The impact of community pharmacies on equity in access to professional rapid antigen testing for SARS-CoV-2 in Portugal

Abstract

Introduction

Amid the COVID-19 pandemic, various public health measures were adopted to reduce the transmission risk, including the full reimbursement of SARS-CoV-2 professional rapid antigen detection tests (Ag-RDT) conducted in clinical pathology laboratories, community pharmacies (CPs), and other authorized entities. This study aimed to assess the impact of integrating CPs into the Portuguese National Health Service (NHS) testing strategy on the capacity of professional Ag-RDT delivery, and to compare the equity in testing access with and without CPs participation.

Methods

This analytical cross-sectional study assessed the impact of adding CPs into the testing strategy based on two main outcomes by municipality: (i) average distance (in Kilometres) of the population to the nearest Ag-RDT site; and (ii) the average number of weekly hours available to testing per 1,000 inhabitants, as of January 31, 2022. Two scenarios were considered: with and without CPs. Access inequalities were evaluated using Lorenz curves and Gini coefficients. A subgroup inequality analysis was conducted based on three socio-demographic indicators: population density, aging index, and per capita purchasing power index.

Results

A total of 1,369 (65.1 %) pharmacies and 735 (34.9 %) laboratories and other entities provided free Ag-RDT to the population. The average distance to the nearest Ag-RDT location was 3.7 km, which decreased to 1.8 km with the inclusion of CPs. Overall, there were 11.5 weekly hours per 1,000 inhabitants available for testing with CPs, compared to 2.1 h without CPs (p < 0.0001). The Gini coefficient for distance distribution decreased from 0.50 to 0.42 with CPs inclusion (-16.8 %). For the distribution of weekly hours, the Gini coefficient decreased from 0.42 to 0.26 (-38.6 %). The reduction was higher in municipalities with lower population density (-43.3 %), higher aging index (-51.3 %), and lower per capita purchasing power index (-54.6 %).

Conclusions

Pharmacies play a crucial role in mitigating geographical and socioeconomic inequalities in healthcare access. Without CPs, the provision of Ag-RDT services would result in significant territorial gaps, exacerbating disparities among already vulnerable population groups.