Chronic Disease and Disasters: Medication Demands of Hurricane Katrina Evacuees

doi:10.1016/j.amepre.2007.04.030

American Journal of Preventive Medicine

Volume 33, Issue 3, September 2007, Pages 207-210

https://doi.org/10.1016/j.amepre.2007.04.030 Get rights and content

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Introduction

On August 29, 2005, Hurricane Katrina struck the Gulf Coast, forcing the relocation of more than 18,000 Louisiana and Mississippi residents into mass evacuee centers in San Antonio, TX. Disaster-related morbidity from acute traumatic injuries, environmental exposures, and infectious diseases was expected, and medical relief plans focused on these well-recognized consequences of natural disasters.¹ Although survivor needs are likely incident specific, recent evidence suggests that post-disaster medical care often involves few patients with acute conditions2, 3 and many patients with low-acuity complaints.4, 5, 6

In this report, disease surveillance and pharmaceutical use data from a group of displaced Hurricane Katrina survivors are presented. These data describe the survivors’ medication requirements and the extent to which these needs were met by federal disaster relief teams and local retail pharmacies.

Section snippets

Methods

The primary outcomes of interest for this ecological study were medications dispensed to Hurricane Katrina evacuees residing in a San Antonio evacuee center from September 2nd through the 21st, 2005. During this period, the Centers for Disease Control and Prevention assisted the San Antonio Metropolitan Health District with disease surveillance in four primary evacuee centers. Health care was provided to evacuees in one evacuee center by the Texas-1 and Florida-2 disaster medical assistance

Results

Daily evacuee census ranged from 2020 to 6219 people (median = 3707). The median number of healthcare encounters per day was 218 (5% of evacuee population), with a range of 5 to 574 encounters (<1% to 13% of evacuee population). Of 5030 evacuee healthcare encounters captured by the syndromic surveillance system, 4229 (84%) were categorized;^b 2834 (67%) were for acute care conditions, 634 (15%) were explicitly for care of chronic medical conditions, and 761 (18%) were for routine care, including

Conclusion

Hurricane evacuees in San Antonio relied on retail pharmacies to meet the majority of their medication needs. Although evacuees seeking care for chronic medical complaints accounted for relatively few healthcare encounters (15%), their medication needs constituted 68% of all DDDs dispensed. The DMATs deployed to San Antonio appeared better equipped to meet the acute care medication needs of evacuees than their chronic medication demands. The DMAT pharmacy dispensed fewer doses per prescription

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Scoping review.
Standard electronic databases were searched. PRISMA-ScR guidelines were followed. Extracted data were organised in response to review questions and narrative accounts developed.
A total of 129 studies were included, conducted across 32 countries, mostly in the USA (n = 42). Sixty-eight (53%) reported on infectious events, 49 (39%) climatological or ecological events and the remainder a mixture of terrorism, war or other disasters. The studies described several medication safety outcomes (medication-related harm, adherence, supply) and adaptive medication practices (self-altering prescribed medications, sharing medications and changing healthcare providers). Challenges to maintaining routine medication practices during a PHE included transport, finance, quarantine and knowledge-related issues. Twenty-eight studies (22%) examined health inequalities pertaining to adverse medication-related outcomes, with findings suggesting that gender, age, ethnicity, educational and socio-economic status may be related to inequalities. Research gaps identified included carers', children's and minority communities' experiences and intervention studies.
There is considerable evidence of disruptions to routine personal medication practices during PHEs and of medication-related harm and other negative outcomes. Maintaining medication supply for the management of chronic conditions is a universal problem across all emergency types. Research is needed to address these disruptions, particularly amongst people who experience health inequalities who may need additional support.
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Brief reportChronic Disease and Disasters: Medication Demands of Hurricane Katrina Evacuees

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Conclusion

Ann Emerg Med

J Emerg Med

Ann Emerg Med

Lancet

Emerg Med Clin N Am

Disasters: introduction and state of the art

Epidemiol Rev

The historical development of public health responses to disaster

Disasters

New York City syndromic surveillance systems. In: syndromic surveillance: reports from a national conference, 2003

MMWR Morb Mortal Wkly Rep

ATC/DDD Index

AHFS Drug Information

Brief report
Chronic Disease and Disasters: Medication Demands of Hurricane Katrina Evacuees