Effect of pharmacist intervention on herpes zoster vaccination in community pharmacies.

OBJECTIVE: To evaluate the effectiveness of community pharmacy-based interventions in increasing vaccination rates for the herpes zoster vaccine. DESIGN: Prospective intervention study with a pre-post design. SETTING: Three independent community pharmacies in Tennessee, from December 2007 to June 2008. PATIENTS: Patients whose pharmacy profiles indicated that they were eligible for the vaccine and patients presenting to receive the vaccine at study sites. INTERVENTION: Pharmacists promoted the herpes zoster vaccine through a press release published in local newspapers, a flyer accompanying each prescription dispensed at participating pharmacies, and a personalized letter mailed to patients whose pharmacy profiles indicated that they were eligible for the vaccine. MAIN OUTCOME MEASURES: Comparison of vaccination rates for the herpes zoster vaccine during the control and intervention periods and patients' indication for their sources of education and influence in receiving the vaccine. RESULTS: Vaccination rates increased from 0.37% (n = 59 of 16,121) during the control period to 1.20% (n = 193 of 16,062) during the intervention period ( P < 0.0001). Cochran-Armitage trend analyses, including the months before and after the interventions, confirmed a significantly higher vaccination rate during the intervention month than other months analyzed. More patients indicated that they were educated about the herpes zoster vaccine by one of the pharmacist-driven interventions than by a physician, family/friend, or other source during the intervention period ( P < 0.0001 for all comparisons). Also, more patients were influenced to receive the vaccination as a result of one of the pharmacist-driven interventions than influenced by a physician ( P = 0.0260) or other source ( P < 0.0001). No difference in the effectiveness of patient influence was found when the pharmacy interventions were compared with family/friends ( P = 0.1025). CONCLUSION: Three pharmacist-driven interventions were effective in increasing vaccination rates for the herpes zoster vaccine.

Overcoming Challenges in the Medical Response to Hurricane Dorian in the Bahamas.

In September 2019, the northwest Bahamas suffered unparalleled damages due to Hurricane Dorian. The storm disrupted all the essential community services, including water, electricity, and medicine. Heart to Heart International provided medical support in a very austere environment to the people of Abaco island. This article examines the challenges faced by the response team from Heart to Heart International in the immediate aftermath of Hurricane Dorian.

Disaster Medicine: Public Health Threats Associated With Disasters.

Understanding common public health threats is critical in preparing for disasters and improving community resilience. Disasters can be natural (eg, earthquakes, landslides, floods, hurricanes, wildfires) or technological (ie, man-made) (eg, mass shootings, bioterrorism). Disasters caused by climate change constitute a combination of these two types-cases in which man-made actions have long-term consequences through natural disasters. After a disaster, immediate public health concerns include access to water and sanitation. Other concerns include safety and security, possible infectious disease outbreaks, mental health issues, and increased risk of human trafficking. Disease outbreaks often occur due to lack of potable water and disruption of sewage disposal systems. Mental stress and mental disorders, such as acute stress disorders and anxiety disorders, should be recognized and addressed. Chaos after disasters can overwhelm law enforcement, increasing the risk of violence and human trafficking for vulnerable populations. Disasters can have a devastating effect on health care infrastructure, increase the need for mortuary and morgue services, and increase demands on the health care system.

Disaster Medicine: Public Health Preparedness for Natural Disasters.

The phases of emergency management are mitigation, preparedness, response, and recovery. Optimal disaster response requires knowledge and understanding of the US disaster response structure. In a disaster, the local government is the first to start a response. It initiates the incident command system, activates the local emergency management plan, sets up an emergency operations center (EOC), and activates mutual aid agreements as needed. Assistance from the state and federal governments may be requested. Hospitals respond using the hospital incident command system. The incident commander declares a hospital emergency, sets up an EOC, and uses the predisaster hazard vulnerability analysis tool to choose the incident action plan specific to the hazard. Principles of the crisis standard of care are used in disaster response when health care needs overwhelm available resources. Alert systems are critical to inform personnel and the public about weather conditions, evacuation orders, and closures of roads and health care facilities. Family physicians can play an important role during disaster response, including patient notification and immediate discharge or transfer of patients with less serious acute conditions from the hospital and emergency department to free beds.

Disaster Medicine: Disaster Preparedness Planning.

Family physicians are well positioned to educate patients about creating their own disaster plans. Disaster preparedness education for individuals and families should include information about creation of Go Bags and personal and family emergency kits. Patients should be advised to include an updated printed or electronic list of their drugs and dosages in case of emergencies. To ensure disaster preparedness education is provided, physicians can offer printed materials or provide information on the office website. Patients who are part of vulnerable populations (eg, elderly patients, pregnant women, children, patients with disabilities) and patients with significant health issues need individualized disaster preparedness plans. During a disaster, patients receiving chemotherapy or facility-based dialysis should be prioritized for transport to facilities that can provide these services. Family physician offices should have disaster plans that are scalable to meet needs during any type of disaster. Planning should include alert systems for patients and staff, access to electronic health records, simulations and drills, mutual aid agreements with local organizations, and personal physician and staff needs during a disaster.

Disaster Medicine: Disaster Response and On-Scene Care.

Volunteering during a disaster is helpful only if there is a need for assistance. Clinicians should not self-deploy to disaster areas. Disaster responders should understand the incident command system, know how to perform reverse triage, and be familiar with the three commonly used mass casualty triage algorithms. The medical supplies needed and types of injuries expected depend on the disaster type and severity. The safety of responders is a priority. As such, they may be required to receive appropriate vaccinations, take prophylactic antibiotics, use personal protective equipment, and take measures to minimize the risk of injury and manage stress. Law enforcement should ensure the safety of a disaster scene before responders enter the area. Patients with life-threatening injuries require immediate stabilization and evacuation to a health care facility. Trauma complications, vector-borne diseases, and mental disorders should be addressed the first day after a disaster and should be managed continuously.