# Community Pharmacy Density Across Remote, Rural, Regional and Metropolitan Areas of Australia: An Ecological Study

## TL;DR

This study maps community pharmacy density in Australia, finding lower access in remote and outer-city areas, which could inform health policy decisions.

## Contribution

The paper provides the first analysis of community pharmacy density at subnational levels in Australia, identifying geographic disparities and correlates.

## Key findings

- Community pharmacy density was lower in outer-city and remote/rural areas compared to inner-metropolitan regions.
- Remote/rural/regional areas and higher proportions of elderly residents were associated with higher pharmacy density.
- Certain regions, like the Northern Territory and parts of Victoria, had clusters of areas with very low pharmacy density ('pharmacy deserts').

## Abstract

To investigate community pharmacy density (CPD) at national and subnational (i.e., below‐national) levels in Australia, and examine area‐level factors associated with CPD.

Aggregate, 2024 data on Australia's community pharmacies (CPs) and Statistical Area Level 3 (SA3) populations were sourced. CPD (number of CPs/10 000 population) was calculated nationally and sub‐nationally. SA3 characteristics associated with CPD quintiles were examined via partial proportional odds regression. Statistical significance was set at p < 0.05.

There were 6 032 CPs across 336 SA3s. CPD was 2.22, 2.09, and 2.63 CPs/10 000 population for Australia overall, metropolitan Australia, and remote/rural/regional Australia, respectively. SA3‐level data revealed CPD tended to be lower for outer‐ than inner‐city metropolitan areas. Clusters of SA3s with lowest‐quintile CPD (i.e., ‘pharmacy deserts’) were observed. Four large, remote SA3s in the Northern Territory (NT) (e.g., Daly‐Tiwi‐West Arnhem) had lowest‐quintile CPD, as did many outer‐city (e.g., Manningham East, Victoria) or other remote/rural/regional (e.g., Baw Baw, Victoria) SA3s. SA3 characteristics associated with a one‐quintile increase in CPD included remote/rural/regional (relative to metropolitan) areas (adjusted odds ratio [aOR] = 4.68, 95% confidence interval [CI] = 2.24–9.81) and percentage of male residents (aOR = 1.38, 95% CI = 1.16–1.63). Additionally, CPD tended to significantly increase with increasing percentages of residents aged 85+ or 65–84 years, and to significantly decrease with increasing SA3 area (km2).

Correlates of CPD, and particular SA3s with lowest‐quintile CPD, could inform legislation, policies, and decisions related to CP premises and workforce Australia‐wide (e.g., Australia's Pharmacy Location Rules and state/territory‐level CP ownership legislation). Future studies of CPD across Australia should assess the correlation between CPD and general practice density, and incorporate additional subnational area characteristics (e.g., socioeconomic status) and CP accommodations (e.g., opening hours).

What is already known?
○The International Pharmaceutical Federation reported that, in 2021, Australia's national‐level community pharmacy density was 2.26 community pharmacies per 10 000 population—below the global mean of 2.75 community pharmacies per 10 000 population.○Community pharmacy density has been investigated across subnational (i.e., below‐national) geographic areas in some countries—including Brazil, China, Malaysia, New Zealand, South Africa and United States—but not in Australia.○Characteristics of subnational areas associated with community pharmacy density have been investigated in Canada and New Zealand but not in Australia.
What this paper adds?
○In Australia during 2024, community pharmacy density was 2.22, 2.09 and 2.63 community pharmacies per 10 000 population for the whole country, metropolitan areas, and remote/rural/regional areas, respectively, consistent with literature suggesting that—despite having fewer pharmacists per community pharmacy—non‐metropolitan Australia is more reliant on community pharmacies due to a relative lack of other health services.○In Australia during 2024, characteristics of subnational geographic areas (i.e., Statistical Area Level 3 areas) independently associated with higher community pharmacy density included higher percentage of 85+‐year‐old or 65–84‐year‐old residents, higher percentage of male residents, and classification as remote/rural/regional, while lower community pharmacy density tended to be associated with higher area (km2)—information that could inform future research as well as legislation, policies, and decisions regarding community pharmacy and pharmacist distribution across Australia.○Choropleth mapping and tabulated area‐level data revealed that community pharmacy density was higher in inner‐metropolitan than outer‐metropolitan areas, that there were clusters of areas with very low (i.e., lowest‐quintile) community pharmacy density across certain parts of Australia (e.g., most of the Northern Territory, including Daly‐Tiwi‐West Arnhem), and that subnational areas across all states/territories of Australia had very low community pharmacy density (e.g., Manningham East and Baw Baw in Victoria)—further information pertinent to future research as well as legislation, policies, and decisions regarding community pharmacy and pharmacist distribution across Australia.

What is already known?
○The International Pharmaceutical Federation reported that, in 2021, Australia's national‐level community pharmacy density was 2.26 community pharmacies per 10 000 population—below the global mean of 2.75 community pharmacies per 10 000 population.○Community pharmacy density has been investigated across subnational (i.e., below‐national) geographic areas in some countries—including Brazil, China, Malaysia, New Zealand, South Africa and United States—but not in Australia.○Characteristics of subnational areas associated with community pharmacy density have been investigated in Canada and New Zealand but not in Australia.

The International Pharmaceutical Federation reported that, in 2021, Australia's national‐level community pharmacy density was 2.26 community pharmacies per 10 000 population—below the global mean of 2.75 community pharmacies per 10 000 population.

Community pharmacy density has been investigated across subnational (i.e., below‐national) geographic areas in some countries—including Brazil, China, Malaysia, New Zealand, South Africa and United States—but not in Australia.

Characteristics of subnational areas associated with community pharmacy density have been investigated in Canada and New Zealand but not in Australia.

What this paper adds?
○In Australia during 2024, community pharmacy density was 2.22, 2.09 and 2.63 community pharmacies per 10 000 population for the whole country, metropolitan areas, and remote/rural/regional areas, respectively, consistent with literature suggesting that—despite having fewer pharmacists per community pharmacy—non‐metropolitan Australia is more reliant on community pharmacies due to a relative lack of other health services.○In Australia during 2024, characteristics of subnational geographic areas (i.e., Statistical Area Level 3 areas) independently associated with higher community pharmacy density included higher percentage of 85+‐year‐old or 65–84‐year‐old residents, higher percentage of male residents, and classification as remote/rural/regional, while lower community pharmacy density tended to be associated with higher area (km2)—information that could inform future research as well as legislation, policies, and decisions regarding community pharmacy and pharmacist distribution across Australia.○Choropleth mapping and tabulated area‐level data revealed that community pharmacy density was higher in inner‐metropolitan than outer‐metropolitan areas, that there were clusters of areas with very low (i.e., lowest‐quintile) community pharmacy density across certain parts of Australia (e.g., most of the Northern Territory, including Daly‐Tiwi‐West Arnhem), and that subnational areas across all states/territories of Australia had very low community pharmacy density (e.g., Manningham East and Baw Baw in Victoria)—further information pertinent to future research as well as legislation, policies, and decisions regarding community pharmacy and pharmacist distribution across Australia.

In Australia during 2024, community pharmacy density was 2.22, 2.09 and 2.63 community pharmacies per 10 000 population for the whole country, metropolitan areas, and remote/rural/regional areas, respectively, consistent with literature suggesting that—despite having fewer pharmacists per community pharmacy—non‐metropolitan Australia is more reliant on community pharmacies due to a relative lack of other health services.

In Australia during 2024, characteristics of subnational geographic areas (i.e., Statistical Area Level 3 areas) independently associated with higher community pharmacy density included higher percentage of 85+‐year‐old or 65–84‐year‐old residents, higher percentage of male residents, and classification as remote/rural/regional, while lower community pharmacy density tended to be associated with higher area (km2)—information that could inform future research as well as legislation, policies, and decisions regarding community pharmacy and pharmacist distribution across Australia.

Choropleth mapping and tabulated area‐level data revealed that community pharmacy density was higher in inner‐metropolitan than outer‐metropolitan areas, that there were clusters of areas with very low (i.e., lowest‐quintile) community pharmacy density across certain parts of Australia (e.g., most of the Northern Territory, including Daly‐Tiwi‐West Arnhem), and that subnational areas across all states/territories of Australia had very low community pharmacy density (e.g., Manningham East and Baw Baw in Victoria)—further information pertinent to future research as well as legislation, policies, and decisions regarding community pharmacy and pharmacist distribution across Australia.