Thesis
Pharmacy deserts and patient medication experience: a patient-centered perspective
University of Iowa
Master of Science (MS), University of Iowa
Spring 2025
DOI: 10.25820/etd.007818
Abstract
Introduction:A pharmacy desert is a community where people have limited access to nearby pharmacies, often due to long distances, low income, or lack of transportation. These areas can make it harder for patients to get their medications, leading to problems with adherence and overall health. Most existing studies have focused on where pharmacy deserts are located, but few have explored how patients living in these areas are personally affected.
Objectives:
This study aimed to: (1) describe the characteristics of patients living in pharmacy deserts; (2) compare medication accessibility and adherence between desert and non-desert residents; and (3) evaluate quality of life using patient-reported outcomes.
Methods:
A cross-sectional online survey of 518 U.S. adults was conducted using a Qualtrics Panel. Participants were classified by ZIP code as pharmacy desert or non-desert residents based on Wittenauer et al.’s (2024) definition. The survey included validated measures: MARS-5 for medication adherence and EQ-5D-3L for health-related quality of life. Data were analyzed using chi-square tests, Mann-Whitney U tests, and regression analyses (logistic and OLS).
Results:
Among participants, 256 (49%) lived in pharmacy deserts. Desert residents were more likely to be younger, female, unemployed or underemployed, and to have lower household income (p < 0.001). Over 80% of desert participants lived in rural areas, compared to just 28% in the non-desert group. Education levels were also lower among desert residents, with fewer college graduates and more high school–only respondents.
Desert residents reported significantly more access barriers. These included higher rates of transportation difficulties (31% vs. 23%, p = 0.032), skipping medications due to cost (45% vs. 36%, p = 0.039), and relying on family or friends for pharmacy transportation (43% vs. 24%, p < 0.001). They also reported longer travel distances, more use of independent pharmacies, and less use of large chains and mail-order services.
While median MARS-5 scores were similar across groups, categorized adherence revealed differences. Only 9.8% of desert residents reported perfect adherence (MARS = 25) compared to 21% in non-desert areas (p = 0.003). Logistic regression showed that living in a pharmacy desert was associated with 43% lower odds of perfect adherence (OR = 0.572, 95% CI: 0.324–0.991, p = 0.049), after adjusting for sociodemographic and health-related factors.
Quality-of-life scores measured by EQ-5D-3L showed disparities, particularly in pain/discomfort and anxiety/depression domains. Desert residents reported lower index values and overall health status on the EQ-VAS scale. While not all differences reached statistical significance, patterns suggest a meaningful burden on well-being among those in pharmacy deserts.
Conclusion:
Living in a pharmacy desert is associated with lower medication adherence, more structural barriers to access, and reduced quality of life. These findings highlight the need for policies that address geographic and social inequalities in pharmacy access.
Keywords:
Pharmacy deserts, medication adherence, healthcare access, quality of life, MARS-5, EQ-5D-3L.
Details
- Title: Subtitle
- Pharmacy deserts and patient medication experience: a patient-centered perspective
- Creators
- Eilan Alhersh
- Contributors
- William R Doucette (Advisor)Linnea A Polgreen (Committee Member)Korey A Kennelty (Committee Member)
- Resource Type
- Thesis
- Degree Awarded
- Master of Science (MS), University of Iowa
- Degree in
- Pharmacy
- Date degree season
- Spring 2025
- DOI
- 10.25820/etd.007818
- Publisher
- University of Iowa
- Number of pages
- ix, 109 pages
- Copyright
- Copyright 2025 Eilan Alhersh
- Language
- English
- Date submitted
- 04/28/2025
- Description illustrations
- illustrations, graphs, charts
- Description bibliographic
- Includes bibliographical references (pages 83-88).
- Public Abstract (ETD)
- Many people in the United States struggle to access the medications they need, especially if they live far from a pharmacy or cannot afford their prescriptions. These areas are called "pharmacy deserts." This study explored how living in a pharmacy desert affects patients' experiences with getting and using their medications. To understand this issue, I conducted a national survey with over 500 adults across the U.S. Participants were grouped based on whether they lived in a pharmacy desert or not. The survey asked about how they get their medications, how often they take them as prescribed, and how they rate their overall health and quality of life. The results showed that people living in pharmacy deserts face more transportation problems, rely more on friends or family to pick up medications, and are more likely to skip doses due to cost. These individuals also reported lower adherence to medications and worse quality of life compared to those living in non-desert areas. This research is important because it gives a voice to patients living in pharmacy deserts. It can help healthcare providers and policymakers better understand the barriers people face and work toward improving medication access for all communities.
- Academic Unit
- Pharmacy
- Record Identifier
- 9984830726702771
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