Self-reported vs RUCA rural-urban classification among North Carolina pharmacists
Background: The various ways in which rurality is defined can have large-scale implications on the provision of healthcare services.
Objective: The purpose of this study was to identify the relationship between self-perceived urban-rural distinction and the United States (US) Census tract-based Rural-Urban Commuting Area (RUCA) scheme that defines rurality among pharmacists.
Methods: This was a secondary analysis of data collected through a web-based survey of licensed pharmacists in North Carolina. Respondents self-reported their workplace settings, zip codes, and the pharmacy services offered in their place of work. Zip codes were replaced with the corresponding RUCA codes. The relationship between self-reported classification and RUCA codes was analyzed and a chi square test was performed to measure statistical significance.
Results: Of the original survey, 584 participants reported their workplace zip code and 579 reported their workplace setting (urban, rural). A significant difference was found between pharmacists who self-reported working in rural areas and the RUCA classifications – 94 (56.6%) of the 166 participants who reported working in “rural” areas were considered “urban” according to RUCA.
Conclusions: A significant discordance between pharmacists’ self-reported classification and the RUCA codes was found, with more respondents self-reporting their workplace area as “rural” as compared to the RUCA classification. Decision-makers examining the pharmacy workforce and pharmacy services should be aware of this discordance and its implications for resource allocation. We recommend the use of standardized metrics, when possible.
United States Census Bureau. 2010 Urban Area FAQs. https://www.census.gov/programs-surveys/geography/about/faq/2010-urban-area-faq.html (accessed Oct 21, 2020).
Kaczynski AT, Eberth JM, Stowe EW, et al. Development of a national childhood obesogenic environment index in the United States: differences by region and rurality. Int J Behav Nutr Phys Act. 2020;17(1):83. https://doi.org/10.1186/s12966-020-00984-x
Bennett K, Olatosi B, Probst J. Health disparities: Rural-urban chartbook. Columbia, SC: South Carolina Rural Health Research Center; 2008.
O'Connor A, Wellenius G. Rural-urban disparities in the prevalence of diabetes and coronary heart disease. Public Health. 2012;126(10):813-820. https://doi.org/10.1016/j.puhe.2012.05.029
Sanders SR, Cope MR, Park PN, Jeffery W, Jackson JE. Infants without health insurance: Racial/ethnic and rural/urban disparities in infant households' insurance coverage. PLoS One. 2020;15(1):e0222387. https://doi.org/10.1371/journal.pone.0222387
Talbert J, Schadler A, Freeman P. Rural/urban disparities in pneumococcal vaccine service delivery among the fee-for-service medicare population. Grand Forks: Rural & Underserved Health Research Center; 2018.
Hart LG, Larson EH, Lishner DM. Rural definitions for health policy and research. Am J Public Health. 2005;95(7):1149-1155. https://doi.org/10.2105/ajph.2004.042432
Davis MM, Spurlock M, Dulacki K, et al. Disparities in Alcohol, Drug Use, and Mental Health Condition Prevalence and Access to Care in Rural, Isolated, and Reservation Areas: Findings From the South Dakota Health Survey. J Rural Health. 2016;32(3):287-302. https://doi.org/10.1111/jrh.12157
Fan JX, Wen M, Kowaleski-Jones L. Rural-urban differences in objective and subjective measures of physical activity: findings from the National Health and Nutrition Examination Survey (NHANES) 2003-2006. Prev Chronic Dis. 2014;11:E141. https://doi.org/10.5888/pcd11.140189
Martins SL, Starr KA, Hellerstedt WL, Gilliam ML. Differences in Family Planning Services by Rural-urban Geography: Survey of Title X-Supported Clinics In Great Plains and Midwestern States. Perspect Sex Reprod Health. 2016;48(1):9-16. https://doi.org/10.1363/48e7116
Lin GE, Rosenthal TC, Horwitz M. Physician location survey: self-reported and census-defined rural/urban locations. Soc Sci Med. 1997;44(11):1761-1766. https://doi.org/10.1016/s0277-9536(96)00378-4
Lor M, Bowers BJ, Krupp A, Jacobson N. Tailored Explanation: A Strategy to Minimize Nonresponse in Demographic Items Among Low-income Racial and Ethnic Minorities. Surv Pract. 2017;10(3):10.29115/SP-2017-0015. https://doi.org/10.29115/sp-2017-0015
Emmet M, Stein Q, Thorpe E, Campion M. Experiences of Genetic Counselors Practicing in Rural Areas. J Genet Couns. 2018;27(1):140-154. https://doi.org/10.1007/s10897-017-0131-6
Howarth HD, Peterson GM, Jackson SL. Does rural and urban community pharmacy practice differ? A narrative systematic review. Int J Pharm Pract. 2020;28(1):3-12. https://doi.org/10.1111/ijpp.12567
Cohen SA, Cook SK, Sando TA, Sabik NJ. What Aspects of Rural Life Contribute to Rural-Urban Health Disparities in Older Adults? Evidence From a National Survey. J Rural Health. 2018;34(3):293-303. https://doi.org/10.1111/jrh.12287
Onega T, Weiss JE, Alford-Teaster J, Goodrich M, Eliassen MS, Kim SJ. Concordance of Rural-Urban Self-identity and ZIP Code-Derived Rural-Urban Commuting Area (RUCA) Designation. J Rural Health. 2020;36(2):274-280. https://doi.org/10.1111/jrh.12364
Scott DM. Assessment of pharmacists' perception of patient care competence and need for training in rural and urban areas in North Dakota. J Rural Health. 2010;26(1):90-96. https://doi.org/10.1111/j.1748-0361.2009.00270.x
Scott DM, Neary TJ, Thilliander T, Ueda CT. Factors affecting pharmacists' selection of rural or urban practice sites in Nebraska [published correction appears in Am J Hosp Pharm 1992 Oct;49(10):2444]. Am J Hosp Pharm. 1992;49(8):1941-1945.
Scott DM, Strand M, Undem T, Anderson G, Clarens A, Liu X. Assessment of pharmacists' delivery of public health services in rural and urban areas in Iowa and North Dakota. Pharm Pract (Granada). 2016;14(4):836. https://doi.org/10.18549/pharmpract.2016.04.836
Haag JD, Stratton TP. Patient care services in rural Minnesota community pharmacies. J Am Pharm Assoc (2003). 2010;50(4):508-516. https://doi.org/10.1331/japha.2010.09134
Sisson EM, Israel MK. Extent of community-based delivery of pharmaceutical care in Virginia. Pharmacotherapy. 1996;16(1):94-102. https://doi.org/10.1002/j.1875-9114.1996.tb02921.x
Seamon GJ, Burke A, Tak CR, Lenell A, Marciniak MW, Scott MA. Role of Pharmacists in Hormonal Contraceptive Access: A Survey of North Carolina Pharmacists. Pharmacy (Basel). 2020;8(4):191. https://doi.org/10.3390/pharmacy8040191
United States Department of Agriculture Economic Research Service. Rural-Urban Commuting Area Codes. https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/ (accessed Oct 4, 2020).
WWAMI Rural Health Research Center. RUCA Data Using RUCA Data. https://depts.washington.edu/uwruca/ruca-uses.php (accessed Oct 23, 2020).
Health Resources and Services Administration. Defining Rural Population. https://www.hrsa.gov/rural-health/about-us/definition/index.html (accessed Dec 1, 2020).
Guirguis LM, Hughes CA, Makowsky MJ, Sadowski CA, Schindel TJ, Yuksel N. Survey of pharmacist prescribing practices in Alberta. Am J Health Syst Pharm. 2017;74(2):62-69. https://doi.org/10.2146/ajhp150349
Poudel A, Lau ETL, Deldot M, Campbell C, Waite NM, Nissen LM. Pharmacist role in vaccination: Evidence and challenges. Vaccine. 2019;37(40):5939-5945. https://doi.org/10.1016/j.vaccine.2019.08.060
National Rural Health Association. Recruitment and retention of a quality health workforce in rural areas. Alexandria, VA; 2005.
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