Addressing rural health disparities through pharmacy curricula

Approximately 75% of the United States is rural. (1) While 20% of the US population lives outside of urban areas, only 9% of physicians and 12% of pharmacists practice in rural areas. (2,3) This lack of access to primary care is compounded by the significant need for primary care by citizens in rural areas. More than 1 in 3 adults living in rural America is in poor to fair health, with nearly half having at least 1 major chronic illness. (4) Individuals in rural areas have higher rates of smoking as well as obesity, diabetes, and other chronic diseases. (5) In its 2005 report on rural health care, the Institute of Medicine asserted that many of the challenges faced by those living in rural areas can be attributed to the lack of access to basic health care services. Furthermore, this report described 5 strategies to address the lack of care in rural areas, and 1 strategy was to increase the supply of primary care health professionals in rural areas through improved education and training. (4) Although the report did not specify types of providers, specially trained pharmacists may be able to address the health care disparities found in rural areas. Although the shortage of primary care clinicians has persisted for decades, there is evidence that medical education has made progress in eliminating deficiencies in access to rural health care. (6-8) The following universities, in addition to Jefferson Medical College, all have histories of a strong curricular commitment to rural health care: Alabama, Arizona, Illinois-Rockford, Minnesota, and Washington. Much of the University of Washington's involvement in rural health care has been through a coalition of the University's School of Medicine and 5 states in the Northwest, entitled WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho). With regard to rural health, pharmacy education is in its infancy and can be described as trailing medical education in its efforts. Based on a survey of Web sites of accredited pharmacy colleges and schools, (9) 3 were found that promote programmatic and longitudinal curricular offerings in education and training in rural pharmacy health. (10-12) If less than 3% of accredited pharmacy colleges and schools are promoting and providing formal curricular programming in rural pharmacy health, pharmacy education is probably not meeting the need for qualified pharmacy practitioners in rural areas. RURAL-FOCUSED PHARMACY PROGRAMS When considering creation of a rural-focused pharmacy curriculum, the UNC Eshelman School of Pharmacy first looked to local resources such as the statewide Area Health Education Centers (AHEC) Program. The AHEC system is designed to train and retain health care professionals across the state and has met this objective to an extent; therefore, AHEC could be a vital partner in a rural health-based pharmacy curriculum. Across the state of North Carolina, additional allies were identified who were willing to engage in the education of pharmacists with a rural health interest. The school also researched several programs throughout the country and surveyed prospective students. The information gathered suggested that the approach to fulfilling the rural health education need must be multi-faceted, including aspects of recruitment, admission processes, curricular innovation, and rural experiential training. Medical educators have found that a medical school applicant from a rural area is more likely to practice in a rural area. (6,7,13) This trend is juxtaposed with deficits in educational resources for rural areas that may place such applicants at a disadvantage compared to counterparts from metropolitan areas. Students with an interest in rural pharmacy practice may be encouraged to participate in rural health programs through tuition waivers, early admission, or the chance to obtain an additional designation or certification. Additionally, pharmacists are now included in the National Health ServiceCorps (NHSC) State Loan Repayment Program which gives grants to states to operate their own loan repayment programs for primary care providers in medically underserved areas. …