Source
Krousel-Wood M, Muntner P, Stanley E, et al. Effects of a disaster: Medication adherence in older adults with hypertension. 2007 Annual Conference on Cardiovascular Disease Epidemiology and Prevention; March 1, 2007; Orlando, FL. Poster 156.
As reported in
Hurricane Katrina wreaked havoc with adherence to medication Michael O’Riordan The Heart.org March 1, 2007
Summary
In the aftermath of Hurricane Katrina, New Orleans residents being treated for hypertension demonstrated decreased rates of adherence to medications.
Pertinent Results
- Ten percent of patients reported not taking their hypertension medication with them when they evacuated, while one third ran out of medicine while they were away from their homes.
- In addition to those who didn’t bring their medication with them when they evacuated and those who ran out while away from home, 15% reported having difficulty getting prescriptions filled after the storm and flood. Another 30% reported a medication change after the disaster, possibly because of a change in their condition or because they did not have their medication or prescription when evacuated, leaving medical personnel in other cities to guess what patients had been taking before Katrina.
- Only 45% of patients reported perfect medication adherence. Younger patients and patients who were not white (predominantly African American) were twice as likely to report less-than-perfect adherence.
- There was also a clear correlation between damage to a patient’s home and the likelihood that the patient would be non-adherent; those patients (75% of patients reported damaged homes) were twice as likely not to be adherent to their medication schedules.
Study Parameters
By chance, the clinical investigators had received a $2 million grant from the National Institute of Aging two weeks before storm to study adherence to medication in patients with chronic conditions, including the use of hypertension medication in older adults. With the hurricane and subsequent flooding, the group was able to assess patients in a clinical setting to determine the extent to which the disaster disrupted medication adherence.
215 patients were surveyed to assess adherence to medication, quality of life, and other measures, as well as general questions about the extent of hurricane damage the patients experienced. A subset of 78 patients answered more detailed questions pertaining to specific barriers to medication adherence, defined, in this setting, as taking hypertension medication without missing a dose.
Commentary
While it is hardly surprising that a catastrophic disaster of the magnitude of Hurricane Katrina disrupted healthcare regimens as well as almost every other routine that comprises everyday life, it is useful to have confirmation, especially if that evidence suggests practical, focused clinical solutions.
The recommendations that evolved from this study are, in retrospect, obvious, but without the hurricane and the research, these issues might have escaped notice indefinitely. For example,
- Post-disaster healthcare providers (e.g., shelters, evacuation centers, and healthcare centers) must be prepared to treat not only acute emergencies such as infectious disease, injuries, and toxic exposures, but also ongoing, chronic disorders such as hypertension and diabetes.
- Both organizations and individual patients should have rudimentary disaster plans in place. This could be as simple as patients carrying cards listing their current medications and dosing frequencies as well as a list of current diagnoses or as complex as widespread use of electronic medical records.
The use of healthcare data and statistical analysis to determine the most likely problems patients would face in a disaster would seem equally obvious.
The ultimate question, of course, is whether the healthcare community will focus the necessary effort to be prepared for the next, inevitable catastrophe.