Self-reported vs RUCA rural-urban classification among North Carolina pharmacists

Background: The various ways in which rurality is defined can have large-scale implications on the provision of healthcare services.

Objective: The purpose of this study was to identify the relationship between self-perceived urban-rural distinction and the United States (US) Census tract-based Rural-Urban Commuting Area (RUCA) scheme that defines rurality among pharmacists.

Methods: This was a secondary analysis of data collected through a web-based survey of licensed pharmacists in North Carolina. Respondents self-reported their workplace settings, zip codes, and the pharmacy services offered in their place of work. Zip codes were replaced with the corresponding RUCA codes. The relationship between self-reported classification and RUCA codes was analyzed and a chi square test was performed to measure statistical significance.

Results: Of the original survey, 584 participants reported their workplace zip code and 579 reported their workplace setting (urban, rural). A significant difference was found between pharmacists who self-reported working in rural areas and the RUCA classifications - 94 (56.6%) of the 166 participants who reported working in "rural" areas were considered "urban" according to RUCA.

Conclusions: A significant discordance between pharmacists' self-reported classification and the RUCA codes was found, with more respondents self-reporting their workplace area as "rural" as compared to the RUCA classification. Decision-makers examining the pharmacy workforce and pharmacy services should be aware of this discordance and its implications for resource allocation. We recommend the use of standardized metrics, when possible.