas with no other healthcare providers.

This paradigm means rural patients are increasingly turning to their community pharmacies with serious health concerns. However, legally, there’s often not a lot that pharmacists can do for these patients. Some states have responded to the demand for care by expanding pharmacists’ scope of practice, for example, allowing them to write and amend prescriptions under certain conditions. In rural communities, this can be particularly effective in ensuring continuity in care, especially since patients may live many hours away from the nearest PCP or specialist.

Barriers that are unique to the community pharmacy

While pharmacists’ roles are expanding to address unmet patient needs, several factors are preventing those services from being widely available. Pharmacists are often not recognized as reimbursable providers. Therefore, their compensation tends to be limited to payments received for dispensed medications. In recent years, Pharmacy Benefits Managers have decreased these margins to the point where pharmacies are not recovering the cost for the medications. So even though the vast majority of Americans currently live near a pharmacy, this could change as these financial pressures force more pharmacies to close their doors. 

In addition to reimbursement barriers, pharmacists often do not have the time outside of dispensing to spend on medication reviews for patients, nor do they have the appropriate data context, such as medical history. 

Last year, California became the first state to mandate that all pharmacies report every prescription error. This is a crucial step for patient safety, but we need to ensure that these measures do not unfairly vilify individual pharmacists, who face severe consequences for errors that largely stem from systemic issues: lack of data to give pharmacists the full picture to assess, as well as over-strained and under-staffed pharmacies handling extremely complex healthcare issues. 

How to empower rural pharmacies

One of the people helping pharmacies overcome these structural shortcomings is Dr. Sanjeev Arora, a hepatitis C specialist who saw first-hand the devastating impacts of poor access to healthcare in rural areas. Hepatitis C is treatable when caught early, but many of Dr. Arora’s rural patients arrived at his New Mexico clinic when the disease was too advanced to treat – simply because they didn’t have access to care closer to home.

He knew something had to change, so he created Project ECHO, which helps specialists in diverse disciplines disseminate knowledge, training and mentorship to local providers, including pharmacists. Through this initiative, rural pharmacists have been trained to identify and treat conditions like hepatitis C, which now can be cured by new direct acting agents. This early intervention is literally a life-saver in regions lacking specialist providers.

These efforts are clearly essential, but community pharmacists will still struggle with the time and data required for success. However, with advanced technology like AI, we can scale and supercharge the upskilling of rural pharmacists to meet the enormous demand for care. Vast amounts of data can be fed into AI clinical decision support systems (CDSS): the latest medication knowledge and clinical guidelines, social determinants of health (SDOH), patients’ medical history, and so on. These systems can then connect the dots and identify patterns, helping prevent medication errors and making hyper-personalized recommendations for each patients’ treatment. 

Tech-powered initiatives like these are critical to reducing labor needs in stretched pharmacies, and providing more effective and efficient solutions for patients. Streamlining services and cutting costs without compromising the quality of care will be vital for sustaining healthcare in rural communities.

Ultimately, our goal should be to bring rural healthcare up to the same levels of access as urban care, providing more immediate access to physicians and preventative care, and reducing reliance on overstrained emergency medical services. But at the moment, our pharmacies are many rural communities’ lifeline. To preserve and empower them, we need to equip pharmacists with technology that can supercharge pharmacists in making impactful clinical interventions in the pharmacy and reimburse them for these services, which would help to address the provider shortage. If we enable pharmacists to more effectively identify and address care gaps, they can better ensure that no rural patient is left behind.

Editor’s Note: The author has no financial relationship with Dr. Arora or Project Echo..

Photo: Ridofranz, Getty Images

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