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Basic Disaster Prepardness of Rural Community Pharmacies in 5 States
Abstract
Objectives
The aim of this study was to investigate the basic preparedness of rural community pharmacies to continue operations during and immediately following a disaster.
Methods
In 2014, we conducted a telephone survey ( N = 990) of community pharmacies in 3 rural areas: North Dakota/South Dakota, West Virginia, Southern Oregon/Northern California regarding whether they had a formal disaster/continuity plan, offsite data backup, emergency power generation, and/or had a certified pharmacy immunizer on staff. Logistic regression and chi square were performed using Stata 11.1.
Findings
Community pharmacies in rural areas (≤50.0 persons/mile ² ) were less likely to have emergency power (odds ratio [OR] = 0.59; 95% confidence interval [CI]: 0.32-1.07) or certified pharmacy immunizer on staff (OR = 0.47; 95% CI: 0.34-0.64). Pharmacies in lower income areas were less likely to have emergency power and offsite data backup or a formal disaster plan (OR = 0.70; 95% CI: 0.49-0.99) compared with pharmacies in higher income areas. Community pharmacies in areas of higher percent elderly population were less likely to have emergency power (OR = 0.54; 95% CI: 0.39-0.73), or certified pharmacy immunizer on staff (OR = 0.65; 95% CI: 0.47-0.91) compared with chain pharmacies in areas with lower percent elderly population.
Conclusions
Being in a rural, low-income, or high-elderly area was associated with lower likelihood of basic preparedness of community pharmacies.
... Pharmacies in lower income areas were less likely to have emergency power and offsite data backup or a formal disas ter plan compared with pharmacies in higher income areas. 14 In the Hurricane Florenceimpacted regions of North Caro lina and South Carolina, locations along the coast had sub optimal pharmacy functionality due to a lack of preparedness, whereas counties located more centrally had higher func tioning pharmacies throughout the disaster. 11 Continuity of care for the uninsured was safeguarded with the Emergency Pharmaceutical Assistance Program (EPAP). ...
... We found that although community pharmacies were highly accessible healthcare locations amid EWCEs, they were not readily prepared to help safeguard the pharmacy and continue delivery of patients' medications, with pharma cies in lower income and rural communities being least prepared. 7,11,14 Finally, most reviewed studies indicated that pharmacy deserts were more prevalent in rural, low income, or Black/African American and Latino neighbor hoods. 3,1829 As such, communities living in these areas were at an increased risk of adverse outcomes given that they were disproportionately affected by both pharmacy deserts and pharmacies not being adequately prepared for EWCEs. ...
... Pharmacies that do exist in these areas are less likely to be prepared for EWCEs, making residents particularly vul nerable to losing medication access. 7,11,14 Pharmacy deserts overlapping with areas prone to EWCEs should be further investigated to identify the pharmacies and communities that are at highest risk. Proactive outreach to better prepare pharmacies for an EWCE, providing incentives to pharma cists to work in underserved areas, and training of pharma cists on the needs of communities in pharmacy deserts can be implemented. ...
Background:
The effects of climate change are seen with a rise of extreme weather and climate events (EWCEs) which lead to the closures of many healthcare facilities, such as community pharmacies. Pharmacists in community pharmacies are seen as the most accessible healthcare professional to the public and are responsible for the continued delivery of care to patients. However, amid closures due to EWCEs and the emergence of pharmacy deserts, there is decreased access to pharmacies and a disruption of care.
Objective:
It is important to address the preparedness and accessibility of pharmacies post-EWCEs to guide future research and policy. Additionally, to tackle health disparities that arise due to pharmacy deserts, the populations most affected by a decreased access to pharmacies should be identified. We conducted a scoping review to assess the preparedness and accessibility of pharmacies post-EWCEs and to identify populations most affected by pharmacy deserts.
Methods:
We searched PubMed, Embase, and Web of Science from January 1, 2012 to September 30, 2022 and included all English-language, peer-reviewed primary literature that examined the preparedness and accessibility of community pharmacies in the United States post-EWCEs and addressed disparities within pharmacy deserts. Studies meeting these criteria were screened of their titles and abstracts by the first author and discrepancies were resolved with co-authors. We used Covidence for data extraction.
Results:
A total of 472 studies were identified (196 duplicates removed) and after screening, 53 studies were assessed for eligibility. The results of included publications (N = 26) showed that pharmacists and pharmacies are not equipped with the necessary emergency protocols which could lead to decreased access of pharmacies in the wake of EWCEs. Pharmacy deserts disproportionately affect residents living in rural, lower income, and Black/African American and Hispanic/Latino neighborhoods. The lack of preparedness of pharmacies post-EWCEs could worsen medication access.
Conclusion:
This scoping review addresses challenges impacting pharmacies and patients post-EWCEs and within pharmacy deserts. In times of increased need, these challenges implicate the well-being of communities affected by EWCEs by breaking the continuum of care and access to medications. Here we offer suggestions for future research and directions for policy change.
... From the literature that was removed during the screening process, it is evident that most of the currently available evidence around pharmacists in disasters is reliant on narrative descriptions of experiences, or research on the preparedness of the facilities that pharmacists work in, and not pharmacists themselves. [40,41] The preparedness of facilities is usually assessed by their access to resources, such as generators, antidotes, medications and disaster plans. These articles assessing facility preparedness do not often consider the preparedness of the workforce within the facilities. ...
... These articles assessing facility preparedness do not often consider the preparedness of the workforce within the facilities. [40,41] Whilst having access to resources and disaster plans play an important role in pharmacists being prepared, it is not the only contributing factor to an individual's disaster preparedness. As Al-Ziftawi et al. [26] and Gillani et al. [27] argue in their work, individual preparedness also relies on internal factors such as knowledge and attitude. ...
Objectives:
In the aftermath of a disaster, the services provided by pharmacists are essential to ensure the continued health and well‐being of the local population. To continue pharmacy services, it is critical that pharmacists are prepared for disasters. A systematic literature review was conducted to explore pharmacists’ and pharmacy students’ preparedness for disasters and the factors that affect preparedness.
Methods:
This review was conducted in April 2020 through electronic databases CINAHL, MEDLINE, Embase, PubMed, Scopus and PsycINFO, and two disaster journals. Search terms such as ‘pharmacist*’, ‘disaster*’ and ‘prepared*’ were used. The search yielded an initial 1781 titles. Articles were included if they measured pharmacists or pharmacy students’ disaster preparedness. After screening and quality appraisal by two researchers, four articles were included in final analysis and review. Data were extracted using a data collection tool formulated by the researchers. Meta‐analysis was not possible; instead, results were compared across key areas including preparedness ratings and factors that influenced preparedness.
Key findings:
Three articles focused on pharmacy students’ preparedness for disasters, and one on registered pharmacists’ preparedness. Preparedness across both groups was poor to moderate with <18% of registered pharmacists found to be prepared to respond to a disaster. Factors that potentially influenced preparedness included disaster competency, disaster interventions and demographic factors.
Conclusion:
For pharmacists, the lack of research around their preparedness speaks volumes about their current involvement and expectations within disaster management. Without a prepared pharmacy workforce and pharmacy involvement in disaster management, critical skill and service gaps in disasters may negatively impact patients.
... In this study, disaster preparedness strategies were implemented to improve the success of Trinidad extension's response to TSK. Disaster preparedness has been highlighted as a critical aspect of disaster management (Henkel & Marvanova, 2019;McLean & Whang, 2019;Nyanga et al., 2018). The fieldwork conducted by extension professionals in the preparedness phase of TSK was conducted to improve the response efforts. ...
The purpose of this study was to investigate the weather-related disaster preparedness and response strategies of agricultural extension professionals in Trinidad during Tropical Storm Karen (TSK). Trinidad faces perennial flooding, and Trinidad extension professionals have often been involved in the management of weather-related disasters. TSK was contextualized as a case study, and a qualitative approach was used to investigate the lived experiences of the extension professionals who directly assisted with managing the event. Semi-structured interview data were collected, along with concept maps and participant-rendered drawings. Each interview was compared with the participant’s concept map and drawing, while the constant comparative technique was used to evaluate the interview data among the participants to derive themes. Data were collected remotely using internet platforms due to the COVID-19 global pandemic. Findings indicated that disaster preparedness was strategized through field activities, including collecting data and providing disaster advice to clients. Disaster responsiveness was strategized through field actions, primarily through field evaluations for subsidy claims. In addition, related to disaster response, extension professionals faced various challenges in responding to TSK, most notably, the inability to access appropriate transportation. The findings of this study can guide the government of Trinidad and Tobago in bolstering the disaster management strategies of the country, as well as inform regional disaster management plans in other Caribbean countries.
... Surveys of U.S. businesses and other employers have repeatedly shown insufficient levels of preparedness for even ''normal'' emergencies, let alone increasingly extreme disasters fueled by climate change. [35][36][37][38] One such example comes from Hurricane Harvey, in 2017. Multiple studies indicate that climate change intensified Harvey's rainfall, contributing to catastrophic flooding across 70% of Harris County, Texas. ...
... Surveys of U.S. businesses and other employers have repeatedly shown insufficient levels of preparedness for even ''normal'' emergencies, let alone increasingly extreme disasters fueled by climate change. [35][36][37][38] One such example comes from Hurricane Harvey, in 2017. Multiple studies indicate that climate change intensified Harvey's rainfall, contributing to catastrophic flooding across 70% of Harris County, Texas. ...
Climate change is already hurting workers and imposing needless health costs on employers. This situation will only worsen as climate change makes weather extremes evermore deadly and disruptive. By being proactive, employers can find the most cost-effective and efficient approaches to maintain business continuity and avoid preventable climate-related illnesses, injuries, and deaths among their workforce.
... To date, the only study that has explored rural pharmacy disaster preparedness found that rural pharmacies had lower levels of basic preparedness, including emergency power, certified pharmacy immunization staff, and a formal disaster plan. 7 This study seeks to add to the limited literature on rural community pharmacy disaster preparedness by documenting their preparedness for and responses to COVID-19. ...
Background
Few studies have documented rural community pharmacy disaster preparedness.
Objectives
To: (1) describe rural community pharmacies’ preparedness for and responses to COVID-19 and (2) examine whether responses vary by level of pharmacy rurality.
Methods
A convenience sample of rural community pharmacists completed an online survey (62% response rate) that assessed: (a) demographic characteristics; (b) COVID-19 information source use; (c) interest in COVID-19 testing; (d) infection control procedures; (e) disaster preparedness training, and (f) medication supply impacts. Descriptive statistics were calculated and differences by pharmacy rurality were explored.
Results
Pharmacists used the CDC (87%), state health departments (77%), and state pharmacy associations (71%) for COVID-19 information, with half receiving conflicting information. Most pharmacists (78%) were interested in offering COVID-19 testing but needed personal protective equipment and training to do so. Only 10% had received disaster preparedness training in the past five years. Although 73% had disaster preparedness plans, 27% were deemed inadequate for the pandemic. Nearly 70% experienced negative impacts in medication supply. There were few differences by rurality level.
Conclusion
Rural pharmacies may be better positioned to respond to pandemics if they had disaster preparedness training, updated disaster preparedness plans, and received regular policy guidance from professional bodies.
Objective
To describe geographic and sociodemographic variations in operating hours and availability of medications commonly prescribed by pediatric urologists at Washington State retail pharmacies.
Methods
We identified all retail pharmacies in the state. We stratified counties by population density and household income (HI) and compared differences in pharmacy operating hours and availability of 10 commonly prescribed medications.
Results
1057/1058 pharmacies were contacted. All pharmacies had liquid formulations of oxycodone, hydrocodone, ibuprofen, acetaminophen, amoxicillin, and trimethoprim-sulfamethoxazole in stock. Liquid formulations of ciprofloxacin (10%) and oxybutynin (14.3%) were uncommonly stocked, while 92.5% of pharmacies stocked nitrofurantoin suspension and 80.9% nitrofurantoin capsules. Statewide, 108 (10.2%) of pharmacies were closed on Saturdays and 297 (28.1%) closed on Sunday. More high (HPDC) than low population density (LPDC) (62.5% vs 0%, p<0.001) and high-HI than low-HI counties (62.5% vs. 0%, p=0.30) had 24-hour pharmacies. A larger proportion of pharmacies were open 7-days in HPDC than LPDC (75.6% vs 56.2%, p<0.0001) and in high-HI than low-HI counties (100% vs. 62.5%, p=0.30). The likelihood of a pharmacy being open 7 days/week was significantly higher in HPDC (versus LPDC; OR=13.2, 95% CI: 4.39-39.7) and high-HI (versus low-HI; OR=4.98, 95% CI: 2.58-9.60) counties.
Conclusions
Most pharmacies in Washington State carry medications commonly prescribed by pediatric urologists. However, retail pharmacy operating hours are widely variable and create geographic and temporal barriers in rural and poor areas that may limit the timely administration of prescription medication. Providers should consider a patient's practical ability to fill a prescription when starting a time-sensitive medication.
Introduction
In a disaster aftermath, pharmacists have the potential to provide essential health services and contribute to the maintenance of the health and well-being of their community. Despite their importance in the health care system, little is known about the factors that affect pharmacists’ disaster preparedness and associated behaviors.
Study Objective
The goal of this study was to determine the factors that influence disaster preparedness behaviors and disaster preparedness of Australian pharmacists.
Methods
A 70-question survey was developed from previous research findings. This survey was released online and registered Australian pharmacists were invited to participate. Multiple linear regression was used to determine the factors that influenced preparedness and preparedness behaviors among pharmacists.
Results
The final model of disaster preparedness indicated that 86.0% of variation in preparedness was explained by disaster experience, perceived knowledge and skills, colleague preparedness, perceived self-efficacy, previous preparedness behaviors, perceived potential disaster severity, and trust of external information sources. The final model of preparedness behaviors indicated that 71.1% of variation in previous preparedness behaviors can be explained by disaster experience, perceived institution responsibility, colleague preparedness, perceived likelihood of disaster, perceived professional responsibility, and years of practice as a pharmacist.
Conclusion
This research is the first to explore the significant factors affecting preparedness behaviors and preparedness of Australian pharmacists for disasters. It begins to provide insight into potential critical gaps in current disaster preparedness behaviors and preparedness among pharmacists.
Background
Extreme events (e.g. flooding) threaten critical infrastructure including power supplies. Many interlinked systems in the modern world depend on a reliable power supply to function effectively. The health sector is no exception, but the impact of power outages on health is poorly understood. Greater understanding is essential so that adverse health impacts can be prevented and/or mitigated.
Methods
We searched Medline, CINAHL and Scopus for papers about the health impacts of power outages during extreme events published in 2011-2012. A thematic analysis was undertaken on the extracted information. The Public Health England Extreme Events Bulletins between 01/01/2013 - 31/03/2013 were used to identify extreme events that led to power outages during this three-month period.
Results
We identified 20 relevant articles. Power outages were found to impact health at many levels within diverse settings. Recurrent themes included the difficulties of accessing healthcare, maintaining frontline services and the challenges of community healthcare. We identified 52 power outages in 19 countries that were the direct consequence of extreme events during the first three months of 2013.
Conclusions
To our knowledge, this is the first review of the health impacts of power outages. We found the current evidence and knowledge base to be poor. With scientific consensus predicting an increase in the frequency and magnitude of extreme events due to climate change, the gaps in knowledge need to be addressed in order to mitigate the impact of power outages on global health.
Mitigating disaster impact requires identifying risk factors. The increased vulnerability of the physically fragile is easily understood. Less obvious are the socio-economic risk factors, especially within relatively affluent societies. Hurricane Katrina demonstrated many of these risks within the United States. These factors include poverty, home ownership, poor English language proficiency, ethnic minorities, immigrant status, and high-density housing. These risk factors must be considered when planning for disaster preparation, mitigation, and response.
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 4,229 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.
Objective:
To share an independent pharmacy's experience creating a practical manual for disaster preparedness that incorporates applicable pharmacy regulations, provides a plan to prepare a community pharmacy for disasters, and addresses the pharmacy's duty to the community during disasters.
Data sources:
A literature search was performed to determine if such a manual or a guide had been published previously. The search returned examples of expectations of hospitals during disasters, but few results were specific to community pharmacy. An Internet search for pharmacy contingency planning returned only a few checklists and descriptive reports of pharmacist involvement in past disasters.
Data extraction and synthesis:
Public resources available from the Centers for Disease Control and Prevention, Environmental Protection Agency, Drug Enforcement Administration, Department of Public Health, Federal Emergency Management Agency, National Community Pharmacists Association, and American Pharmacists Association were explored. The Iowa State Board of Pharmacy also was contacted. Information was compiled to create a useful guide that addressed disaster planning, risk assessment, and public need during a disaster and that prioritized the needs of the pharmacy and community.
Conclusion:
Every community pharmacy should have a detailed disaster preparedness manual that is readily accessible and easy to follow. The manual created for Valley Drug focused on continuing pharmacy operations while minimizing disruptions in patient care during a disaster. Our manual included only necessary information required to prepare for, operate during, or recover from a disaster.
Purpose: The proportion of people over 65 years of age is higher in rural areas than in urban areas, and their numbers are expected to increase in the next decade. This study used Andersen's behavioral model to examine quality of life (QOL) in a nationally representative sample of community-dwelling adults 65 years and older according to geographic location. Specifically, associations between 3 dimensions of QOL (health-related QOL [HQOL], social functioning, and emotional well-being) and needs and health behaviors were examined.
Methods: The 2005-2006 National Health and Nutrition Examination survey was linked with the 2007 Area Resources File via the National Center for Health Statistics’ remote access system. Frequencies and distribution patterns were assessed according to rural, adjacent, and urban locations.
Findings: Older adults reported high levels of QOL; however, rural older adults had lower social functioning than their urban counterparts. Older blacks and Hispanics had lower scores than whites on 2 dimensions of QOL. Associations between QOL and needs and health behaviors varied. Although activities of daily living were associated with all 3 dimensions, others were associated with 1 or 2 dimensions.
Conclusions: The lower scores on social functioning in rural areas suggest that rural older adults may be socially isolated. Older rural adults may need interventions to maintain physical and mental health, strengthen social relationships and support, and increase their participation in the community to promote QOL. In addition, older blacks and Hispanics seem more vulnerable than whites and may need more assistance.
The changing demographic landscape of the United States calls for a reassessment of the societal impacts and consequences oJ so-called "natural" and technological disasters. An increasing trend towards greater demographic and socio-economic diversity (in part due to high rates of international immigration), combined with mounting disaster losses, have brought about a more serious focus among scholars on how changing population patterns shape the vulnerability and resiliency of social systems. Recent disasters, such as the Indian Ocean Tsunami (2004) and Hurricane Katrina (2005), point to the differential impacts of disasters on certain communities, particularly those that do not have the necessary resources to cope with and recover from such events. Ihis paper interprets these impacts within the context of economic, cultural, and social capital, as well as broader human ecological forces. The paper also makes important contributions to the social science disaster research literature by examining population growth, composition, and distribution in the context of disaster risk and vulnerability. Population dynamics (e.g., population growth, migration, and urbanization) are perhaps one of the most important factors that have increased our exposure to disasters and have contributed to the devastating impacts of these events, as the case of Hurricane Katrina illustrates Nevertheless, the scientific literature exploring these issues is quite limited. We argue that if we fail to acknowledge and act on the mounting evidence regarding population composition, migration, inequality, and disaster vulnerability, we will continue to experience disasters with greater regularity and intensity.
Many rural elders experience limited access to health care. The majority of what we know about this issue has been based upon quantitative studies, yet qualitative studies might offer additional insight into individual perceptions of health care access.
To examine what barriers rural elders report when accessing needed health care, including how they cope with the high cost of prescription medication.
During Spring 2001, thirteen 90-minute focus groups were conducted in 6 rural West Virginia communities. A total of 101 participants, aged 60 years and older, were asked several culminating questions about their perceptions of health care access.
Five categories of barriers to health care emerged from the discussions: transportation difficulties, limited health care supply, lack of quality health care, social isolation, and financial constraints. In addition, 6 diverse coping strategies for dealing with the cost of prescription medication were discussed. They included: reducing dosage or doing without, limiting other expenses, relying on family assistance, supplementing with alternative medicine, shopping around for cheapest prices, and using the Veteran's Administration.
Overall, rural older adults encounter various barriers to accessing needed health care. Qualitative methodology allows rural elders to have a voice to expound on their experiences. Research can contribute valuable information to shape policy by providing a forum where older adults can express their concerns about the current health care delivery system.
To shed light on how the public health community can promote the recovery of Hurricane Katrina victims and protect people in future disasters, we examined the experiences of evacuees housed in Houston area shelters 2 weeks after the hurricane.
A survey was conducted September 10 through 12, 2005, with 680 randomly selected respondents who were evacuated to Houston from the Gulf Coast as a result of Hurricane Katrina. Interviews were conducted in Red Cross shelters in the greater Houston area.
Many evacuees suffered physical and emotional stress during the storm and its aftermath, including going without adequate food and water. In comparison with New Orleans and Louisiana residents overall, disproportionate numbers of this group were African American, had low incomes, and had no health insurance coverage. Many had chronic health conditions and relied heavily on the New Orleans public hospital system, which was destroyed in the storm.
Our results highlight the need for better plans for emergency communication and evacuation of low-income and disabled citizens in future disasters and shed light on choices facing policymakers in planning for the long-term health care needs of vulnerable populations.
Patients in rural areas may use less medical care than those living in urban areas. This could be due to differences in travel distance and time and a utilization of a different mix of generalists and specialists for their care.
To compare the travel times, distances, and physician specialty mix of all Medicare patients living in Alaska, Idaho, North Carolina, South Carolina, and Washington.
Retrospective design, using 1998 Medicare billing data. Travel time was determined by computing the road distance between 2 population centroids: the patient's and the provider's zone improvement plan codes.
There were 2,220,841 patients and 39,780 providers in the cohort, including 6,405 (16.1%) generalists, 24,772 (62.3%) specialists, and 8,603 (21.6%) nonphysician providers. There were 20,693,828 patient visits during the study. The median overall 1-way travel distance and time was 7.7 miles (interquartile range 1.9-18.7 miles) and 11.7 minutes (interquartile range 3.0-25.7 minutes). The patients in rural areas needed to travel 2 to 3 times farther to see medical and surgical specialists than those living in urban areas. Rural residents with heart disease, cancer, depression, or needing complex cardiac procedures or cancer treatment traveled the farthest. Increasing rurality was also related to decreased visits to specialists and an increasing reliance on generalists.
Residents of rural areas have increased travel distance and time compared to their urban counterparts. This is particularly true for rural residents with specific diagnoses or those undergoing specific procedures. Our results suggest that most rural residents do not rely on urban areas for much of their care.
When disaster strikes: emergency preparedness for the community pharmacy
- R Cohen
When chronic conditions become acute: prevention and control of chronic diseases and adverse health outcomes during natural disasters
- G A Mensah
- A H Mokdad
- Posner
- Sf