Intermediary roles in regulatory programs: Toward a role-based framework

This paper develops a role-based framework of intermediaries in regulatory programs. In examining the types of roles that organizations adopt in regulation and governance, we argue that roles have important implications for understanding organizational and program level dynamism and outcomes. We utilize the Regulator-Intermediary-rule Taker framework (Abbott, Levi-Faur, & Snidal, 2017a; 2017b) to describe how organizational roles can be adopted through assignment, appropriation, or promotion. We then go deeper into how intermediaries adopt a variety of different roles in key regulatory programs. We examine generic intermediary roles across programs that involve four main groups of activities: Creating and/or organizing, coordinating between programs, supporting implementation, and voicing an opinion. All in all, our role-based framework allows for a novel relational way to understand interorganizational and institutional dynamism in complex, interactive, and ever-changing regulatory regimes

Mapping pharmacy deserts and determining accessibility to community pharmacy services for elderly enrolled in a State Pharmaceutical Assistance Program

<div><p>Objectives</p><p>Limited studies have investigated geographic accessibility to a nearby community pharmacy for elderly which is an essential determinant of the access to medications and pharmacy services. This research identified pharmacy deserts and investigated availability of different types of community pharmacies and their services for elderly enrolled in a State Pharmaceutical Assistance Program (SPAP).</p><p>Methods</p><p>The state of Pennsylvania in the US was used as a case to demonstrate the geographic accessibility to community pharmacy and services for elderly enrolled in SPAP. The locations of community pharmacies and households of elderly enrolled in SPAP were derived from Pharmaceutical Assistance Contract for the Elderly programs’ database. The street addresses were geocoded and the distance to a nearby community pharmacy was calculated for study sample using the haversine formula. The demographic and geographic data were aggregated to Census Tracts and pharmacy deserts were identified using the predefined criteria. Descriptive statistical analysis was used to determine whether there are statistical differences in the socio-demographic profiles and distribution of different types of community pharmacies and their services in pharmacy deserts and non-deserts. This research used hot spot analyses at county level to identify clusters of pharmacy deserts, areas with high concentration of different racial/ethnic groups and clusters of high densities of chain and independent pharmacies.</p><p>Results</p><p>The Spatial analysis revealed that 39% and 61% Census Tracts in Pennsylvania were pharmacy deserts and non-deserts respectively (p < 0.001). Pharmacy deserts were found to have significantly more females, married and white elderly and fewer blacks and Hispanics compared to pharmacy non-deserts. Pharmacy deserts had significantly fewer chain and independent pharmacies and less delivery and 24-hour services in pharmacies than pharmacy non-deserts. Hot spot analyses showed that clusters of pharmacy deserts were more concentrated in southcentral, northwest and northeast regions of the state which represent rural areas and overlapped with clusters of high concentration of white individuals.</p><p>Conclusions</p><p>The findings suggest that urban-rural inequality, racial/ethnic disparity and differences in availability of pharmacies and their services exist between pharmacy deserts and non-deserts. The methodological approach and analyses used in this study can also be applied to other public health programs to evaluate the coverage and breadth of public health services.</p></div

Access to community pharmacies in pharmacy deserts and pharmacy non-deserts in Pennsylvania, 2015.

<p>Access to community pharmacies in pharmacy deserts and pharmacy non-deserts in Pennsylvania, 2015.</p

Pharmacy locations in Pennsylvania by geographic regions, 2015.

<p>Pharmacy locations in Pennsylvania by geographic regions, 2015.</p

County-specific hot spot maps for density of (A) chain and (B) independent pharmacies per 1000 PACE enrollees in Pennsylvania, 2015.

<p>County-specific hot spot maps for density of (A) chain and (B) independent pharmacies per 1000 PACE enrollees in Pennsylvania, 2015.</p

Hot spot analysis of pharmacy deserts at the county level in Pennsylvania, 2015.

<p>Hot spot analysis of pharmacy deserts at the county level in Pennsylvania, 2015.</p

A quartile map of percent of pharmacy deserts at county level in Pennsylvania, 2015.

<p>A quartile map of percent of pharmacy deserts at county level in Pennsylvania, 2015.</p

Socio-economic and demographic characteristics of the sampled enrollees by community type, 2015.

<p>Socio-economic and demographic characteristics of the sampled enrollees by community type, 2015.</p

Geographic regions and counties in Pennsylvania.

<p>Geographic regions and counties in Pennsylvania.</p

Urban and rural counties in Pennsylvania, 2015.

<p>Urban and rural counties in Pennsylvania, 2015.</p