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Household Income and Minority Population Analysis of Tampa Bay for Future MedNet© Program Sites Author: William Velasquez, University of South Florida, College of Public Health, Introduction to Geographic Information Systems, Spring 2013 Introduction According to a recent Centers of Disease Control and Prevention (CDC) study approximately one-fifth of Americans cannot afford the prescription medication prescribed to them (Picchi, 2013). The increasing number of people not able to afford their prescription medication has become a challenge that not only affects individuals, but also society. Prescription drug access affects most Americans (even those with healthcare coverage), with the most vulnerable groups consisting of the medically indigent, minorities, and the elderly (Reed, 2005). Insufficient access to prescription drugs leads to drug compliance issues and misuse of the healthcare system which ultimately costs tax payers in unnecessary healthcare costs (Picchi, 2013). Problem In the year 2000 the Health Councils sponsored a regional study that found that the greatest issue impacting the local health system was limited access to medications (Health Councils, n.d.). In response to the findings the MedNet© Program was created to address the issue. In 2012 the MedNet© Program was able to obtain approximately 30,000 medications for patients with an estimated value of approximately $18 million (Health Councils, n.d.). Such a successful program has raised the question of possible expansion. Currently, 14 MedNet© sites are located in four counties: Pinellas, Polk, Manatee and Hillsborough. This study aims to locate possible new MedNet© sites by analyzing the income and minority population distribution in surrounding counties in the Tampa Bay region. Objectives Highlight areas of minority populations Highlight areas of lower income populations Highlight rates of residents with no health insurance coverage by county Identify local free clinics and health department clinics Methodology With the aid of GIS, a cross-sectional analysis was conducted of the Tampa Bay area to identify possible new locations for MedNet© sites. Of the many eligibility requirements an area needs for successful MedNet© program implementation, this study focused on two requirements: percentage of minorities and low-income individuals in the general population. A geodatabase was created containing the following information: Number of households earning less than $50,000 per year per census tracts Percentage of minority population per census tract Insurance status of residents by county Address locations of current MedNet© sites and viable healthcare facilities Medication Company Cost Lipitor Pfizer $451-$652 Norvasc Pfizer $291-$399 Levemir Flexpen Novo Nordisk $1491 Synthroid Abbvie $65-$129 Nexium AstraZeneca $637-$653 Advair Diskus 250/50 GlaxoSmithKline $424 Results The results highlight counties where large populations of minority, uninsured, or low-income populations reside. Each factor plays an important role in determining if a MedNet© site would be viable in that area. Conclusions To be eligible for prescription assistance, patients need to be of low- income (usually 200% poverty level), have no prescription drug coverage, and be in care of a primary care physician (Chisholm & DiPiro, 2002). The Health Council (n.d.) studies as well as Reed (2005) conclude that minorities are at higher risk for facing obstacles in obtaining prescriptions. The analysis of the region highlights numerous low-income areas and areas with large minority populations; however, the Tampa metro area in Hillsborough County and the Winter Haven area in Polk County contain numerous census tracts that meet both criteria. Feasibility of creating new sites in these two counties would be much simpler than to the north or south. MedNet currently operates sites in both counties and can reach out to community partners and local government to aid in the development. Expanding to the northern counties of Pasco, Hernando, and Citrus, should be a priority for the MedNet© program, but it must realize that these populations are more homogenous and that brand recognition might be a problem. Map (1) shows the rates of the uninsured population or each county in the Tampa Bay region. Pasco, Pinellas, and Hillsborough counties have the highest rates of uninsured residents. Table (1) shows medication cost for a patient with multiple conditions. Prices reflect name brand medication and do not include generic alternatives. The medications listed are available for free from prescription assistance programs (PAPs). Map (2) highlights the percentage of minority population per census tract in Tampa Bay. Minority population density is higher in urban and inland areas. Map (3) focuses on the number of households making less than $50,000 per year. This number encompasses the majority of income guidelines limits for most PAPs. Maps (6) and (7) below. Hillsborough county has large minority and low-income populations. Additional MedNet sites would be desirable in the north central part of the county. Maps (4) and (5) indicate minority and low-income population density in rural sections of the county. Central Polk County does not have a MedNet© site. Maps (8) and (9) above and (10) and (11) below. Winter Haven and Tampa Metro contain large minority and low-income populations. In Winter Haven four area clinics could be potential partners. The Tampa metro area boasts eight potential clinic partners. References Chisholm, M. A. & DiPiro, J. T. (2002) Pharmaceutical manufacturer assistance programs. Archives of Internal Medicine, 162 (2), 780-784. doi:10.1001/archinte.162.7.780 Health Councils. (n.d.). Community programs – Community projects. Retrieved from http:// healthcouncils.org/html/hc_programs_projects.html Picchi, A. (2013, April 9). The high cost of unaffordable prescriptions. MSN Money. Retrieved from http:// money.msn.com/now/post.aspx?post=8d2bfc7b-6161-4966-bc04-4969ffeea1a0 Reed, M. (2005). An update on Americans’ access to prescription drugs. Issue Brief: Findings from Center for Studying Health System Change, 95. Retrieved from http://www.hschange.com/CONTENT/738/ Create MedNet and clinic location address tables Download state, county and census tract shapefiles Download patient demographic tables Create file geodatabase Geocode clinic and MedNet addresses to Tampa Bay polygon Select Tampa Bay counties and export data Clip Tampa Bay polygon from Florida polygon Geocode unmatched addresses manually Calculate total households making less than $50,000 by adding a new field Display income and minority data Create finished maps Workflow

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Household Income and Minority Population Analysis of Tampa Bay for Future MedNet© Program Sites

Author: William Velasquez, University of South Florida, College of Public Health, Introduction to Geographic Information Systems, Spring 2013

Introduction

According to a recent Centers of Disease Control and Prevention (CDC) study approximately one-fifth of Americans cannot afford the prescription medication prescribed to them (Picchi, 2013). The increasing number of people not able to afford their prescription medication has become a challenge that not only affects individuals, but also society. Prescription drug access affects most Americans (even those with healthcare coverage), with the most vulnerable groups consisting of the medically indigent, minorities, and the elderly (Reed, 2005). Insufficient access to prescription drugs leads to drug compliance issues and misuse of the healthcare system which ultimately costs tax payers in unnecessary healthcare costs (Picchi, 2013).

ProblemIn the year 2000 the Health Councils sponsored a regional study that found that the greatest issue impacting the local health system was limited access to medications (Health Councils, n.d.). In response to the findings the MedNet© Program was created to address the issue. In 2012 the MedNet© Program was able to obtain approximately 30,000 medications for patients with an estimated value of approximately $18 million (Health Councils, n.d.). Such a successful program has raised the question of possible expansion. Currently, 14 MedNet© sites are located in four counties: Pinellas, Polk, Manatee and Hillsborough. This study aims to locate possible new MedNet© sites by analyzing the income and minority population distribution in surrounding counties in the Tampa Bay region.

Objectives Highlight areas of minority populations Highlight areas of lower income populations Highlight rates of residents with no health insurance coverage by county Identify local free clinics and health department clinics

Methodology

With the aid of GIS, a cross-sectional analysis was conducted of the Tampa Bay area to identify possible new locations for MedNet© sites. Of the many eligibility requirements an area needs for successful MedNet© program implementation, this study focused on two requirements: percentage of minorities and low-income individuals in the general population. A geodatabase was created containing the following information: Number of households earning less than $50,000 per year per census tracts Percentage of minority population per census tract Insurance status of residents by county Address locations of current MedNet© sites and viable healthcare facilities

Medication Company Cost

Lipitor Pfizer $451-$652

Norvasc Pfizer $291-$399

Levemir Flexpen Novo Nordisk $1491

Synthroid Abbvie $65-$129

Nexium AstraZeneca $637-$653

Advair Diskus 250/50 GlaxoSmithKline $424

ResultsThe results highlight counties where large populations of minority, uninsured, or low-income populations reside. Each factor plays an important role in determining if a MedNet© site would be viable in that area.

ConclusionsTo be eligible for prescription assistance, patients need to be of low-income (usually 200% poverty level), have no prescription drug coverage, and be in care of a primary care physician (Chisholm & DiPiro, 2002). The Health Council (n.d.) studies as well as Reed (2005) conclude that minorities are at higher risk for facing obstacles in obtaining prescriptions. The analysis of the region highlights numerous low-income areas and areas with large minority populations; however, the Tampa metro area in Hillsborough County and the Winter Haven area in Polk County contain numerous census tracts that meet both criteria. Feasibility of creating new sites in these two counties would be much simpler than to the north or south. MedNet currently operates sites in both counties and can reach out to community partners and local government to aid in the development. Expanding to the northern counties of Pasco, Hernando, and Citrus, should be a priority for the MedNet© program, but it must realize that these populations are more homogenous and that brand recognition might be a problem.

Map (1) shows the rates of the uninsured population or each county in the Tampa Bay region. Pasco, Pinellas, and Hillsborough counties have the highest rates of uninsured residents.

Table (1) shows medication cost for a patient with multiple conditions. Prices reflect name brand medication and do not include generic alternatives. The medications listed are available for free from prescription assistance programs (PAPs).

Map (2) highlights the percentage of minority population per census tract in Tampa Bay. Minority population density is higher in urban and inland areas.

Map (3) focuses on the number of households making less than $50,000 per year. This number encompasses the majority of income guidelines limits for most PAPs.

Maps (6) and (7) below. Hillsborough county has large minority and low-income populations. Additional MedNet sites would be desirable in the north central part of the county.

Maps (4) and (5) indicate minority and low-income population density in rural sections of the county. Central Polk County does not have a MedNet© site.

Maps (8) and (9) above and (10) and (11) below. Winter Haven and Tampa Metro contain large minority and low-income populations. In Winter Haven four area clinics could be potential partners. The Tampa metro area boasts eight potential clinic partners.

References Chisholm, M. A. & DiPiro, J. T. (2002) Pharmaceutical manufacturer assistance programs. Archives of Internal Medicine, 162 (2), 780-784. doi:10.1001/archinte.162.7.780 Health Councils. (n.d.). Community programs – Community projects. Retrieved from http://healthcouncils.org/html/hc_programs_projects.html Picchi, A. (2013, April 9). The high cost of unaffordable prescriptions. MSN Money. Retrieved from http://money.msn.com/now/post.aspx?post=8d2bfc7b-6161-4966-bc04-4969ffeea1a0 Reed, M. (2005). An update on Americans’ access to prescription drugs. Issue Brief: Findings from Center for Studying Health System Change, 95. Retrieved from http://www.hschange.com/CONTENT/738/

Create MedNet and clinic location address tables

Download state, county and census tract shapefiles

Download patient demographic tables

Create file geodatabase

Geocode clinic and MedNet addresses to Tampa Bay polygon

Select Tampa Bay counties and export data

Clip Tampa Bay polygon from Florida polygon

Geocode unmatched addresses manually

Calculate total households making less than $50,000 by adding a new field

Display income and minority data

Create finished maps

Workflow