engaging health care professionals in bioterrorism preparedness & response planning

Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning

Jeffrey S. Duchin, M.D.Chief, Communicable Disease Control, Epidemiology &

Immunization Section, Public Health - Seattle & King County

Division of Allergy and Infectious Diseases

University of Washington


Why do health care professionals reject participation in BT preparedness planning?


Why do health care professionals reject participation in BT preparedness planning?

Competing Priorities


Competing priorities

• “Economic crisis” for practicing physicians and hospitals– changes in health care economics

– managed care

– typical patient encounter is 10-15 minutes for 30 or more patients/day

– no time/compensation for training, conferences, meetings



• Perception of planning for a low probability event– not a priority for hospital administrators for allocation of internal

funds and resources

– don’t see the relevance to more common situations



• Health care professionals prioritize management of individual patients, not populations– not trained to manage populations

– may not want to do this

– no expectations to do this

– not paid to do this



• Information overload/avalanche for subjects directly relevant to clinical practice– new diseases

– new treatments and drugs

– new tests

– new technologies

– new management strategies

– changing administrative procedures, rules and regulations



• Lack of funding to support participation of medical professionals despite allocations for public health, fire, law enforcement, pharmaceutical stockpile, research



• The bottom line: bioterrorism, and public health in general, are not priorities in either the academic or private health care sectors



• The challenge: how can we change this?



“Emphasis by state and local health departments may impact

the physicians and public health officials who work for them,

but it is unlikely to have an important impact on most

practicing physicians and most in academic medicine”

John Bartlett, MD

Director, Division of Infectious Diseases

Johns Hopkins School of Medicine and Center for Civilian Biodefense Strategies


The role of health care professionals

• First step:define the role of the clinician in the public health response• Use examples from actual outbreaks to educate clinicians

– 2001 anthrax outbreak– West Nile Virus– hantavirus pulmonary syndrome

• JAMA and New England Journal editorials describing role of clinicians in bioterrorism response

• Set expectations



• What is the role of the clinician in bioterrorism response?



• Detection of a possible event– clinicians must be familiar with the clinical signs and symptoms and

epidemiological clues of disease due to biological terrorism

– know how and when to engage appropriate clinical and public health resources

• Medical management of sick patients– treatment

– post-exposure prophylaxis with antibiotics or vaccine

– monitoring for adverse effects of treatments

• Evaluation of the “worried well”

Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning Methods to engage health care providers - key principles

• Relevance

• Credibility

• Value

• Efficiency


Relevance

• Emphasize concept of biological disaster planning: relevance of BT planning to other common, naturally-occurring diseases, outbreaks and disasters

• Use actual local examples when possible

• Demonstrate the logic and necessity of community-wide response planning (table top exercises help)

• Keep the issue alive


Relevance

• Emphasize concept of biological disaster planning: relevance of BT planning to other common, naturally-occurring diseases, outbreaks and disasters

• Use actual local examples when possible

• Demonstrate the logic and necessity of community-wide response planning (table top exercises help)

• Keep the issue alive– establish communication channels to provide ongoing information

reinforcing the importance of planning and preparedness

– use the media


Relevance

• Naturally-occurring clinical conditions– meningitis/encephalitis syndrome: meningococcal disease, West

Nile virus, rabies, enteroviruses

– cough illness: pertussis, TB

– rash with fever: measles, varicella, rubella

– botulism


Relevance

• Naturally-occurring outbreaks– Food- and water borne outbreaks: E. coli 0157:H7, salmonella,

shigella, cryptosporidium, etc.

– hepatitis A

– nosocomial outbreaks

– hantavirus pulmonary syndrome

– West Nile virus infection

– 2001 anthrax outbreak

– pandemic influenza


Relevance

The influenza pandemic of 1918-19 killed more humans than any other disease in a period of similar duration in the history of the world.

Alfred W. CrosbyAmerica’s Forgotten Pandemic - The Influenza of 1918Cambridge University Press, 1989

Deaths By Week due to Pneumonia & InfluenzaOctober, 1918 through March, 1919 - Philadelphia, PA

0500

100015002000250030003500400045005000

Dea

ths Population: 1,761,371

Total deaths: 15,785


RelevancePandemic Influenza, 1918

• Approximately 675,000 Americans died, 10 times as many as in WW I

• The effect of the epidemic was so severe that the average life span in the U.S. was depressed by 10 years

• Death rate 25 times higher than previous epidemics

• The epidemic preferentially affected and killed younger, healthy persons

• Epidemic suspected to be biological warfare

Influenza H5N1 “Bird Flu” - Hong Kong, 1997“Slaughter of the Innocents”

Time Magazine


Credibility

• Peer driven process– develop partnerships (“champions”) in the clinical sector

– physicians must be convinced before they will engage in training

– “train the trainer” model

– identify and promote training opportunities by quality organizations respected by clinicians

• Ensure technical expertise, appropriate credentials and relevant experience


Credibility

• Endorsements by relevant and respected authorities, organizations, and professional societies

• Understand and address the needs and concerns of the clinical community

• Establish personal contacts with key constituents

• Work with local leadership to set expectations

Engaging Health Care Professionals in Bioterrorism Preparedness & Response Planning King County Outbreak Response Work Group (ORWG)

• Meeting of King County hospital leadership convened by local health officer

• Made case for preparedness planning

• CEOs designated representatives to attend ORWG

• Group co-chaired by Public Health and respected local physician-leader

• Addressing communicable disease response and preparedness planning with an focus on smallpox


Value

• Provide practical resources that allow clinicians to fulfill role defined for them


Value

• Preparedness and planning


Value

• Preparedness and planning – authoritative resources and references

– training and tabletops

– tools for improving recognition and management of biological terrorism

– communication methods


Value

• Outbreak response– demonstrate how public health can help clinicians

– provision of timely local epidemiological and surveillance data

– “real time” health advisories

– facilitate diagnostic testing

– provision of drugs and vaccine

– links for authoritative BT information and updates: CDC and IDSA sites

– communication


Value

• Integrate with routine disease control issues– management and infection control guidelines for communicable diseases

– Control of Communicable Diseases Manual, AAP Red Book

– ACIP statements/immunization issues

• Take advantage of opportunities related to quality assurance activities and JCAHO guidelines and accreditation requirements


Value

• Public health must be visible in the clinical community

• Regular, ongoing presence at:– medical grand rounds

– teaching conferences

– preparedness planning meetings

– hospital BT response exercises

• Training materials– provide useful, authoritative materials

– CME accreditation when possible

• Be available and responsive

Preparing and Responding to Bioterrorism: Information for

Primary Care Clinicians

http://www.kcmo.org/health/bioterrorism.jpg

http://www.anesoft.com/demo/bio/bio.html


Efficiency

• Don’t waste their time

• Use proven learning strategies when possible

• Integrate BT planning with delivery of other existing, valuable resources and services

• Tabletop exercises– help clinicians understand the issues they will be confronted with

– conceptualize response needs

– appreciate role of public health


Methods to engage health care providers

• Advocate for additional resources for hospitals and health care providers for training and preparedness and planning activities– identify and advertise funding opportunities

• Incorporate training on the clinician’s roles and responsibilities in the public health system and in biological disaster response into professional and post-graduate education


Summary

• Understand your audience and their priorities

• Define the role of the clinician in BT and outbreak response

• Help the clinicians meet the expectations for that role

• Stress relevance: use examples

• Have high credibility: partner with respected clinical authorities and organizations

• Provide value: deliver something useful now

• Efficiency: make it worth their time and effort

Communicable Disease SectionPublic Health - Seattle & King County

Contact us for additional information and to report suspected cases.

24-hour communicable disease line:

206-296-4774Public Health - Seattle & King County Web Site

http://www.metrokc.gov/health/bioterrorism

engaging health care professionals in bioterrorism preparedness & response planning

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