Pharmacy density in rural and urban communities in the state of Oregon and the association with hospital readmission rates

Published:August 01, 2016DOI:



      To characterize the pharmacy density in rural and urban communities with hospitals and to examine its association with readmission rates.


      Ecologic study.


      Forty-eight rural and urban primary care service areas (PCSAs) in the state of Oregon.


      All hospitals in the state of Oregon.


      Pharmacy data were obtained from the Oregon Board of Pharmacy based on active licensure. Pharmacy density was calculated by determining the cumulative number of outpatient pharmacy hours in a PCSA.

      Main outcome measures

      Oregon hospital 30-day all-cause readmission rates were obtained from the Centers for Medicare and Medicaid Services and were determined with the use of claims data of patients 65 years of age or older who were readmitted to the hospital within 30 days from July 2012 to June 2013.


      Readmission rates for Oregon hospitals ranged from 13.5% to 16.5%. The cumulative number of pharmacy hours in PCSAs containing a hospital ranged from 54 to 3821 hours. As pharmacy density increased, the readmission rates decreased, asymptotically approaching a predicted 14.7% readmission rate for areas with high pharmacy density.


      Urban hospitals were in communities likely to have more pharmacy access compared with rural hospitals. Future research should determine if increasing pharmacy access affects readmission rates, especially in rural communities.
      To read this article in full you will need to make a payment
      APhA Member Login
      APhA Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jencks S.F.
        • Williams M.V.
        • Coleman E.A.
        Rehospitalizations among patients in the Medicare fee-for-service program.
        N Engl J Med. 2009; 360: 1418-1428
        • U.S. Department of Health and Human Services
        New HHS data shows major strides made in patient safety, leading to improved care and savings.
        Department of Health and Human Services, Washington, DC2014 (Available at:) (Accessed August 25, 2015)
      1. Centers for Medicare and Medicaid Services. 30-day unplanned readmission and death measures. Official US Government Site for Medicare. Available at: Accessed February 17, 2016.

        • Silverstein M.D.
        • Qin H.
        • Mercer S.Q.
        • Fong J.
        • Haydar Z.
        Risk factors for 30-day hospital readmission in patients ≥65 years of age.
        Proc (Bayl Univ Med Cent). 2008; 21: 363-372
        • Joynt K.E.
        • Jha A.K.
        Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program.
        JAMA. 2013; 309: 342-343
        • Hu J.
        • Gonsahn M.D.
        • Nerenz D.R.
        Socioeconomic status and readmissions: evidence from an urban teaching hospital.
        Health Aff (Millwood). 2014; 33: 778-785
        • Herrin J.
        • St Andre J.
        • Kenward K.
        • Joshi M.S.
        • Audet A.M.
        • Hines S.C.
        Community factors and hospital readmission rates.
        Health Serv Res. 2015; 50: 20-39
        • Sarangarm P.
        • London M.S.
        • Snowden S.S.
        • et al.
        Impact of pharmacist discharge medication therapy counseling and disease state education: Pharmacist Assisting at Routine Medical Discharge (project PhARMD).
        Am J Med Qual. 2013; 28: 292-300
        • Luder H.R.
        • Frede S.M.
        • Kirby J.A.
        • et al.
        TransitionRx: impact of community pharmacy postdischarge medication therapy management on hospital readmission rate.
        J Am Pharm Assoc (2003). 2015; 55: 246-254
        • DiMatteo M.R.
        Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research.
        Med Care. 2004; 42: 200-209
        • Nieuwlaat R.
        • Wilczynski N.
        • Navarro T.
        • et al.
        Interventions for enhancing medication adherence.
        Cochrane Database Syst Rev. 2014; : CD000011
        • Qato D.M.
        • Daviglus M.L.
        • Wilder J.
        • Lee T.
        • Qato D.
        • Lambert B.
        “Pharmacy deserts” are prevalent in Chicago's predominantly minority communities, raising medication access concerns.
        Health Aff (Millwood). 2014; 33: 1958-1965
        • Blank C.
        N.Y. hospital retail pharmacy aims to cut readmission rates.
        Drug Topics. August 12, 2015;
        • Lawlor J.
        Maine Med opening state's only 24-hour pharmacy.
        Portland Press Herald. January 26, 2015;
        • Blank C.
        Meijer opens pharmacy in Michigan hospital.
        Drug Topics. November 9, 2015;
        • Goodman D.C.
        • Mick S.S.
        • Bott D.
        • et al.
        Primary care service areas: a new tool for the evaluation of primary care services.
        Health Serv Res. 2003; 38: 287-309
      2. Oregon Office of Rural Health. Rural definitions. Available at: Accessed August 25, 2015.

      3. Dartmouth Institute for Health Policy and Clinical Practice. The Dartmouth atlas of health care. Available at: Accessed July 7, 2015.

      4. Centers for Medicare and Medicaid. Hospital Compare. Available at: Accessed July 7, 2015.

      5. Quality Net. Chapter 3: readmission measures. Available at: Accessed October 12, 2015.

        • SAS Institute
        Base SAS 9.3 procedures guide [computer program].
        SAS Institute, Cary, NC2011
        • US Census Bureau
        Explanation of race and Hispanic origin categories.
        1999 (Available at:) (Accessed May 14, 2016)
        • Pedersen C.A.
        • Schneider P.J.
        • Scheckelhoff D.J.
        ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education—2012.
        Am J Health Syst Pharm. 2013; 70: 787-803
        • Pollack C.E.
        • Armstrong K.
        The geographic accessibility of retail clinics for underserved populations.
        Arch Intern Med. 2009; 169 (discussion 950–953): 945-949
        • Thompson C.A.
        Pharmacy departments innovate to reduce readmissions penalty.
        Am J Health Syst Pharm. 2013; 70: 296-298
        • Yamamoto L.G.
        • Manzi S.
        • Shaw K.N.
        • et al.
        Dispensing medications at the hospital upon discharge from an emergency department.
        Pediatrics. 2012; 129: e562
        • Barnett M.L.
        • Hsu J.
        • McWilliams J.M.
        Patient characteristics and differences in hospital readmission rates.
        JAMA Intern Med. 2015; 175: 1803-1812


      Sarah Bissonnette, PharmD, Postdoctoral Fellow, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR


      Leah Goeres, PharmD, Postdoctoral Fellow, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR; Ambulatory Care Clinical Coordinator, CareOregon, Portland, OR


      David S. H. Lee, PharmD, PhD, Assistant Professor, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR