Distribution of community pharmacies and primary healthcare centers in Portugal: a cross-sectional analysis

Abstract

Introduction: Poor access to community pharmacies has been associated with restricted accessibility to medicines. We aimed to compare the geographic distribution of community pharmacies and healthcare centers (HCCs) and identify sociodemographic variables associated with geographical discrepancies at the municipal level in Portugal. Methods: Data on HCC, physicians, pharmacies, and pharmacists were collected at the municipality level in 2024. Municipality population and area per healthcare establishment and professional were compared, as well as pharmacies/HCC and physician/pharmacist ratios. Multivariate analyses were conducted between dependent variables and sociodemographic factors. Results: Portugal municipalities had a mean 516 residents (SD 319) per physician and 1,021 (SD 450) per pharmacist (paired Cohen's d= 1.127 [0.76:1.277]), with a ratio physician/pharmacist of 2.55 (SD 1.55). The surface area covered by professionals was 22.0 km2 (SD 35.8) per physician and 37.9 km2 (SD 57.8) per pharmacist (d=0.449 [0.325:0.572]). However, population per HCC was 22,998 (SD 22,038) while 3,206 (SD 1,087) per pharmacy (d=0.924 [0.783:1.064]) and the area covered was 82.2 km2 (SD 98.3) per pharmacy and 304.6 km2 (SD 287.1) per HCC (d= 0.912 [0.771:1.051]). Positive associations were found between the ratio pharmacies/HCC and percentage of young population, higher educational level, or literacy. Conclusion: Despite the greater number of physicians than pharmacists, community pharmacies showed a more intensive coverage of Portuguese mainland territory when compared to HCCs. The wider dispersion of pharmacies may facilitate the role of pharmacists as public health agents.