Background: Pharmacists can offer medication expertise to help better control diabetes and cardiovascular disease (CVD) and improve patient outcomes, particularly in rural communities. This project evaluated the impact of an awareness campaign on perceptions of expanded pharmacy services. Methods: The “Your Pharmacists Knows” campaign included a 30-s commercial, print material, and media announcements. A non-randomized pre-post study was completed using a modified theory of planned behavior (mTPB) to assess knowledge, attitude, perceived benefits and norms, and perceived control. A 73-item survey was administered to a convenience sample (n = 172) across South Dakota. Regression models to assess intent and utilization were conducted using age, gender, race, education, population, and insurance status as predictors for mTPB constructs. Results: Most common predictors were female gender and higher education level (p < 0.001). All mTPB constructs were significant predictors of intent to use services (p < 0.001). Knowledge and perceived control had the largest influence on intent. Additionally, there was significant improvement in post-campaign service utilization (p < 0.001). Conclusions: This campaign positively influenced intent to seek and utilize services in rural communities where pharmacies may be the only healthcare option for miles. Through targeted campaigns, patients with diabetes or CVD may find access to services to better manage their conditions.

Access to healthcare remains a major issue in the United States, particularly in rural communities. Mobile health clinics (MHCs), including those utilizing a pharmacist-driven model, are one effective solution to address access-related barriers. To our knowledge, limited information is available to aid in the development, implementation, and operation of a pharmacist-driven MHC model. This project aims to fill this gap by exploring the characteristics of existing pharmacist-driven MHCs. This project used semi-structured interviews, guided by a 23-item interview guide, conducted with groups and individuals from pharmacist-driven mobile health programs to identify logistics for the development of a pharmacist-driven MHC model. Fifteen pharmacist-driven MHCs that met the inclusion criteria were identified through a web-based search. Of these, eight programs agreed to participate (53%). An additional two programs were identified through snowball sampling, for a total of ten participating programs. Prior to the interview, programs completed a 14-item intake questionnaire to allow for adaptation of the interview guide. Interview data was analyzed using a mixed deductive (hypothesis-driven) strategy, in which four areas of inquiry, logistics, partnerships, outcomes, and lessons learned, were identified through a literature review process and guided the analysis. In this manuscript we focus on program logistics. Sixteen participants from ten pharmacist-driven MHCs completed an interview. Six subthemes were identified related to program logistics: (1) programs exist to increase access to care; (2) programs have an awareness of scope/role; (3) programs identify and meet community needs; (4) programs meet patients’ needs; (5) programs have a small staff with large volunteer-base; and (6) programs have a three-step clinical workflow. By utilizing the MHC model, pharmacists may be better able to address health gaps while leveraging existing resources, and providing services tailored to the needs of the patients within a community. These findings may be used as a guide for the development, implementation, and operation of current and future pharmacy-driven MHC programs.

Rural communities are disproportionately affected by substance use disorder (SUD) and public stigma impedes access to and utilization of treatment and support services. This study compares data from a 2020 study conducted in rural Ohio (N = 173) with results from a recent study conducted in South Dakota (N = 41) on publicly-held stigmatizing views of SUD. South Dakota participants were recruited at several public events across the state via convenience sampling between August 2022-February 2023 to complete a survey. Data from responses to 19 stigma-related questions were merged with the associated data from the 2020 Ohio study and a comparative analysis was performed using Fisher’s exact and Chi square tests. The data shows that respondents in South Dakota, when compared to respondents in Ohio, are more likely to believe addiction is an illness (SD = 86.5%, OH = 48.5%, p < 0.001). The belief in SUD as an illness aligns with reduced stigmatizing beliefs, as indicated by respondents in SD showing lower stigmatizing ideologies and higher support for naloxone and harm reduction services, when compared to Ohio respondents. In both studies, the belief that SUD is an illness was associated with a reduction in other stigmatizing beliefs. These results can be used to inform more focused anti-stigma efforts. As more people adopt fewer stigmatizing views on SUD in rural areas, more people with SUD may be supported to seek treatment and recovery services.

Background: Access to healthcare services is a major barrier to residents of the rural state of South Dakota. As a highly accessible member of the healthcare team, outpatient pharmacists can play a key role in a patient's healthcare journey. There is a need to identify the unique barriers and facilitators pharmacists in both rural and urban areas face to maximize the impact of their role. Objective: The objective of this work was to compare perceptions of rural and urban pharmacists regarding the facilitators and barriers to providing patient care in South Dakota. Methods: This qualitative project highlights results from interviews and focus group sessions with a convenience sample of South Dakota pharmacists. Participants were recruited using a referral word-of-mouth system, contracts with healthcare market research agencies, newspaper advertisements, and posters displayed in public locations in South Dakota. Practice location was characterized as rural or urban based on United States Department of Agriculture definitions. Findings from interviews and focus group sessions were coded and analyzed using content analysis by two student researchers. Results: Participants included 12 rural-practicing and 21 urban-practicing pharmacists in South Dakota. In both rural and urban areas, key barriers included communication with providers (50% rural; 50% urban), lack of electronic health record access (25% rural; 14% urban), not enough staff (22% rural; 20% urban), and patient misunderstanding the scope of pharmacy (22% rural; 40% urban). Barriers specific to rural areas included time to provide services (22%), having smaller facilities (27%) and provider hesitation regarding collaborative practice agreements (29%). There were no urban-specific barriers. Facilitators specific to urban areas included frequent communication with patients (6.1%) and good quality support staff (9.1%). There were no rural-specific facilitators. Conclusions: Next steps include increasing awareness of pharmacy-based patient care services, researching further to identify the extent to which facilitators and barriers influence the ability to initiate and sustain pharmacy services in rural and urban areas, and providing support to pharmacies to overcome barriers and leverage facilitators.