Using GIS mapping to improve access to prescription medications in rural Minnesota

Introduction: In 2023, 339,000 Minnesota residents (3.8% of the state’s population) lacked healthcare insurance. In that same year, approximately 32% of 1,400 Minnesota residents surveyed who earned less than US$50,000 indicated that they did not get a prescription filled, split tablets, or skipped doses due to the cost of their medications. RoundtableRx, Minnesota’s medication repository program regulated by the Minnesota Board of Pharmacy, receives unopened, in-date, no-longer-needed medications donated by healthcare facilities and individuals. These medications are distributed to local RoundtableRx partner repositories (pharmacies or clinics), repackaged and dispensed at low cost/no cost to patients unable to afford the medication. As of the time of this report, of RoundtableRx’s 42 local repositories, 15 are located in Minnesota’s 49 rural counties. RoundtableRx desired to expand its services to additional rural counties, particularly areas of the state defined as Pharmacy Deserts, located 10 or more driving miles (16 kilometers) from the nearest pharmacy. Most local repositories are recruited through in-person visits by RoundtableRx leaders. To efficiently plan visits to potential repository partners in Minnesota’s most socially vulnerable rural areas, interactive Geographic Information System (GIS) mapping was employed to identify existing rural RoundtableRx partner repositories, rural pharmacies not currently participating with RoundtableRx, rural pharmacy deserts, and clinics within those rural pharmacy deserts. Methods: RoundtableRx partnered with University of Minnesota’s (UMN) U-Spatial, two UMN first-year (PGY1) pharmacy residents and the UMN College of Pharmacy to generate a map of pharmacy deserts in socially vulnerable Minnesota rural counties. Community and hospital pharmacies located in rural Minnesota were identified through a list from the Minnesota Board of Pharmacy. Pharmacy deserts were defined as rural areas either 10 miles (16 kilometers) by road or 30 minutes driving time from the nearest pharmacy. Outlets of national chain pharmacies were included in identifying pharmacy deserts; however, these pharmacies were not considered as potential partners due to lack of corporate responsiveness to earlier RoundtableRx overtures to recruit repository sites in either rural or urban communities. Clinics located within rural pharmacy deserts were identified through an internet search for primary care clinics in Minnesota. The University of Wisconsin’s Area Deprivation Index (ADI) was used to determine an area’s level of social vulnerability instead of the USA Centers for Disease Control and Prevention’s (CDC) Social Vulnerability Index (SVI). The ADI more explicitly addresses measures of socioeconomic status than does the SVI. Staff from U-spatial incorporated each of the above data sets as individual layers in a web-based interactive GIS map that the team used to interrogate the data. Findings: The resulting GIS map was used by RoundtableRx leaders to efficiently plan driving trips to rural pharmacies or clinics that might be recruited as RoundtableRx local repositories in Minnesota’s most socially vulnerable counties. Conclusions: GIS mapping enabled Minnesota’s prescription drug repository program to efficiently plan in-person visits to potential RoundtableRx local repositories in socially-vulnerable rural communities. The map also suggests that a mail-order pharmacy option would further increase prescription drug access for patients living in rural Minnesota’s medically-underserved pharmacy deserts.