Community Pharmacies Make Care Possible in Medical Deserts

Cambridge, Nebraska is the largest city in Furnas County, with just over 900 residents, according to the 2020 Census.¹ In fact, the 7 counties that surround Furnas—5 in southern Nebraska and 2 in northern Kansas—have an average of fewer than 5000 people in the entire county. Cambridge is nearly 80 miles from the nearest level 2 trauma hospital, located in Kearney, making the area a medical desert.^2,3

The difficulty for patients who live in a medical desert is decreased access and quality of care coupled with increased health care costs. As one of the most accessible health care resources in our county, the staff at Mark’s Pharmacy is committed to caring for both the people living in Cambridge and those living miles and miles beyond city limits.

Many communities across south-central Nebraska with small medical clinics or nursing homes do not have a local pharmacy. We are committed to meeting the needs of the people living in those communities by offering hand delivery to the patients’ doorsteps and locally administered well-care services, including vaccines and health screenings. We take the care to our customers.

Like many other medical deserts, this rural area faces multiple barriers to consistent, quality care. A lack of public transportation, nontraditional workdays, much longer than normal mail delivery, and isolation (eg, living on a farm or in a smaller community with no medical services) are ever-present barriers that our pharmacy staff sees each and every day. On top of those challenges, a high percentage of our population consists of older adults who are less tech savvy, making mobile-friendly websites and intuitive health care apps mostly ineffective with many of our patients.

These barriers challenge us to think differently and provide a "high touch" level of care. We feel an obligation to improve access to medicines and quality of care, even as we are confronted with the reimbursement controls of pharmacy benefit managers. When dispensing, we focus on medication synchronization and adherence packaging to make it easier for patients to manage their medications and limit our need for extra deliveries. Before it was trendy, we adopted a community wellness approach and focused on well-care services to help our patients remain healthy, rather than simply providing medications to treat illnesses. We are a community care access point with services that supplement and complement the entire health care delivery system.

Before COVID-19, we provided blood pressure devices to patients who were called each month and instructed to bring the devices back to the pharmacy or to send back with deliveries. Results were downloaded and sent to their general practitioners and specialists. We also performed health screenings and administered vaccinations locally and at outreach locations. During COVID-19, we worked closely with the health department to offer regional testing and vaccinations. We also served as a minor medical triage provider. Area medical clinics were often inundated with sick patients and would refer minor medical cases to our pharmacy. We expanded our COVID-19 testing and vaccine adminis- tration to local communities by holding events at area schools and recreation centers. During these events, we would often visit homebound patients.

We have also seen a significant reduction in nursing home and assisted-living beds in many local communities, including a recent closure.⁴ We provide many services to help patients stay in their home environment for as long as possible. Our mantra of taking care to our customers has expanded to include additional pharmacy care services “at home” instead of “in a home.” Hand delivery to patient doorsteps, adherence packaging, vaccinations, and ongoing medication management are examples of pharmacy care services we provide.

Being the primary health care destination in a rural area does come with challenges, including weekend and after-hours requests for antibiotics and pre-scription changes. These challenges are just a small obstacle in our overall effort to improve the health of every patient in the communities we serve while increasing patient satisfaction and building customer loyalty in the process.

We believe that reimbursement for the enhanced patient care and medication use services we provide is the future of community-based pharmacy practice. We have a small payer contract with one of the medical providers to reimburse us for some of the enhanced services we provide. Through our work with Community Pharmacy Enhanced Services Network (CPESN) Nebraska, known in the state as Nebraska Enhanced Services Pharmacies, we hope to continue to show our pharmacy’s value to the insurance companies and contract directly for the services that reduce their overall costs.

Mark McCurdy is the owner of Mark’s Pharmacy in Cambridge, Nebraska, and a CPESN Nebraska Luminary.

References

1. Cambridge, Nebraska population 2022. World Population Reviews. Accessed April 13, 2022. https://worldpopulationreview.com/us-cities/cambridge-ne-population
2. Carr BG, Bowman AJ, Wolff CS, et al. Disparities in access to trauma care in the United States: a population-based analysis. Injury. 2017;48(2):332-338. doi:10.1016/j.injunry.2017.01.008
3. Nebraska trauma designated hospitals. Emergency Health Systems Nebraska. Updated September 28, 2021. Accessed April 13, 2022. https://dhhs.ne.gov/OEHS%20Program%20Documents/Trauma%20Designated%20Hospitals.pdf
4. Nitcher E. Nursing home closures force elderly Nebraskans to ask, ‘where do we go?’ Omaha World-Herald. February 20, 2022. Updated March 29, 2022. Accessed April 13, 2022. https://omaha.com/news/local/govt-and-politics/nursing-home-closures-force-elderly-nebraskans-to-ask-where-do-we-go/article_75453b98-903e-11ec-95fe-67f7ac3ca80f.html