Access to pharmacies in Ontario, Canada is calculated using the Canadian Accessibility and Remoteness Index (CARI+) via travel time and distance to publicly accessible pharmacies.
This measure was calculated using the general methodology for CARI+, as described in the overall methodology publication (link). This was adapted to calculate accessibility to pharmaceutical care in Ontario. It was achieved by measuring from population-weighted DA centroids to the closest pharmacy instead of the closest service centres.
Lists of pharmacies were obtained from the Government of Ontario Ministry of Health service provider locations database. Pharmacies not accessible to the public were excluded, cleaning the data. Examples include pharmacies located in Seniors Active Living Centres, Retirement Homes, Long-Term Care Homes, and Specialized Care Centres (developmental services, pediatric care, infectious disease services, etc.).
Interpretation
The continuous index can be used within statistical modelling as a measure of access, while the categorical scores can be mapped to show areas with higher or lower access. The latter can also be included in statistical modelling as a categorical or ordinal measure. The purpose of the analysis is to understand the measure of accessibility for pharmacies depending on a population’s geographic location, as indicated by travel time and distance. This can be interpreted as a relative measure of spatial access between small geographic areas (DAs) to pharmacy locations. Additionally, mapping pharmacy access indirectly maps access to extended pharmacist services, such as the prescription of contraception. By mapping pharmacy access in Ontario, the objective of this study is to demonstrate how expanding pharmacists’ prescribing authority could improve access to key health needs (such as contraception, where applicable), reduce barriers to care that may be exacerbated by social determinants of health, and better utilize existing allied health services and healthcare infrastructure. The last point is especially important given the increased reliance on allied health professionals due to limited access to family physicians, especially in rural communities, helping with reducing the burden on other primary care providers. Determining the distribution and availability of pharmacies in all regions of Ontario will reflect access to other services as well, specifically allied health services. The model can be expanded to include other healthcare resources and support broader research on healthcare access in Canada.
Future studies can examine how pharmacy distribution affects overall healthcare access, explore accessibility to other allied-health and reproductive health services, help with identifying underserved communities, and create interactive public databases that can be updated over time.
The CARI+ score and/or classification can be used as a covariate alongside other individual and area-based measures such as demographics (e.g., race, gender, age) and socioeconomic factors (e.g., income, education) in a study on rates of access to pharmacist services in rural Canada. Specifically, in rural contexts, the data can be used to assess the relationship between pharmacy accessibility and the degree of marginalization, where present.
Geography shapes how easily people can reach healthcare, especially when services are concentrated far from where they live. Large geographic areas mean longer travel times, and smaller communities often lack the resources found in urban centres. In the case of pharmacies, distance can limit access to medications and essential services, reinforcing the gaps between rural and urban healthcare availability. However, the government’s classification of “urban” centers has some complications. The label is usually based on population counts rather than real-world accessibility. As a result, some regions designated as urban may still face significant barriers to care.
The data from this study can be used to advocate for pharmacist prescribing practices in Ontario, since they are particularly well-equipped for this role due to their strong understanding of adverse drug-interactions, side effects, and available remedies or alternatives. Adopting such practices requires patient and pharmacist support to maintain patient-centric values. This reality is especially relevant in the context of contraceptive prescription since its use is associated with numerous side effects, which are further complicated by the potential for harmful drug interactions. From the perspective of the pharmacists, there is potential for professional benefits such as increased job satisfaction, while many patients prefer pharmacists for contraceptive access. Expanding the full range and scope of practice for pharmacists could improve overall access to aspects of reproductive care.
Definitions and Caveats
Pharmacy: publicly accessible pharmacy
Allied health services and professionals: Allied health professionals are members of the health workforce (not physician or nurse related) who are not physicians, dentists, or nurses, but who provide specialised, occupationspecific‑ services that support, deliver, or inform direct patient care (Alshalalfah et al., 2025; B.C. Ministry of Health, 2025). They complete dedicated training in fields such as physiotherapy, occupational therapy, speech pathology, podiatry, and dietetics (B.C. Ministry of Health, 2025). Their work spans preventative, diagnostic, therapeutic, and conditionmanagement‑ services (B.C. Ministry of Health, 2025).
Social determinants of health: factors that influence health outcomes as a result of economic, social, and environmental factors.
Access
2021 census population counts for DAs and CSDs were used, alongside the road networks available in 2024. List of pharmacies were obtained in 2024, the same year the data was analyzed. The frequency of updates is as needed.
Calculation Year: Access scores will vary for other years as service locations open or close over time and as the underlying population distribution changes. Differences will also occur across census periods and may vary in between them as well.
References
- Alshalalfah, M., Pit, S. W., Bagade, T., Hamiduzzaman, K., Burrows, J., & Brown, L. J. (2025). Access and utilisation of allied health services among community dwelling rural adults aged 50 years and older living with chronic conditions: a scoping review. Age and Ageing, 54(5). https://doi.org/10.1093/ageing/afaf123
- B.C. Ministry of Health. (2025, December 9). Allied Health Professions and Occupations. Province of British Columbia. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/allied-health-professions-and-occupations