The availability of pharmacists with Additional Prescribing Authorization in relation to the distribution of vulnerable populations - A cross-sectional study.

BACKGROUND: For vulnerable patients- such as immigrants or those with low income- to benefit from pharmacists' advanced services, such as independent prescribing, pharmacists must be accessible to these populations. OBJECTIVES: This research examines the geographical relationship between Alberta pharmacists with Additional Prescribing Authorization (APA) and a neighbourhood's proportion of vulnerable populations. METHODS: Publicly available data were extracted from the Alberta College of Pharmacy website for active registered pharmacists' primary location of practice and APA status. Pharmacists with APA were grouped depending on the postal codes of their main self-reported place of practice. These postal codes were converted to geospatial locations and then linked to aggregated dissemination area's (ADA's) income and immigrant quintiles. The mean number of APA pharmacists per ADA was compared using analysis of variance (ANOVA) between income and immigrant quintiles. The number of APA pharmacists per ADA in the highest and lowest income and immigrant quintiles was compared using negative binomial regression model. RESULTS: The records of 3,742 pharmacists with 1,054 unique postal codes of practice sites were included in the study and were linked to unique ADAs (N = 527). Almost one half of all ADAs in Alberta (47.6%, n = 251) had no APA pharmacist. Income quintiles of ADAs were associated with the mean number of APA pharmacists (p < 0.001), with high income areas estimated to have 0.44 more APA pharmacists (p = 0.01). Similarly, areas with the highest quintile of recent immigrants were estimated to have 0.66 more APA pharmacists than other ADAs (p < 0.01). CONCLUSIONS: A sizable proportion of the Alberta population still does not have access to a pharmacist with APA, and those with APA seem to concentrate in areas with higher income and higher proportions of the population who are immigrants. Future research should examine the utilization of expanded scope of practice in relation to the distribution of vulnerable populations.