Martha I. Arrieta

Providing Continuity of Care for Chronic Diseases in the Aftermath of Katrina: From Field Experience to Policy Recommendations

This study sought to elicit challenges and solutions in the provision of health care to those with chronic diseases after Hurricane Katrina in coastal Alabama and Mississippi. In-depth interviews with 30 health and social service providers (key informants) and 4 focus groups with patients with chronic diseases were conducted. Subsequently an advisory panel of key informants was convened. Findings were summarized and key informants submitted additional feedback. The chronic diseases identified as medical management priorities by key informants were mental health, diabetes mellitus, hypertension, respiratory illness, end-stage renal disease, cardiovascular disease, and cancer. The most frequently mentioned barrier to providing care was maintaining continuity of medications. Contributing factors were inadequate information (inaccessible medical records, poor patient knowledge) and financial constraints. Implemented or suggested solutions included relaxation of insurance limitations preventing advance prescription refills; better predisaster patient education to improve medical knowledge; promotion of personal health records; support for information technology systems at community health centers, in particular electronic medical records; improved allocation of donated medications/medical supplies (centralized coordination, decentralized distribution); and networking between local responders and external aid.

Insuring Continuity of Care for Chronic Disease Patients After a Disaster : Key Preparedness Elements

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 fewer 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. Methods:Focusing on agencies providing care to health disparate populations, a qualitative methodology was employed using in-depth interviews with health and social service providers. Participants identified key elements essential to disaster preparedness. Results:Predisaster issues were patient education and preparedness, evacuation, special needs shelters, and health care provider preparedness. Postdisaster issues were communication, volunteer coordination, and donation management. Conclusions:Lessons learned from those on the ground administering health care during disasters should inform future disaster preparations. Furthermore, the methodological approach used in this study engendered collaboration between health care institutions and may enhance future interagency disaster preparedness.

Using zip code-level mortality data as a local health status indicator in Mobile, Alabama.

Objective:Having local health data is critical to combat health disparities, and zip code-level data are an underutilized source of such information. We sought to use zip code-level mortality data to determine where health disparities existed in our local area. Methods:The most heavily populated zip codes were aggregated into 2 groups: (1) study area population (SAP) where ≥20% of individuals lived in poverty in 1999; (2) comparison area population, <20% in poverty. Disease-specific mortality rates (per 100,000 population) were calculated and compared. The relative risk (RR) of death from specific causes was the ratio of the mortality rate experienced by the SAP compared with that experienced by the comparison area population. Results:The SAP had higher percentages of African Americans and women and much lower levels of income, employment, and education. Some zip codes in SAP had over 40% living below the poverty level. The RR of death from all but 4 of the 22 causes examined was ≥40% higher in the SAP. Major disparities (RR >2.5) were seen for human immunodeficiency virus, homicide, hypertensive heart and renal disease, and kidney disease. Actual death rates were highest for major cardiovascular disease and cancer, and the level of disparities here (RR ∼ 1.4) make them important areas for concentration. Conclusion:Using zip code-level data provides an accurate foundation from which to design local interventions to address health disparities.

Investigating Health Disparities through Community-Based Participatory Research: Lessons Learned from a Process Evaluation

This article describes one universitys efforts to partner with a local agency (the “Coalition”) within a disadvantaged, predominantly African American neighborhood, to assist them with studying their communitys health disparities and health care access. The final, mutually agreed-upon plan used a community-based participatory research approach, wherein university researchers prepared neighborhood volunteers and Coalition members to conduct face-to-face interviews with residents about their health and health care access. Subsequently, the Coalition surveyed 138 residents, and the agency now possesses extensive data about the nature and extent of health problems in their community. Lessons learned from these experiences are offered.

Post-disaster Gulf Coast Recovery Using Telehealth

OBJECTIVE The Gulf Coast continues to struggle with service need far outpacing available resources. Since 2005, the Regional Coordinating Center for Hurricane Response (RCC) at Morehouse School of Medicine, Atlanta, GA, has supported telehealth solutions designed to meet high service needs (e.g., psychiatry) within primary care and other healthcare organizations. The overall RCC vision is to support autonomous, useful, and sustainable telehealth programs towards mitigating unmet disaster-related needs. SUBJECTS AND METHODS To assess Gulf Coast telehealth experiences, we conducted semistructured interviews with both regional key informants and national organizations with Gulf Coast recovery interests. Using qualitative-descriptive analysis, interview transcripts were analyzed to identify shared development themes. RESULTS Thirty-eight key informants were interviewed, representing a 77.6% participation rate among organizations engaged by the RCC. Seven elements critical to telehealth success were identified: Funding, Regulatory, Workflow, Attitudes, Personnel, Technology, and Evaluation. These key informant accounts reveal shared insights with telehealth regarding successes, challenges, and recommendations. CONCLUSIONS The seven elements critical to telehealth success both confirm and organize development principles from a diverse collective of healthcare stakeholders. The structured nature of these insights suggests a generalizable framework upon which other organizations might develop telehealth strategies toward addressing high service needs with limited resources.

STRUCTURAL AND HIDDEN BARRIERS TO A LOCAL PRIMARY HEALTH CARE INFRASTRUCTURE: AUTONOMY, DECISIONS ABOUT PRIMARY HEALTH CARE, AND THE CENTRALITY AND SIGNIFICANCE OF POWER

PURPOSE To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States. METHODOLOGY/APPROACH Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach. FINDINGS Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers. RESEARCH LIMITATIONS/IMPLICATIONS Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power. ORIGINALITY/VALUE This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

Research Apprenticeship and Its Potential as a Distinct Model of Peer Research Practice

Abstract:Background: Three models of peer research have emerged: advisory, employment, and partner. We propose a fourth model, the “research apprentice” prototype conceived as a postsecondary workforce development avenue for members of disadvantaged communities.Objectives: We introduce the research apprenticeship experience and its potential contributions to the fields of health equity and translational research.Methods: Implementation of the research apprenticeship model within a survey research project.Results: In this article, we 1) identify the model’s distinctive qualities, 2) conceptualize an appropriate industry for graduates, 3) recognize its value for those with little access to postsecondary education, and 4) formulate a vision for contributing to health equity and translational research.Conclusions: The research apprenticeship holds potential to realize goals of capacity building, empowerment, and co-learning; generate educational progress and employment for participants; expand diversity in biomedical research; support two-directional co-learning between community and academia; and contribute to dismantling structural racism within the biomedical sciences.

Katrina’s Legacy: Processes for Patient Disaster Preparation Have Improved but Important Gaps Remain

Background: Ensuring continuity of care for patients with chronic illness, 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 of 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 patients with chronic illness in case of disasters. Changes include patient assistance with predisaster 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. Conclusions: Although changes were implemented, results indicate that these may be inadequate to completely address patient needs. Thus, additional efforts may be needed, underscoring the complexity of adequate disaster preparation among disparate populations.