Like many other ACCP members, I was born and raised in a rural area. In my case, it was in the town of Perth, a largely agricultural and farming community in Upstate New York with an estimated population of 3600. Many of you, like me, may have family that reside in rural areas. I’ve lived in Colorado for the past 24 years, where about 73% of the state’s footprint is considered rural but the largest percentage of the population resides near major metropolitan areas. There’s no universal definition of rural area, but according to the U.S. Department of Agriculture Economic Research Service (USDA ERS), the term is often based on population density or geographic location in relation to population hubs. It’s estimated that 46 million Americans live in rural areas, according to the Rural Health Information Hub. 

Although we continue to make great strides in advancing health care treatments and preventive strategies, access to care in rural areas remains a major area of need. A recent article published by the USDA ERS indicates that access to health care services significantly declines in most rural counties in the United States. This includes an insufficient number of health care facilities, as well as fewer primary care, dental, and mental health providers. Rural Healthy People 2030 notes that the overall health status of those residing in rural areas is lower, with higher rates of obesity, smoking, and addiction; activity limitations because of chronic conditions; and lower income and insurance coverage compared with urban dwellers.¹ Given these findings, there is great potential to positively influence health care and patient outcomes in rural areas. 

Some of the main challenges of accessing care in rural areas involve insufficient infrastructure and workforce. The presence of a community pharmacy has typically been a staple of health care delivery in rural areas. However, pharmacy closures across the country threaten to reduce the number of practice sites available to serve patients. Other facilities geared toward care for rural communities, such as rural health clinics, critical access hospitals, and federally qualified health centers, also depend on adequate funding, reimbursement, and personnel to function. Attracting health care professions students who ultimately wish to practice in rural settings is becoming a focus of recruitment strategies, as is exposing trainees to rural health care during their experiential training. Indeed, recent data suggest that clinical trainees from rural areas are more likely to pursue practice in a rural setting.² Nonetheless, significant barriers still exist for health professionals, including clinical pharmacists, such as patients’ mistrust of public health interventions in rural settings and lack of access to electronic health records in the community pharmacy setting.³ 

Despite these challenges, there are many great opportunities for clinical pharmacists in rural settings. The advent of telehealth has reduced barriers related to transportation and geographic location. Telehealth can also facilitate interprofessional collaboration and team-based care. States that have adopted collaborative practice agreements and statewide protocols allow clinical pharmacists to provide more direct patient care for both disease prevention and treatment. Many states have opportunities for clinical pharmacists to be involved in advocacy efforts focused on telehealth. Finally, emerging areas such as veterinary pharmacy have the potential to expand clinical pharmacy services beyond humans. As we continue to seek opportunities for clinical pharmacists to positively influence patient care, keep in mind how we can address the needs of those who live in rural America. 

Have a great summer – I hope to see you in Phoenix this fall. 

References 

1. Callaghan T, Kassabian M, Johnson N, et al. Rural Healthy People 2030: new decade, new challenges. Prev Med Rep 2023;33:102176. 

2. Patterson DG, Shipman SA, Pollack SW, et al. Growing a rural family physician workforce: the contributions of rural background and rural place of residency training. Health Serv Res 2024;59:e14168. 

3. Lister JJ, Joudrey PJ. Rural mistrust of public health interventions in the United States: a call for taking the long view to improve adoption. J Rural Health 2023;39:18-20.