The association between pharmacy closures and prescription drug use: a retrospective analysis of Medicaid prescription claims in Iowa.
OBJECTIVES: The objectives of this study were 2-fold: (1) to examine the association of pharmacy closures with prescription drug use by Medicaid recipients in Iowa; and (2) to evaluate how drug utilization patterns differ between patients whose pharmacies closed and patients whose pharmacies remained open. DESIGN: A 2-group pretest-posttest study of Medicaid enrollees who may have been affected by pharmacy closures. Prescription medication use during the periods preceding and after pharmacy closures was compared. A comparison group was used to account for extraneous factors. PATIENTS AND METHODS: Sixteen community pharmacies were selected from a pool of pharmacies that closed during 1994; 1092 patients were identified as the main users of these pharmacies, and a comparison group of 3491 patients whose main pharmacies had not closed also was identified. The average number of each patient's prescription claims for the 6 months preceding closing and the 6 months after closing was computed. Multiple regression analysis was conducted to determine whether any association existed between pharmacy closures and the use of prescription drugs. RESULTS: Patients whose pharmacies closed during 1994 had fewer prescription claims after the closings than before the closings. In contrast, patients whose pharmacies remained open had more prescription claims. This difference remains statistically significant after controlling for other factors, such as patient demographics and health status. CONCLUSIONS: A decrease in prescription drug use was associated with pharmacy closures. Attention should be directed to patient access to prescription medications in rural areas, as relatively more pharmacies close in rural areas.