Pharmacology & Pharmacy, 2013, 4, 438-442
http://dx.doi.org/10.4236/pp.2013.45062 Published Online August 2013 (http://www.scirp.org/journal/pp)
Use of Spatial Analysis to Assess Geographic Accessibility
of Community Pharmacies in São Mateus
Brígida Dias Fernandes1, Aracelli Ferreira Lírio1, Rodrigo Randow de Freitas2*,
Ana Carolina Melchiors3
1Universidade Federal do Espírito Santo-UFES, Centro Universitário Norte do Espírito Santo-CEUNES, Departamento de Ciências
da Saúde-DCS, São Mateus, Brasil; 2Universidade Federal do Espírito Santo-UFES, Centro Universitário Norte do Espírito
Santo-CEUNES, Departamento de Engenharias e Computação-DETEC, Núcleo de Pesquisa em Gestão de Sistemas de Produção
(NPGSP), Laboratório de Gestão Costeira-Aquicultura e Pesca (LGCap), São Mateus, Brasil; 3Pharmacy Pratice Research Group,
Departamento de Ciências da Saúde-DCS, São Mateus, Brasil.
Received May 20th, 2013; revised June 28th, 2013; accepted July 19th, 2013
Copyright © 2013 Brígida Dias Fernandes et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Pharmaceutical services contribute to the rational use of medicines by ensuring the provision of appropriate, safe and
effective pharmacotherapies. Thus, it is important to investigate whether the geographical distribution of pharmacies
causes inequalities in access in countries like Brazil, where there is no federal law regulating the opening of new esta-
blishments (in contrast to many European countries). This study analyzed the accessibility of community pharmacies in
the city of São Mateus, Espírito Santo, Brazil. The authors obtained the geographical coordinates of pharmacies and
healthfacilities, which scanned and georeferenced the study area. The 40 pharmacies included in the spatial analysis
presented a heterogeneous distribution, with the existence of neighborhoods with an accumulation of pharmacies and
others with no pharmacies. The authors found that only 43.7% of the study area received pharmaceutical service covera-
ge, when buffer zones of 350 meters are incorporated, and that most of the districts have a minimum distance of 100
meters between health facilities and pharmacies. It was concluded that the use of GIS proved to be very suitable for
analysis of pharmaceutical services, enabling knowledge of the local situation and serving as a stimulus for future studi-
es.
Keywords: Geographical Accessibility; Quality Pharmaceutical Service; Spatial Analysis; Distribution of Pharmacies;
Quality Assessment
1. Introduction
This study defines access to health services narrowly,
utilizing Avedis Donabedian’s conceptualization of geo-
graphical accessibility [1]. According to Donabedian, the
quality of health services can be assessed by attributes
that include socio-organizational and geographical ac-
cessibility. These two dimensions are interrelated and
express characteristics of health services that can facili-
tate or impede access by users. Geographical accessi-
bility refers to the location of supply and the location of
users, as well as the physical and temporal distance
patients must travel to get the care they need and/or want
[1-3].
When analyzing pharmaceutical services in Brazil
from the perspective of geographical accessibility, phar-
maceutical services, it is observed that the geographical
distribution of pharmacies is unordered, because there is
no federal law that establishes geographic and demo-
graphic criteria for the opening of new establishments.
Thus, pharmacies may accumulate in certain areas of the
city and exceed the ratio of pharmacies recommended by
the World Health Organization (one for every 6000 to
7000 people) [4]. This is in contrast to some European
countries, where there is specific legislation that guides
the distribution of pharmacies. In Portugal [5], for
example, legislation states that for a new pharmacy to be
installed, it must be at least 350 meters distant from other
pharmacies; a minimum distance of 100 meters between
the pharmacy and a health center or hospital must be
observed; and must be at least 3500 inhabitants. In other
*Corresponding a uthor.

Use of Spatial Analysis to Assess Geographic Accessibility of Community Pharmacies in São Mateus 439
European countries as well, the regulation of pharmacies
according to demographic and geographic criteria has
ensured the quality of pharmaceutical services [6].
While several cities in Brazil have developed laws
limiting the distance between pharmacies, they have not
always been implemented. Opponents argue that they are
unconstitutional and violate the principles of free com-
petition, freedom of exercise of economic activity, and
consumer law. There is also a lack of mechanisms that
would enable the zoning of pharmacies in order to meet
the provisions of such laws.
In this context, analysis of the spatial location of
health services through the use of Geographic Informa-
tion Systems (GIS) has an important role and is be-
coming more frequent within the area of public health.
Such analysis provides information about geographical
access vis-à-vis different socioeconomic factors, contri-
buting to the discussion of equity [7], while also contri-
buting new information on the spatial distribution of
diseases, health services and environmental hazards, thus
offering an important too l for connections between health
and the environment [8,9].
However, in the pharmaceutical area there are few
studies that use spatial analysis to assess the distribution
and quality of pharmaceutical services, partly due to the
lack of geographic and demographic criteria for the de-
ployment of new establishments. Thus, it is important to
understand geographical distribution and analyze its im-
pact on people, as part of an observed emphasis on ana-
lyzing the reality of pharmacy services and improving
the quality of the evolving pharmaceutical sector. Thus,
this study aims to contribute information in order to
better understand the spatial reality of the city of São
Mateus, with respect to the distribution of pharmacies
and health services, as well as the coverage area of com-
munity pharmacies and the demographic density of their
associated populations.
2. Materials and Methods
The study area was limited to the urban area of São
Mateus, Espírito Santo, Brazil (18˚43'04.97"S, 39˚51'
13.50"W). According to the synopsis of the 2010 census
compiled by the Brazilian Institute of Geography and
Statistics (IBGE), the city has a population of 109,028
inhabitants, a lan d area of 2343.15 square kilometers and
a population density of 46.53/km² [10].
The sample design consists of a cross-sectional
observational study, with the object of study comprising
private pharmacies located within the urban area and
possessing a technical supervisor (according to the Re-
gional Pharmacy Council of the Espírito Santo state).
Pharmacies located in the coastal area were excluded
because the distance from the downtown, as were public
pharmacies such as the “Farmácia Básica Municipal” and
the “Farmácia Cidadã Estadual”, because they provide
differentiated services, which could not be assessed with
a questionnaire proposed in this study. The research
project, No. 036/2010, was approved by the Research
Ethics Committee of the University Center North of
Espírito Santo, University of Espírito Santo (Opinion
001/2011).
The study used high-resolution images of the study
area (dimensions: 4484 × 3056 pix els, resolutio n: 91 dpi) ,
which are freely available on the Internet via the “Google
Earth” application. The information processing and digi-
tal modeling were performed by the GIS Idrisi Andes
Edition® (version 1.15-Clark University).
The image was georeferenced using the re-sample
module in Idrisi GIS. It was then necessary to perform
the scanning and separation into layers of all th e features
of interest in the study area, including streets, district
boundaries, pharmacies and health facilities (HF), using
the program CartaLinx®. The study utilized the addresses
of pharmacies, basic health units (BHU) and hospitals.
The decision to work this way (without using GPS) was
evaluated and accepted by the authors, in an effort to
achieve the most accurate results possible and given that
there are few differe nc e s generated by these met ho ds.
The demarcation of districts was not performed ac-
cording to an administrative definition, because the mu-
nicipality does not have legislation that establishes the
neighborhoods of the city. To achieve the required defi-
nitions, scanning was performed according to the regions
that had BHU and a map was constructed and defined by
local businesses. Thus, some quarters were grouped toge-
ther to form one district, totaling 12 neighb orhoods.
Analyses of the spatial distribution of pharmacies in
each district were also performed. Using the Idrisi Andes
edition®, buffer zones of 350 meters were created, based
on the Portuguese legislation [5] that guides the spatial
distribution of pharmacies. Also analyzed were the
number of HF in each neighborhood, including BHU,
hospitals and emergency care centers. A 100-meter buf-
fer zone was created for each pharmacy in order to assess
the presence of HF within that range (again, based on the
Portuguese legislation) [5].
Finally, we analyzed the number of pharmacies per
inhabitant. This assessment was also based on the Portu-
guese legislation [5], which requires a new pharmacy to
have a minimum range of 3500 inhabitants. However, the
lack of an official definition of neighborhoods in the city
prevented the attainment of demographic data by admini-
strative units, and left only the total number of inhabi-
tants supplied by IBGE. Thus, we used the number of
citizens served by the family health teams (ESF) and by
community health workers for each demarcated unit of
BHU (provided by the Health Department). This does not
faithfully portray the reality of the city, since BHU do
not have 100% coverage, but it was the most feasible and
reliable representation that could be used in this study.

Use of Spatial Analysis to Assess Geographic Accessibility of Community Pharmacies in São Mateus
440
Thus, the population density per pharmacy was calcu-
lated by dividing the number of inhabitants served by
BHU by the number of pharmacies in each district, and is
represented in the study by a thematic map.
3. Results and Discussion
The city of São Mateus, according to the Regional
Pharmacy Council of Espírito Santo, had 58 community
pharmacies in November 2010. Of these, 4 no longer
exist, 11 are not located in the study ar ea, 1 did not have
a pharmacist and 2 were public pharmacies (thus ex-
cluded from the study, as previously described). Thus, 40
pharmacies are georeferenced, as shown in Figure 1.
Community pharmacies in São Mateus are spatially
distributed unevenly, concentrated mainly in the center
of the city. Neighborhoods like Centro have accumulated
28 pharmacies while others, such as Aroeira, have no
pharmacies. This disorderly and inefficient distribution
of community pharmacies in the city may be due to the
predominant concept and practice of medicine as a con-
sumer product or commodity, as opposed to an instru-
ment in the service of health promotion, making a phar-
macy setting strictly commercial and profit-seeking. The
installation of pharmacies thus follows the requirements
for any other commercial establishment, abiding by the
principles of free competition, freedom of exercise of
economic activity, and consumer law, as determined by
the Federal Constitution [11].
However, analysis of the market aspects suggests that
the concentrated installation of pharmacies increases
competitiveness and, despite being a very lucrative
industry, decreases the stability of businesses and can
lead to their closure. Perhaps for this reason, the rapid
opening and closing of many pharmacies was observed
during the study. Moreover, this instability can lead to
Figure 1. Buffer Zones (350 m) of community pharmacies in
the city of São Mateus, ES. (1. Aroeira; 2. Bom Sucesso; 3.
Santo Antônio; 4. Vila Nova; 5. Boa Vista; 6. Cacique; 7.
Porto; 8. Centro; 9. Aviação; 10. Cohab; 11. Morada do Ri-
beirão; 12. Seac).
spending cuts, thereby reducing the investment structure
and organization of the pharmacy, its human resources
and even the drugs themselves, thus reducing the quality
of pharmaceutical services provided.
In addition, the current layout of pharmacies in th e city
reflects the past as well as the present, due to trends in
urban development. Perhaps the lack of pharmacies in
distant neighborhoods is due to the neighborhoods being
relatively new, since accumulated changes occur over
time [12].
Using the 350-meter buffer zone generated for each
pharmacy, we obtained the spatial extent of area phar-
macies. As can be seen in Figure 1, the accumulation of
pharmacies in some areas leaves a good part of the city
without pharmaceutical services. According to the calcu-
lation of the total area, only 43.7% of the study area
receives pharmaceutical services coverage.
The main aim of any pharmacy is to ensure a quality
pharmacy service to the public, where people can have
access, on equal terms; the drugs are safe and reliable,
resulting in improved quality of life; and pharmacists are
trained and operating within an appropriate structure and
organization. It is important that this is available to all,
and that patients can reach facilities to have access to
medicine.
The results found in São Mateus with respect to the
quality of service being offered are worrying. The accu-
mulation of pharmacies in the center of the city has
hindered access for the population located in remote
areas, who must expend greater effort, time and money to
obtain the necessary care.
Using the GIS Idrisi tool overlay, we obtained the
coverage area of pharmacies in each district, as shown in
Table 1. In some cases, districts did not have pharmacies
but were within the 350-meter buffer zone of neigh-
boring pharmacy services (for example, in Aviação,
Porto, Cacique and Bom Sucesso). While it was observed
that the neighborhoods with the greatest number of
Figure 2. Presence of HF Buffer Zones within 100 m of
community pharmacies in neighborhoods in the city of São
ateus, ES. M

Use of Spatial Analysis to Assess Geographic Accessibility of Community Pharmacies in São Mateus
441
Table 1. Distribution of results according to geographic and demographic variables and neighborhood.
Neighborhood Number of
pharmacies Number of basic health units (BHU) Cover area (%) Number of intersections (350 m Buffer) Number of intersections (100 m Buffer) Populatio n Density
Aroeira 0 1 0 0 0 0
Bom Sucesso 0 1 1806 0 0 0
Boa Vista* 5 2 7077 5 1 0
Cacique 0 1 5675 5 0 0
Porto 0 1 8147 10 0 0
Aviação 0 1 3158 2 0 0
Centro 28 3 6673 247 3 15,857
Cohab 1 2 2492 0 0 4635
Seac 1 1 7571 0 0 3704
Morada do Ribeirão 0 1 0 0 0 0
Vila Nova 2 1 3857 3 0 2284
Santo Antônio 4 1 3759 2 0 2486,25
*Neighborhood witho ut Family Health Teams (ESF) or was not availab le the number of inha b it ants.
pharmacies had good coverage areas, the neighborhoods
of Cacique and Porto also had good coverage of phar-
maceutical services despite not having any pharmacies.
As noted, most pharmacies are located very close to
each other, even when located in different (but adjacent)
neighborhoods. This created a high number of inter-
sections between buffer zones, showing that the mini-
mum distance of 350 meters there is in many districts of
the municipality, as a Centro, Santo Antônio and Boa
Vista, extending this reality to the surrounding neigh-
borhoods, while not having pharmacies. Other neigh-
borhoods, such as Bom Sucesso, Seac and Cohab, only
have a few pharmacies but they are well distributed
throughout the neighborhood.
Regarding the presence of HF, it was observed that
every neighborhood had a BHU (which was, after all,
one of the criteria for defining the neighborhood para-
meters). In addition to the BHU, we spatially analyzed
the presence of hospitals and emergency care units, as
illustrated in Figure 2. For example, we noted the
presence of a hospital in th e neighborh oods of Coh ab and
Centro, in addition to the emergency care unit located in
the Boa Vista neigh borhood.
After creating the 100-meter buffer zones, the pre-
sence of HF located within the coverage area of phar-
macies was observed, as shown in Figure 2. Most neigh-
borhoods presented no HF in the coverage area; only
those with high numbers of pharmacies, such as Centro
and Boa Vista, did not possess the minimum distance of
100 meters suggested by the Portuguese legislation [5].
The distribution of pharmacies should be guided by
the location of HF, in order to complement the health
care services that are offered. However, the distance that
users must travel to obtain health care should be weight-
ed by the level of attention sought, since the distance to
more specialized services will be longer than for those
that require simpler levels of care [13].
Regarding the ratio of inhabitants to pharmacies,
Figure 3 shows that the values were far from those re-
commended by the Portuguese legislation [5]. As shown
in Table 1 , three districts have pharmacies serving fewer
than 3500 people. Of note is the Centro neighborhood,
with about 158 inhabitants per pharmacy, an extremely
low number. However, in more distant neighborhoods,
the presence of only one pharmacy was sufficient under
the Portuguese law, as seen in the neighborhoods of Co-
hab and Seac.
In countries with legislation that sets demograph ic and
geographic criteria for the establishment of new phar-
macies, the inhabitant-pharmacy ratios are very distant
from the values found in th is study. Austria, for example,
requires 5500 habitants per pharmacy. In France, the
ratio is determined by the size of the commune, ranging
from 2500 to 3500 inhabitants per pharmacy. In Italy, the
ratio requires more than 5000 inhabitants fo r populations
with fewer than 12,500 inhabitants, and 4000 for popu-
lations with more than 12,500 inhabitants. The average
number of inhabitants per pharmacy in Spain is 2099 [6].
Thus, the number of people covered by each pharmacy
in São Mateus is extremely low, compared to other
countries. However, the lack of demographic data that
more accurately represents the reality of each neighbor-

Use of Spatial Analysis to Assess Geographic Accessibility of Community Pharmacies in São Mateus
442
Figure 3. Categorization of districts according to population
density, the city of Sao Mateus, ES.
hood makes it difficult to evaluate these results with
certainty, and only provides a good idea of the situation
in São Mateus.
4. Conclusions
With this study, we conclude that the distribution of
community pharmacies in São Mateus is disorganized
and heterogeneous, depriving much of the population
access to pharmaceutical services and generating their
accumulation in certain districts. This is an unfavorable
development when analyses pharmacies as health faci-
lities. However, the research also highlights flaws in
municipal zoning; for example, the lack of delimitation
of administrative units impedes the acquisition of demo-
graphic data and more precise analysis of the results.
The use of GIS proved to be suitable for analysis of
pharmaceutical services, providing information on the
local situation and drawing attention to the distribution of
pharmacies. Its use also serves as a stimulus for future
studies and for the implementation of national and muni-
cipal-level regulations to guide the installation of these
health services.
Finally, this study shows the need for improvements in
the distribution of pharmaceutical services in the city, in
order to serve the entire population efficiently and with
quality. Moreover, additional studies of pharmaceutical
services and their quality are needed to better identify
local needs and develop public health strategies.
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