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Critical Challenges and Impediments Affecting Rural Physicians During a Public Health Emergency

Published online by Cambridge University Press:  08 April 2013

Gavin J. Putzer ,
Mirka Koro-Ljungberg  and
R. Paul Duncan
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Abstract

Objective: Disaster preparedness has become a health policy priority for the United States in the aftermath of the anthrax attacks, 9/11, and other calamities. It is important for rural health care professionals to be prepared for a bioterrorist attack or other public health emergency. We sought to determine the barriers impeding rural physicians from being prepared for a human-induced disaster such as a bioterrorist attack.

Methods: This study employed a qualitative methodology using key informant interviews followed by grounded theory methods for data analysis. Semistructured interviews were conducted with 6 physicians in the state of Florida from federally designated rural areas.

Results: The interview participants articulated primary barriers and the associated factors contributing to these barriers that may affect rural physician preparedness for human-induced emergencies. Rural physicians identified 3 primary barriers: accessibility to health care, communication between physicians and patients, and rural infrastructure and resources. Each of these barriers included associated factors and influences. For instance, according to our participants, access to care was affected by a lack of health insurance, a lack of finances for health services, and transportation difficulties.

Conclusions: Existing rural organizational infrastructure and resources are insufficient to meet current health needs owing to a number of factors including the paucity of health care providers, particularly medical specialists, and the associated patient-level barriers. These barriers presumably would be exacerbated in the advent of a human-induced public health emergency. Thus, strategically implemented health policies are needed to mitigate the barriers identified in this study.

(Disaster Med Public Health Preparedness. 2012;6:342–348)

Keywords

impedimentsrural physiciansbioterrorismdisaster managementqualitative research
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 6 , Issue 4 , December 2012 , pp. 342 - 348
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2012

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References

REFERENCES

1.Van Fleet-Green, JMChen, FMHouse, P. Identifying the gaps between biodefense researchers, public health, and clinical practice in a rural community. J Rural Health. 2008;24(3):326–329.CrossRefGoogle Scholar
2.Spranger, CBVillegas, DKazda, MJHarris, AMMathew, SMigala, W. Assessment of physician preparedness and response capacity to bioterrorism or other public health emergency events in a major metropolitan area. Disaster Manag Response. 2007;5(3):82–86.Google Scholar
3.McHugh, MStaiti, ABFelland, LE. How prepared are Americans for public health emergencies? twelve communities weigh in. Health Aff (Millwood). 2004;23(3):201–209.Google Scholar
4.Madsen, JMGreenberg, MI. Preparedness for the evaluation and management of mass casualty incidents involving anticholinesterase compounds: a survey of emergency department directors in the 12 largest cities in the United States. Am J Disaster Med. 2010;5(6):333–351.Google Scholar
5.Rumoro, DPBayram, JDMalik, MPurim-Shem-Tov, YA; Emergency Response Training Group. A comprehensive disaster training program to improve emergency physicians' preparedness: a 1-year pilot study. Am J Disaster Med. 2010;5(6):325–331.Google Scholar
6.Kochtitzky, CSFrumkin, HRodriguez, R, et alCenters for Disease Control and Prevention. Urban planning and public health at CDC. MMWR Morb Mortal Wkly Rep. 2006;55(2)(suppl 2):34–38.Google Scholar
7.Rosenthal, TC.Rural bioterrorism: are we exempt? J Rural Health. 2003;19 (1):5–6.Google Scholar
8.Office of Rural Health Policy. Rural Communities and Emergency Preparedness. Washington, DC: US Dept of Health and Human Services; 2002. ftp://ftp.hrsa.gov/ruralhealth/Ruralpreparedness.pdf. Accessed November 10, 2009.Google Scholar
9.Putzer, GJKoro-Ljungberg, MDuncan, RPDobalian, A. Preparedness of rural physicians for bioterrorist events in Florida.South Med J. In press.Google Scholar
10.Dobalian, ATsao, JCPutzer, GJMenendez, SM. Improving rural community preparedness for the chronic health consequences of bioterrorism and other public health emergencies. J Public Health Manag Pract. 2007;13(5):476–480.Google Scholar
11.Tsao, JCDobalian, AWiens, BAGylys, JAClawson, ABrooks, R. PTSD and substance use: unrecognized sequelae of bioterrorism in primary care providers. South Med J. 2006;99(8):817–822.Google Scholar
12.Clawson, ABrooks, RG. Protecting rural communities from terrorism: a statewide, community-based model. J Rural Health. 2003;19(1):7–10.Google Scholar
13.Stamm, BH. Terrorism risks in rural and frontier America: their importance to the successful functioning of urban America makes rural and frontier areas ripe targets for terrorism. IEEE Eng Med Biol Mag. 2002;21(5):100–111.Google Scholar
14.Cliff, BJMorlock, LCurtis, AB. Is there an association between risk perception and disaster preparedness in rural US hospitals? Prehosp Disaster Med. 2009;24(6):512–517.CrossRefGoogle ScholarPubMed
15.Reilly, MMarkenson, DS. Education and training of hospital workers: who are essential personnel during a disaster? Prehosp Disaster Med. 2009;24(3):239–245.Google Scholar
16.Hsu, CEMas, FSJacobson, HEHarris, AMHunt, VINkhoma, ET. Public health preparedness of health providers: meeting the needs of diverse, rural communities. J Natl Med Assoc. 2006;98(11):1784–1791.Google Scholar
17.Sterling, DAClements, BRebmann, T, et alOccupational physician perceptions of bioterrorism. Int J Hyg Environ Health. 2005;208(1–2):127–134.Google Scholar
18.McFee, RBLeikin, JBKiernan, K. Preparing for an era of weapons of mass destruction (WMD—-are we there yet? why we should all be concerned: part II. Vet Hum Toxicol. 2004;46(6):347–351.Google Scholar
19.Shadel, BNRebmann, TClements, BChen, JJEvans, RG. Infection control practitioners' perceptions and educational needs regarding bioterrorism: results from a national needs assessment survey. Am J Infect Control. 2003;31(3):129–134.Google Scholar
20.Danzig, R.Catastrophic Bioterrorism—What Is to Be Done?. Washington, DC: National Defense University Center for Technology and National Security Policy; 2003.Google Scholar
21.Inglesby, TVDennis, DTHenderson, DA, et al; Working Group on Civilian Biodefense. Plague as a biological weapon: medical and public health management. JAMA., 2000;283(17):2281–2290.Google Scholar
22.Karwa, MBronzert, PKvetan, V. Bioterrorism and critical care. Crit Care Clin. 2003;19(2):279–313.CrossRefGoogle ScholarPubMed
23.Inglesby, TVGrossman, RO’Toole, T. A plague on your city: observations from TOPOFF. Clin Infect Dis. 2001;32(3):436–445.Google Scholar
24.Borio, LFrank, DMani, V, et alDeath due to bioterrorism-related inhalational anthrax: report of 2 patients. JAMA. 2001;286(20):2554–2559.Google Scholar
25.O’Toole, T. Smallpox: an attack scenario. Emerg Infect Dis. 1999;5(4):540–546.CrossRefGoogle ScholarPubMed
26.Crabtree, BMiller, W. Doing Qualitative Research. Thousand Oaks, CA: Sage Publications; 1999.Google Scholar
27.Frankel, RM. Standards of qualitative research. In: Miller, W, ed. Doing Qualitative Research. Thousand Oaks, CA: Sage Publications; 1999.Google Scholar
28.Denzin, NLincoln, Y. Introduction: the discipline and practice of qualitative research. In: Denzin, N, Lincoln, Y, eds. The Sage Handbook of Qualitative Research. Thousand Oaks, CA: Sage Publications; 2005:1–32.Google Scholar
29.Glaser, BG. Basics of Grounded Theory Analysis. Mill Valley, CA: Sociology Press; 1992.Google Scholar
30.Strauss, ACorbin, J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2nd ed. Thousand Oaks, CA: Sage Publications; 1998.Google Scholar
31.Charmaz, K. Grounded theory. In: Smith, JA, ed. Qualitative Psychology: A Practical Guide to Research Methods. London, England: Sage Publications; 2003:81–110.Google Scholar
32.Penchansky, RThomas, JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981;19(2):127–140.Google Scholar
33.Loeb, MMcGeer, AHenry, B, et alSARS among critical care nurses, Toronto. Emerg Infect Dis. 2004;10(2):251–255. http://www.cdc.gov/ncidod/EID/vol10no2/030838.htm. Accessed June 7, 2011.Google Scholar
34.Lu, SNJiang, DDLiu, JW, et alOutbreak of severe acute respiratory syndrome in southern Taiwan, 2003. Am J Trop Med Hyg. 2005;73(2):423–427.Google Scholar
35.Centers for Disease Control and Prevention. Severe acute respiratory syndrome—Taiwan, 2003. Morb Mortal Wkly Rep. 2003;52(20):461–466.Google Scholar
36.Williams, MVParker, RMBaker, DW, et alInadequate functional health literacy among patients at two public hospitals. JAMA. 1995;274(21):1677–1682.Google Scholar
37.The Health Literacy of America's Adults. Results From the 2003 National Assessment of Adult Literacy. Washington, DC: National Center for Education Statistics; 2006.Google Scholar
38.Paasche-Orlow, MKParker, RMGazmararian, JANielsen-Bohlman, LTRudd, RR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20(2):175–184.CrossRefGoogle ScholarPubMed
39.Varkey, PPoland, GACockerill, FR IIISmith, TFHagen, PT. Confronting bioterrorism: physicians on the front line. Mayo Clin Proc. 2002;77(7):661–672.Google Scholar
40.Deprez, R. Physician specialty practices: strategic survival for rural hospitals. Healthc Financ Manage. 2004;58(1):76–80.Google ScholarPubMed
41.Miller, WLCrabtree, BFAddison, RBGilchrist, VKuzel, AJ, eds. Exploring Collaborative Research in Primary Care. Thousand Oaks, CA: Sage Publications; 1994:180.Google Scholar
42.Patton, MQ. Qualitative Evaluation and Research Methods. 2nd ed. Newbury Park, CA: Sage Publications; 1990.Google Scholar
43.Merriam, SB. What can you tell from an N of 1? issues of validity and reliability in qualitative research. PAACE J Lifelong Learn. 1995;4:51–60.Google Scholar
44.Pelto, PPelto, G. Intra-cultural diversity: some theoretical issues. Am Ethnol. 1975;2:1–18.Google Scholar