Impact of Hurricane Katrina on healthcare delivery for New Orleans patients, 2005-2014

Communication in disasters to support families with children with medical complexity and special healthcare needs: a rapid scoping review

Disasters can disrupt normal healthcare processes, with serious effects on children who depend upon regular access to the health care system. Children with medical complexity (CMC) are especially at risk. These children have chronic medical conditions, and may depend on medical technology, like feeding tubes. Without clear, evidence-based processes to connect with healthcare teams, families may struggle to access the services and supports they need during disasters. There is limited research about this topic, which has been pushed forward in importance as a result of the COVID-19 pandemic. The authors therefore conducted a rapid scoping review on this topic, with the intention to inform policy processes. Both the peer-reviewed and gray literatures on disaster, CMC, and communication were searched in summer 2020 and spring 2021. Twenty six relevant articles were identified, from which four main themes were extracted: 1. Cooperative and collaborative planning. 2. Proactive outreach, engagement, and response. 3. Use of existing social networks to connect with families. 4. Return to usual routines. Based on this review, good practices appear to involve including families, professionals, other stakeholders, and children themselves in pre-disaster planning; service providers using proactive outreach at the outset of a crisis event; working with existing peer and neighborhood networks for support; employing multiple and two-way communication channels, including social media, to connect with families; re-establishing care processes as soon as possible, which may include virtual connections; addressing mental health issues as well as physical functioning; and prioritizing the resumption of daily routines. Above all, a well-established and ongoing relationship among children, their caregivers, and healthcare teams could reduce disruptions when disaster strikes.

Climate disasters and oncology care: a systematic review of effects on patients, healthcare professionals, and health systems

PURPOSE

Climate disasters have devastating effects on communities and society that encompass all aspects of daily life, including healthcare. Patients with cancer are particularly vulnerable when disaster strikes. As the number and intensity of disasters increases, it is important to understand the effects across the cancer care continuum. This systematic review investigates the effect of climate disasters on patients, the oncology healthcare workforce, and healthcare systems.

METHODS

A medical librarian conducted a literature search in PubMed, Embase, CINAHL, and Web of Science from January 1, 2016, through May 11, 2022. Eligible studies included any published report on a climate disaster globally reporting on patient-, oncology healthcare workforce-, or healthcare systems-level outcomes. Study quality was assessed, and findings were narratively synthesized, given the diversity of reported evidence.

RESULTS

The literature search identified 3618 records, of which 46 publications were eligible for inclusion. The most frequent climate disaster was hurricanes (N = 27) followed by tsunami (N = 10). Eighteen publications were from disasters that occurred in the mainland USA with 13 from Japan and 12 from Puerto Rico. Patient-level outcomes included treatment interruptions and inability to communicate with the healthcare team. At the workforce level, findings included distressed clinicians caring for others when their own lives have been affected by a disaster along with lack of disaster preparedness training. Health systems reported closures or shifting services post-disaster and a need to have improved emergency response plans.

CONCLUSION

Response to climate disasters necessitates a holistic approach at the patient, workforce, and health systems levels. Specifically, interventions should focus on mitigating interruptions in care for patients, advanced coordination and planning for workforce and health systems, and contingency planning for allocation of resources by health systems.

Hurricane Ida Emergency Medicine Resident Disaster Response

This report describes the medical response, action plan, and after-action summary adopted by the Louisiana State University (LSU) New Orleans - Emergency Medicine (EM) Residency Program in response to Hurricane Ida which occurred in New Orleans, Louisiana (USA) late August through early September 2021. New Orleans has an estimated 385,000 people within the 350 square miles surrounding the metropolitan area, with greater than one million residents in all of Louisiana. In the two-week time span during and following the event, residents, nurses, attendings, ancillary staff, and Emergency Medical Services (EMS) managed a substantial intensification in daily EM activities due to a substantial lack of resources (ie, food, electricity, water, housing, medications, oxygen, and primary care). This report outlines the redistribution of emergency department (ED) residents within the primary clinical site, University Medical Center New Orleans (UMCNO); describes the daily communication flow from the chief residents and program director; describes the daily EM response; describes the pre- and post-action plans based on those efforts during hurricane operations; and summarizes the obtained information.

The impact of the COVID-19 pandemic on the continuity of care for at-risk patients in Swiss primary care settings: A mixed-methods study

Continuity of care is important for the health of aging individuals with comorbidities. When initial coronavirus mitigation campaigns involved messaging such as "Stay at home-stay safe," and banned provision of non-urgent care, at-risk patients depending upon regular consultations with general practitioners (GPs) faced confusion about the possibility of seeking non-COVID-19 related healthcare. We employed a sequential explanatory mixed-methods design, consisting of a quantitative component followed by a qualitative component, to understand at-risk patients' health services use during the COVID-19 pandemic in Switzerland. Quantitatively, we used electronic medical records data from 272 GPs and 266,796 patients. Based on pre-pandemic data, we predicted weekly consultation counts as well as weekly measurement counts (blood pressure, glycated hemoglobin, and low-density lipoprotein cholesterol) per 100 patients that would be expected in 2020 in absence of a pandemic and compared those to actual observed values. Qualitatively, we conducted 23 semi-structured interviews with 24 GPs (∼45 min) and 37 interviews with at-risk patients (∼35 min). Quantitative results demonstrate a significant decrease in consultation and measurement counts during the first shutdown period, with consultation counts quickly returning to normal and moving within expected values for the rest of 2020. Qualitative data contextualize these findings with GPs describing constantly implementing material, administrative, and communication changes. GPs reported communication gaps with the authorities and noted a lack of clear guidelines delineating how to define "at-risk patients" and what cases were "urgent" to treat during shutdowns. Patient interviews show that patient-level factors, such as fear of contracting coronavirus, perceptions that GPs were overburdened, and a sense of solidarity, influenced patients' decisions to consult less at the beginning of the pandemic. Findings demonstrate communication gaps during pandemic periods and provide valuable lessons for future pandemic preparedness, particularly the need for contingency plans for the overall healthcare system instead of plans focusing only on the infectious agent itself.

Hospitalizations for chronic conditions following hurricanes among older adults: A self-controlled case series analysis

BACKGROUND/PURPOSE

Extreme events such as hurricanes adversely impact healthcare systems and the communities they serve. The degree to which hurricanes affect healthcare use among high need groups such as older adults with chronic conditions has not been well examined, nor has the impact of hurricane severity on health outcomes. We characterized hospitalizations among older adults by chronic condition after eight large-scale hurricanes in the United States.

METHODS

Using a combination of administrative healthcare data and the Federal Emergency Management Agency's Disaster Declaration database we conducted a self-controlled case series analysis. We identified Medicare beneficiaries who were exposed to one of eight hurricanes and compared hospitalizations in the 30-days after a hurricane to hospitalizations in the rest of the calendar year of the hurricane. We examined hospitalizations (1) in total, (2) separately for diabetes, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) admissions, and (3) by hurricane damage category.

RESULTS

Among all older adults exposed, hospitalizations in the 30-day period after each disaster increased for all three chronic conditions; diabetes (incidence rate ratio [IRR] = 1.06, 95% confidence interval [CI] 1.03, 1.10), COPD (IRR = 1.06, 95% CI 1.04, 1.08), and CHF (IRR = 1.19, 95% CI 1.17, 1.21. In the 30-to-60-day period hospitalizations also increased for each chronic condition; diabetes (IRR = 1.06, 95% CI 1.03, 1.10), COPD (IRR = 1.12, 95% CI 1.10, 1.15), and CHF (IRR = 1.32, 95% CI 1.30, 1.34). Substantial differences in hospitalizations were observed according to individual hurricane and by the chronic disease examined.

CONCLUSION

Exposure to hurricanes is associated with an increase in hospitalizations for chronic conditions across all hurricane damage categories. As disasters are expected to increase in strength and frequency, our results underscore the need for response strategies and health policy planning for healthcare systems designed to address the health needs of older Americans with chronic conditions.

The effects of Hurricane Harvey on the physical and mental health of adults in Houston

Using data from the 2017-18 Health of Houston Survey, this study estimates the effect of Hurricane Harvey, the second costliest storm in the history of the United States, on the physical and mental health of adults living in Houston, Texas. The survey was fielded to a population-based probability sample whose data collection activities were interrupted and delayed by Hurricane Harvey. This interruption in data collection created a natural experiment that allowed for a comparison of community health before and after the storm. Following the storm, adults in Houston on average experienced an increase of 1.12 days a month of poor physical health and an increase of 1.31 days a month of poor mental health. These effects were most pronounced in parts of the city where structural damage from the storm was most severe.

Neoadjuvant endocrine therapy use in early stage breast cancer during the covid-19 pandemic

Purpose

Physician treatment preferences for early stage, estrogen positive breast cancer (ER + BC) patients were evaluated during the initial surge of the COVID-19 pandemic in the US when neoadjuvant endocrine therapy (NET) was recommended to allow safe deferral of surgery.

Methods

A validated electronic survey was administered May–June, 2020 to US medical oncologists (MO), radiation oncologists (RO), and surgeons (SO) involved in clinical trials organizations. Questions on NET use included practice patterns for locoregional management following NET.

Results

114 Physicians from 29 states completed the survey—42 (37%) MO, 14 (12%) RO, and 58 (51%) SO. Before COVID-19, most used NET ‘rarely’ (49/107, 46%) or ‘sometimes’ (36, 33%) for ER + BC. 46% would delay surgery 2 months without NET. The preferred NET regimen was tamoxifen for premenopausal and aromatase inhibitor for postmenopausal women. 53% planned short term NET until surgery could proceed. Most recommended omitting axillary lymph node dissection (ALND) for one micrometastatic node after 1, 2, or 3 months of NET (1 month, N = 56/93, 60%; 2 months, N = 54/92, 59%; 3 months, N = 48/90, 53%). With longer duration of NET, omission of ALND decreased, regardless of years in practice, percent of practice in BC, practice type, participation in multidisciplinary tumor board, or number of regional COVID-19 cases.

Conclusion

More physicians preferred NET for ER + BC during the pandemic, compared with pre-pandemic times. As the duration of NET extended, more providers favored ALND in low volume metastatic axillary disease. The Covid-19 pandemic affected practice of ER + BC; it remains to be seen how this may impact outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10549-021-06153-3.

Long-term healthcare provider availability following large-scale hurricanes: A difference-in-differences study

Background

Hurricanes Katrina and Sandy were two of the most significant disasters of the 21^st century that critically impacted communities and the health of their residents. Despite the assumption that disasters affect access to healthcare, to our knowledge prior studies have not rigorously examined availability of healthcare providers following disasters.

Objective

The objective of this study was to examine availability of healthcare providers following large-scale hurricanes.

Methods

Using historical data on healthcare providers from the National Plan and Provider Enumeration System and county-level population characteristics, we conducted a quasi-experimental study to examine the effect of large-scale hurricanes on healthcare provider availability in the short-term and long-term. We separately examined availability of primary care physicians, medical specialists, surgeons, and nurse practitioners. A difference-in-differences analysis was used to control for time variant factors comparing county-level health care provider availability in affected and unaffected counties the year before Hurricanes Katrina and Sandy, to five years after each storm.

Results

Counties affected by Hurricane Katrina compared to unaffected locales experienced a decrease of 3.59 primary care physicians per 10,000 population (95% CI: -6.5, -0.7), medical specialists (decrease of 5.9 providers per 10,000 (95% CI: -11.3, -0.5)), and surgeons (decrease of 2.1 (95% CI: -3.8, -0.37)). However, availability of nurse practitioners did not change appreciably. Counties affected by Hurricane Sandy exhibited less pronounced changes. Changes in availability of primary care physicians, nurse practitioners, medical specialists, and surgeons were not statistically significant.

Conclusion

Large-scale hurricanes appear to affect availability of healthcare providers for up to several years following impact of the storm. Effects vary depending on the characteristics of the community. Primary care physicians and medical specialists availability was the most impacted, potentially having long-term implications for population health in the context of disaster recovery.