Evaluation of racial and socioeconomic disparities in medication pricing and pharmacy access and services.

PURPOSE: Results of a study to determine if disparities in drug pricing, pharmacy services, and community pharmacy access exist in a Tennessee county with a predominantly minority population are reported. METHODS: A cross-sectional survey of community pharmacies in Shelby County, a jurisdiction with a total population more than 60% composed of racial and ethnic minority groups, was conducted. Data collection included "out-of-pocket" (i.e., cash purchase) prices for generic levothyroxine, methylphenidate, and hydrocodone-acetaminophen; pharmacy hours of operation; availability of selected pharmacy services; and ZIP code-level data on demographics and crime risk. Analysis of variance, chi-square testing, correlational analysis, and data mapping were performed. RESULTS: Survey data were obtained from 90 pharmacies in 25 of the county's 33 residential ZIP code areas. Areas with fewer pharmacies per 10,000 residents tended to have a higher percentage of minority residents (p = 0.031). Methylphenidate pricing was typically lower in areas with lower employment rates (p = 0.027). Availability of home medication delivery service correlated with income level (p = 0.015), employment rate (p = 0.022), and crime risk (p = 0.014). CONCLUSION: A survey of community pharmacies in Shelby County, Tennessee, found that areas with a high percentage of minority residents had lower pharmacy density than areas with a high percentage of white residents. Pharmacies located in communities with low average income levels, low employment rates, and high scores for personal crime risk were less likely to offer home medication delivery services.

Hydrocodone: does it have a role in palliative care?

Hydrocodone is an epoxy-methoxy-methylmorphinan semisynthetic opioid (6-deoxy-3-O-methyl-6-oxomorphine hydrogen tartrate hemipentahydrate), which is structurally related to codeine, and is classified as a step 2 opioid on the World Health Organization's stepladder for pain. Hydrocodone is typically found in fixed dose combination with acetaminophen and is often used for pain management. Hydrocodone is a heavily prescribed drug and it is important to understand the evidence base that is guiding this use. This article reviews the pharmacodynamics, pharmacology, and evidence base for the use of hydrocodone in palliative care.