Healthcare deserts are regions in the United States with limited access to healthcare providers and medicine, often contributing to poor health outcomes and healthcare inequities for residents of these communities. Federal healthcare professionals play a critical role in addressing healthcare deserts.
LCDR Nivedita Das of the Indian Health Service’s Chinle Comprehensive Health Care Facility (CCHCF), discussed this role at the Joint Federal Pharmacy Seminar, held in San Diego, California, recently. During this talk and in an interview with this publication following the meeting, LCDR Das and LT Sunuk Park described the challenges that these healthcare professionals often face, engaged with the audience on how healthcare teams and others can address these challenges, and emphasized the key role these professionals play in these communities, particularly those that serve indigenous populations.
LCDR Das noted that the Chinle Service Unit, which includes CCHCF, based in Chinle, Arizona, and the Tsaile and Pinon Health Centers. Chinle provides healthcare services to approximately 37,000 active users, "with strong Navajo cultural traditions existing within the community." Healthcare deserts, also called pharmacy deserts, are challenges in parts of Arizona, New Mexico, and Alaska, where residents are often forced to travel long distances to obtain essential medications, and even further for critical medical services. These issues, and others, have led to about a third of the 400,000 citizens of the Navajo Nation—which stretches 27,000 square miles through Arizona, New Mexico, and Utah—to report having higher-than-average occurrences of diabetes, heart conditions, and lung disease compared with the general population, LCDR Das said.
The CCHCF is the closest pharmacy for many residents, yet the facility struggles to maintain staff, with vacancy rates hovering around 50%. Staffing is often impacted by logistical challenges such as recruiting and retaining pharmacists and health care providers in the area, and geographic challenges like poor road conditions.
After the resignation of the system’s chief pharmacist in June 2023 and the departure of 2 other pharmacists, the facility was left without a permanent pharmacist for several months, LCDR Das said. Facing a 100% vacancy rate, the local team was forced to innovate quickly to ensure that patients continued to receive essential medications.
During this period, the team had to rely on contractors, telepharmacy, and staff from other healthcare centers. This created logistical challenges but also highlighted the importance of adaptability and creative thinking in times of crisis, LCDR Das noted.
Telemedicine and telepharmacy are 2 of the most promising solutions for overcoming the challenges of pharmacy deserts. The ability to provide consultations and verify prescriptions remotely allows pharmacists to extend their services far beyond the traditional boundaries of the pharmacy. In Alaska, for example, pharmacists are using video consultation systems like MHS Video Connect to provide counseling to patients in remote villages.
As was clearly demonstrated during the COVID-19 pandemic, telemedicine also offers the advantage of reducing the impact of healthcare vacancies by enabling healthcare professionals to work remotely. Pharmacists can consult with patients, verify prescriptions, and provide essential medication management services without needing to be physically present.
One strategy employed at Chinle was pseudoremote verification for prescriptions from other sites, LCDR Das said. Pharmacists stationed at other facilities or working remotely could verify prescriptions through telemedicine platforms, ensuring that medication was provided to patients in a timely manner, even in the absence of an on-site pharmacist. This method not only maintained the flow of pharmacy services but also kept the healthcare providers and patients connected, despite the geographic and staffing challenges.
In other areas, such as the Pinon Health Center, where the pharmacy also faced staffing shortages, the solution was to consider closing the pharmacy temporarily and directing patients to a nearby facility. However, logistical complications made this unfeasible. Instead, the team opted to extend operating hours and create temporary housing for staff, a solution that addressed both safety concerns and the need for ongoing pharmacy services.
Stepping Up and Offering Solutions
As with other communities, pharmacists at Chinle are often the most accessible healthcare professionals, LCDR Das said. They are a valuable resource for medication consultations, screenings, and advice on managing chronic diseases. In many rural settings, pharmacists are relied upon to perform duties traditionally handled by physicians or nurse practitioners. They are also uniquely positioned to provide services that prevent serious health conditions from escalating, such as lung cancer screenings and smoking cessation programs.
For instance, in a presentation at the International Association for the Study of Lung Cancer’s 2024 World Conference on Lung Cancer, also held in San Diego, California, Shanada Monestime, PharmD, Director of Community-Engaged Research for GO2 for Lung Cancer, emphasized the importance of utilizing pharmacists to navigate patients through basic screenings and consultations. For instance, a pharmacist could ask 3 questions: “Do you have a smoking history?” “How long have you smoked?” and “Would you be interested in a lung cancer screening?” This quick, 5-minute consultation could potentially save lives, and countries like the United Kingdom and Canada are already integrating pharmacists into this capacity, she explained.
However, in many remote and underserved areas, the absence of pharmacists exacerbates the challenge of addressing healthcare issues such as these. Pharmacists are uniquely positioned to be able to step up in ways that extend beyond their traditional role, taking on responsibilities typically assigned to physicians or nurses, LCDR Das said.
Training, Recruitment Strategies
Addressing the shortage of pharmacists in healthcare deserts requires long-term strategies focused on recruitment, training, and retention. One approach is to encourage local residents to pursue careers in pharmacy, LCDR Das explained. Many remote communities, such as those in rural Alaska and Native American reservations, have a strong desire to see their own people in healthcare roles. However, pharmacy education is often a barrier, as it requires specialized training and access to educational resources.
Efforts are being made to overcome this barrier by offering loan repayment programs, scholarships, and training initiatives aimed at recruiting local residents into the field. For instance, programs like the “Grow Your Own” initiative aim to support individuals from underserved communities in pursuing pharmacy degrees and returning to serve their own populations. These programs not only help to address workforce shortages but also foster a sense of trust and cultural competence between healthcare providers and the communities they serve.
Another strategy that was discussed during the session was the potential use of reserve officers and temporary contractors to fill staffing gaps. The US Public Health Service reserves, for example, can be deployed to remote healthcare facilities to provide temporary staffing relief. While this is not a permanent solution, it can help stabilize the workforce during periods of high vacancy rates.
The Importance of Collaboration
During the discussion part of LCDR Das’ talk, collaboration was an agreed upon key theme in overcoming the challenges of healthcare deserts. By working together across disciplines and organizations, healthcare professionals can develop innovative solutions to address staffing shortages and improve access to care. Pharmacists, in particular, can collaborate with other healthcare providers, such as physicians, nurses, and social workers, to create a more integrated and holistic approach to healthcare delivery.
References
- Das N, Park S. Supporting a rural IHS clinic with 100% pharmacist vacancy. Presented at: Joint Federal Pharmacy Seminar. November 9-12, 2024; San Diego, CA.
- Phipps NM, Rigney M, Monestime S, et al. Development of a framework to address lung cancer health disparities: one organization’s experience. Presented at: 2024 World Conference on Lung Cancer. September 7-10, 2024; San Diego, CA. Abstract P2.16C.02.