Rural Community Pharmacy: A Critical Need in Texas

• By Jerry H. Hodge School of Pharmacy
• March 31, 2020

West Texas is an expansive and varied region where you can find wide-open prairies, cattle ranches, hundreds of oil wells, and mountain deserts along with tumbleweeds, rock formations, and cacti that look like they came straight out of a Wild West movie set. 

What may be more difficult to find in West Texas, however, is a health care professional. While the remote nature of the region is a major draw for many of its residents, the low population density in some areas can be problematic when it comes to accessing professional health care services.

According to the Fort Worth Star-Telegram, there are only 63,871 practicing doctors serving 28 million residents in Texas — a shortage that most deeply impacts the state’s rural communities. In West Texas, the problem is so severe that many of the region’s communities have been designated as Health Professional Shortage Areas and Frontier areas — geographic areas with recognized shortages of primary care doctors, and mental health and dental practitioners. In West Texas, that translates into communities where there are more than 3,500 patients per physician, significantly higher than the commonly accepted industry-recommended limit of 2,500 patients per physician. It’s a mind-boggling number even at the recommended level.

To ensure that residents in rural Texas have access to appropriate medical care, community pharmacy locations need professionals who can step up and serve at the front lines of health care for residents in these areas. However, this area of practice is also struggling to meet demand in the region. According to research by the RUPRI Center for Rural Health Policy Analysis, 1,231 independently owned rural pharmacies in the U.S. — 16.1% of the national total — closed between 2012 and 2018 alone. A staggering 630 rural communities that housed at least one independent, chain or franchise retail pharmacy in March 2003 no longer had those services by March 2018.

To help ensure that rural communities in Texas have access to critical health care services, pharmacy schools in the region, including the Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy, are preparing students who can serve as the first line of defense against a variety of rural health care challenges in the state. 

Expanding Rural Health Care in Texas

While the open expanses of West Texas are well-suited for the petroleum, natural gas, and cattle industries, the conditions are less ideal for the field of health care. For residents who live in this region, accessing needed medical attention — from emergency services to specialist appointments — can be a major challenge.

“Access to care is a huge issue,” says Professor Charles Seifert, Pharm.D., a senior associate dean at TTUHSC. “Many areas, especially in rural West Texas, have a community pharmacy but no other health care provider in the town. With telemedicine, we can sometimes bridge that gap, but it is still there.”

Because many of these towns do not have primary care or specialty providers, residents are forced to drive long distances to access the care they need. The challenging nature of these trips can force patients to delay seeking care, or skip important appointments altogether — which can threaten their health and even their lives.

This pattern is expected to continue in the coming decade. The Texas Department of Health and Human Services predicts that by 2030, the shortage of primary care physicians (which includes family medicine, general practice, internal medicine, obstetrics and gynecology, and pediatrics) in the state will increase by 67% — that’s an additional shortage of 3,375 providers.

In addition to primary care shortages, a variety of factors are contributing to the overarching health care crisis in rural Texas, including:

• Hospital closures: Major health care facilities are limited in rural communities. And those that do exist are under near-constant threat of closure. According to research conducted by the Cecil G. Sheps Center for Health Services Research, 113 rural hospitals across the nation closed their doors between January 1, 2010, and August 21, 2019. Of those, Texas lost 20 facilities, the highest number of closures in any state in the nation.
  
  
• Referral patterns: Even when patients have access to primary care, referrals to specialty care and other services that tend to be offered in larger cities can be difficult.
  
  “The geography of referral patterns in this region is challenging,” Seifert says. “We see patients not only from our area but even from the eastern third of New Mexico. Patients have to travel long distances, sometimes through the mountains, and that can be problematic — especially when we have to deal with out-of-state insurance policies.”
  
  
• Availability of illegal drugs: Because the state shares 1,254 miles of common border with Mexico, many communities are impacted by cartel activity — and easy access to a variety of illegal drugs, including highly addictive substances such as crystal meth.
  
  “Oftentimes, the cartels are trying to move farther from the border where law enforcement is not on high alert,” Seifert says. “Consequently, they set up shop in some of these small communities, which can create a big issue.”
  
  However, illegal drugs are not the only substances that can lead to abuse — and even death — in Texas. Opioids, including legal prescriptions, are also creating a health crisis. Between 1999 and 2014, prescription opioid sales nearly quadrupled in the U.S., according to the Centers for Disease Control and Prevention. In Texas, the Texas Department of Health and Human Services reported that almost half of the state’s drug overdose deaths involve opioids.

The Role of Pharmacists in Rural Environments

Too often, pharmacists are viewed as technicians who simply dispense medication. The reality is that community pharmacy professionals can play a critical role in ensuring the health and safety of their communities.

In the communities of West Texas, in particular, Texas pharmacists are stepping up to answer the region’s evolving rural health care crisis. This is being accomplished through a variety of strategies found at the pharmacy-level, including:

• Identifying health concerns: In rural areas, pharmacists can act as front line health care advisers for anything from cough and colds to rashes. While pharmacists do not diagnose conditions, they can help identify when a health concern is something serious that should be referred to a physician, specialist, or even emergency medical personnel. If patients are not regularly seeing physicians, nurse practitioners, or other primary care providers, Texas pharmacists may be the first health care professional to notice that something is wrong.
  
  “The pharmacist can look at a rash, for example, and recommend an over-the-counter prescription, or say ‘Oh no, that's more serious. You need to go to see a physician right away,’” Seifert says. “That happens all the time. And I think in rural areas, it is even more important because no one else is close by. So while they are not making diagnoses, they end up being the ones who can identify problems, acting as the first line of defense.”
  
  
• Increasing vaccination rates: Pharmacists are increasingly being empowered to administer a wide variety of vaccinations. For residents of rural communities who have limited access to regular primary care, the option to receive immunizations at a local community pharmacy is a much more convenient option — which increases the likelihood that they will follow through and receive the shot. According to Seifert, rural Texas pharmacists have played a critical role in dramatically increasing the rate of vaccination in the state, spearheading programs that have influenced care at the national level.
  
  
• Combating the opioid crisis: When it comes to addressing opioid abuse in rural Texas, pharmacists can play a powerful role, particularly when it comes to getting Naloxone in the hands of people who could be at risk of overdose. Naloxone is a medication that can counteract the effect of opioids, saving lives when used appropriately.
  
  “Pharmacists in rural areas can identify signs of abuse much faster than a provider who is miles away in a city somewhere,” Seifert says. “They can pick up on warning signs and try to get the patients the help that they deserve.”
  
  
• Educating the public: An often overlooked component of a pharmacist’s role is the educational component. These professionals can play an influential role by ensuring that rural communities receive proper education, not only about prescriptions but about larger health concerns, such as the opioid epidemic and other drug abuse.
  
  “The educational role can even extend to middle school, junior high and high school,” Seifert says. “For example, a very common drug of abuse in the middle school population is inhalants. It can be a huge problem. Pharmacists can not only talk to students but also they can educate teachers on what to look for and how to respond.” 

Training Texas Pharmacists to Work in Rural Communities

While pharmacists — in both urban and rural communities — still perform the traditional role of preparing and supervising the distribution of medications, professional opportunities in the health care field for these positions have never been more varied or diverse. But in order for pharmacists to effectively take on additional responsibilities and play a more active role in addressing the rural health care challenges of Texas, they first need proper training.

Though a higher degree is required for any type of pharmaceutical practice, professionals who intend to work in a rural area can benefit from a degree program that offers a rural community clerkship. During these hands-on learning opportunities, students are exposed to the challenges and opportunities of community pharmacy practice by working in a rural setting.

The TTUHSC Jerry H. Hodge School of Pharmacy is one of only three pharmacy schools in the nation that requires its students to participate in a rural community clerkship. The program’s rural community rotation emphasizes preventative care, telecare, acute care, extended care, and ambulatory care. 

“In terms of percentages, we have more pharmacists in rural and frontier counties than any other school in the state,” Seifert says. “And approximately 11.5% of our alumni go on to work in rural areas. That is the highest rate of any pharmacy school in the state of Texas.” 

Earning Your Degree at the TTUHSC Jerry H. Hodge School of Pharmacy 

If you are interested in working in a community pharmacy setting, particularly in a rural community, the TTUHSC Jerry H. Hodge School of Pharmacy may be right for you.  In the four-year Doctor of Pharmacy program, you will participate in classroom, laboratory, and clinical experiences designed to equip you with critical knowledge and skills in drug distribution and control, practice management, and direct patient skills, with emphasis on the skills you need to work in a rural setting.

“Our students leave equipped for rural practice,” Seifert says. “In the South Plains rural health clinic, for example, we have alumni who man the pharmacy, but they also have all kinds of other responsibilities, including blood pressure checks, diabetes checks, immunizations, and patient compliance follow-ups.”

Hands-on experience is an important component of the Doctor of Pharmacy program. As a student at the TTUHSC Jerry H. Hodge School of Pharmacy,  you will participate in an above-average number of clinical hours in order to refine the skills you learn in the classroom.

“The quality of our clinical program is really, really superb,” Seifert says. “We have nearly 100 faculty members, and most of our clerkships are taught by faculty. So the students get a much more in-depth experience than at other schools.”

The TTUHSC Jerry H. Hodge School of Pharmacy is also the only school of pharmacy in the country that requires both a pediatric and geriatric clerkship. Because Texas pharmacists may be one of the few points of health care access in rural communities, the goal is to provide students with a well-rounded education for assisting patients at any point in the age spectrum.

As part of the curriculum, you will additionally complete a course on drug addiction. While the course was previously offered as an elective, it is now a requirement to ensure that students are prepared to address the state’s addiction-related challenges — particularly in light of the opioid crisis.

Want to learn more about how a degree from the TTUHSC Jerry H. Hodge School of Pharmacy can help you meet the critical need for health care in rural Texas?  Call (806) 414-9393 or email us at sopadmissions@ttuhsc.edu to speak with one of our admissions representatives today.