Providing Continuity of Care for Chronic Diseases in the Aftermath of Katrina: From Field Experience to Policy Recommendations (original) (raw)
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Katrina’s Legacy: Processes for Patient Disaster Preparation Have Improved but Important Gaps Remain
The American Journal of the Medical Sciences, 2016
Background-Ensuring continuity of care for the chronically ill, who are elderly or indigent presents unique challenges after disasters; this population has fewer financial resources, is less likely to evacuate, has limited access to recovery resources, and is significantly dependent on charitable and government-funded institutions for care. This study expands a previous investigation of the extent to which healthcare providers in coastal Mississippi and Alabama have made changes to facilitate continued care to these populations after disasters. Methods-Key informants representing healthcare and social services organizations serving health disparate residents of the Mississippi and Alabama Gulf Coast were interviewed regarding disaster preparation planning for the period 2009-2012. Interview transcripts were qualitatively coded and analyzed for emerging themes using Atlas.ti ® software. Results-Participant organizations have implemented changes to ensure continuity of care for the chronically ill in case of disasters. Changes include patient assistance with pre-disaster preparation and training; evacuation planning and assistance; support to find resources in evacuation destinations; equipping patients with prescription information, diagnoses, treatment plans, and advance medications when a disaster is imminent; multiple methods for patients to communicate with providers; and more mandated medical needs shelters. Patients whose chronic conditions were diagnosed post-Katrina are more likely to underestimate the need to prepare. Further, patients' lack of compliance tends to increase as time passes from disasters.
Insuring Continuity of Care for Chronic Disease Patients After a Disaster: Key Preparedness Elements
The American Journal of the Medical Sciences, 2008
Background-Care for patients with chronic diseases is a challenge after a disaster. This is particularly true for individuals from health disparate populations as they are less likely to evacuate, have less financial resources and often depend on resource-strapped institutions for their care. The specific aim of the study presented here was to elicit challenges and solutions in the provision of health care to those with chronic diseases after Hurricane Katrina in coastal Alabama and Mississippi.
Chronic disease in health emergencies: in the eye of the hurricane
Preventing chronic disease, 2006
Inadequately controlled chronic diseases may present a threat to life and well-being during the emergency response to natural disasters. An estimate of the possible numbers of people who may require treatment for chronic diseases should help in planning a response, but such information for local areas is not easily accessible. We explored how a current surveillance system could be used to provide estimates of the potential needs for emergency treatment of chronic diseases in the wake of a natural disaster. We used data from adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2004 to estimate the prevalence and numbers of people with diabetes, heart disease, stroke, hypertension, and current asthma who lived in the New Orleans-Metairie-Kenner, La, metropolitan statistical area. About 9.0% of participants had diabetes, 4.6% had angina or coronary heart disease, 3.0% had had a myocardial infarction, 2.0% had had a stroke, and 6.3%...
American Journal of Preventive Medicine, 2007
Preparing for natural disasters has historically focused on treatment for acute injuries, environmental exposures, and infectious diseases. Many disaster survivors also have existing chronic illness, which may be worsened by post-disaster conditions. The relationship between actual medication demands and medical relief pharmaceutical supplies was assessed in a population of 18,000 evacuees relocated to San Antonio TX after Hurricane Katrina struck the Gulf Coast in August 2005.Healthcare encounters from day 4 to day 31 after landfall were monitored using a syndromic surveillance system based on patient chief complaint. Medication-dispensing records were collected from federal disaster relief teams and local retail pharmacies serving evacuees. Medications dispensed to evacuees during this period were quantified into defined daily doses and classified as acute or chronic, based on their primary indications.Of 4229 categorized healthcare encounters, 634 (15%) were for care of chronic medical conditions. Sixty-eight percent of all medications dispensed to evacuees were for treatment of chronic diseases. Cardiovascular medications (39%) were most commonly dispensed to evacuees. Thirty-eight percent of medication doses dispensed by federal relief teams were for chronic care, compared to 73% of doses dispensed by retail pharmacies. Federal disaster relief teams supplied 9% of all chronic care medicines dispensed.A substantial demand for drugs used to treat chronic medical conditions was identified among San Antonio evacuees, as was a reliance on retail pharmacy supplies to meet this demand. Medical relief pharmacy supplies did not consistently reflect the actual demands of evacuees.
International Journal of Disaster Risk Reduction, 2020
In this study we explore the capabilities and the impact of Emergency Prescription Assistance Program (EPAP) during Hurricane Maria in the U.S. Virgin Islands (USVI) using descriptive analytic methods and mapping from the data provided by the Department of Health and Human Services. To date, this is the first peerreviewed analysis of EPAP claims conducted since its launch in 2008 post Hurricanes Ike and Gustav. Three primary study objectives are explored: a) characterization of the chronic care medication needs met by EPAP; b) characterization and analysis of the type and timing of claims processed and c) involved pharmacy characterization. During the study period of November 2017-April 2018, EPAP has served over 2000 patients amounting to over 17,000 prescription claims. Maintenance medications claims for hypertension, diabetes and antibiotics were the top three drug categories processed by the program. Through local pharmacies enrolled with EPAP, continuity of care for the uninsured was safeguarded, and local business operations were not required to donate inventory and services to provide that continuity of care. EPAP services are a critical component of the disaster recovery efforts to address chronic care medication needs of displaced disaster survivors.
Different Medical Needs Between Hurricane and Flood Victims
Wilderness & Environmental Medicine, 2003
Objective.-Through the review of patient records seen by the New Mexico-1 Disaster Medical Assistance Team (NM-1DMAT) after various disasters, we hoped to find patterns that might help in disaster planning. Our hypothesis was that flood and hurricane victims have different medical conditions and needs.
Annals of Emergency Medicine, 2008
Study objective: Anecdotal evidence suggests that the population displaced to shelters from Hurricane Katrina had a significant burden of disease, socioeconomic vulnerability, and marginalized health care access. For agencies charged with providing health care to at-risk displaced populations, knowing the prevalence of acute and chronic disease is critical to direct resources and prevent morbidity and mortality. Methods: We performed a 2-stage 18-cluster sample survey of 499 evacuees residing in American Red Cross shelters in Louisiana 2 weeks after landfall of Hurricane Katrina. In stage 1, shelters with a population of more than 100 individuals were randomly selected, with probability proportional to size sampling. In stage 2, 30 adult heads of household were randomly chosen within shelters by using a shelter log or a map of the shelter where no log existed. Survey questions focused on demographics, socioeconomic indicators, acute and chronic burden of disease, and health care access. Results: Two thirds of the sampled population was single, widowed, or divorced; the majority was female (57.6%) and black (76.4%). Socioeconomic indicators of under-and unemployment (52.9%), dependency on benefits or assistance (38.5%), lack of home ownership (66.2%), and lack of health insurance (47.0%) suggested vulnerability. One third lacked a health provider. Among those who arrived at shelters with a chronic disease (55.6%), 48.4% lacked medication. Hypertension, hypercholesterolemia, diabetes, pulmonary disease, and psychiatric illness were the most common chronic conditions. Risk factors for lacking medications included male sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 0.96 to 2.59) and lacking health insurance (OR 2.25; 95% CI 1.21 to 4.20). More than one third (34.5%) arrived at the shelter with symptoms warranting immediate medical intervention, including dehydration (12.0%), dyspnea (11.5%), injury (9.4%), and chest pain (9.7%). Risk factors associated with presenting to shelters with acute symptoms included concurrent chronic disease with medication (OR 2.60; 95% CI 1.98 to 3.43), concurrent disease and lacking medication (OR 2.22; 95% CI 1.36 to 3.63), and lacking health insurance (OR 1.83; 95% CI 1.10 to 3.02). Conclusion: A population-based understanding of vulnerability, health access, and chronic and acute disease among the displaced will guide disaster health providers in preparation and response. [Ann Emerg Med.
A Katrina Experience: Lessons Learned
The American Journal of Medicine, 2006
Almost no data exist on how best to respond to the medical needs of civilians displaced by natural disasters. After Hurricane Katrina destroyed the Gulf Coast and seriously damaged the infrastructure of Jackson, Miss, the University of Mississippi Medical Center (UMMC) was challenged with serving a large group of evacuees at a major Red Cross evacuation shelter near our campus. We reviewed our experiences and share lessons learned. METHODS: This is a retrospective review of administrative and clinical records for patients served by a medical clinic established emergently after Hurricane Katrina. RESULTS: Red Cross regulations precluded their volunteers from providing medical care other than first aid. Faced with numerous evacuees seeking medical assistance, UMMC established an ambulatory clinic at the shelter. The majority of patients had multiple medical problems, no medical insurance, and limited ability to purchase medications. The greatest need was for management of chronic illnesses. The clinic provided 2394 patient visits and filled more than 4902 prescriptions over 17 days. CONCLUSION: While medical facilities have emergency response plans for epidemics and mass trauma, little attention has focused on plans for care of evacuated populations. Shelter operators should consider advance coordination of medical care with existing health care systems. Medical facilities along evacuation routes should be aware that they may be asked to provide care for sheltered evacuees.
Annals of Emergency Medicine, 2009
We aimed to examine community knowledge about and attitudes toward the threat of pandemic influenza and assess the community acceptability of strategies to reduce its effect. METHODS: We conducted computer-aided telephone interviews in 2007 with a cross-sectional sample of rural and metropolitan residents of South Australia. RESULTS: Of 1975 households interviewed, half (50.2%) had never heard of pandemic influenza or were unaware of its meaning. Only 10% of respondents were extremely concerned about the threat of pandemic influenza. Respondents identified children as the highest priority for vaccination, if supplies were limited; they ranked politicians and teachers as the lowest priority. Although only 61.7% of respondents agreed with a policy of home isolation, 98.2% agreed if it was part of a national strategy. Respondents considered television to be the best means of educating the community. CONCLUSION: s. Community knowledge about pandemic influenza is poor despite widespread concern. Public education about pandemic influenza is essential if strategies to reduce the impact of the disease are to be effective.