Wyte-Lake Tamar, Claver Maria, Griffin Anne, Dobalian Aram
Veterans Emergency Management Evaluation Center (VEMEC), Sepulveda, Calif., USA.
Gerontology. 2014;60(4):336-45. doi: 10.1159/000355660. Epub 2014 Jan 10.
Veterans receiving home-based primary care (HBPC) are an especially vulnerable population served by the Veterans Health Administration (VHA) due to high rates of physical, functional, and psychological limitations. These vulnerabilities may prevent these persons from being adequately prepared for disasters. HBPC providers connect the community-dwelling population with their regional health care system and thus are appropriate partners for assessing preparedness. The limited literature on this topic suggests that there are issues with the development and implementation of emergency management plans, dissemination to staff, and inconsistencies with preparedness strategies across agencies.
To further explore identified issues regarding emergency management planning for patients receiving medical care in their home, including ways in which policy and procedures support the routine assessment of disaster preparedness for patients.
This exploratory pilot project, carried out in a single VHA HBPC program located in an urban area, involved seven 15- to 25-min semistructured interviews with practitioners and leadership. Transcripts of the interviews were analyzed using content analysis techniques to develop themes to describe information obtained through the interviews.
Six themes emerged from the data: (1) a national policy regarding the inclusion of disaster preparedness assessment in routine HBPC assessment exists in only a skeletal manner and individual HBPC programs are tasked with developing their own policies; (2) the tools used at the initial assessment were rudimentary and, in some cases, individually developed by providers; (3) the comprehension of criteria for assigning risk categories (i.e. acuity levels) varied among providers; (4) the primary challenges identified by respondents to patient engagement in emergency preparedness activities included cognitive impairments, patients' willingness to invest in preparedness activities, and limited resources; (5) providers received limited formal training on how to prepare their patients for a disaster, and (6) provider recommendations included training to focus on better strategies to get patients to participate, more consistent time spent on patient education, formalization of the initial assessment, and having emergency preparedness be formally addressed on a more consistent basis.
Formal standardized strategies regarding disaster preparedness assessment for HBPC patients, which leave room for flexibility in consideration of local factors, could assist in creating more comprehensive emergency management planning agendas and community collaboration.
接受居家初级保健（HBPC）的退伍军人是退伍军人健康管理局（VHA）服务的特别脆弱群体，因为他们在身体、功能和心理方面存在较高程度的限制。这些脆弱性可能使这些人无法为灾难做好充分准备。HBPC提供者将社区居住人群与区域医疗保健系统联系起来，因此是评估备灾情况的合适合作伙伴。关于这一主题的有限文献表明，应急管理计划的制定和实施、向工作人员的传播以及各机构备灾策略的不一致存在问题。
进一步探讨在患者家中接受医疗护理的应急管理规划方面已发现的问题，包括政策和程序支持对患者备灾情况进行常规评估的方式。
在位于市区的一个VHA HBPC项目中开展了这个探索性试点项目，对从业者和领导层进行了7次15至25分钟的半结构化访谈。使用内容分析技术对访谈记录进行分析，以形成主题来描述通过访谈获得的信息。
数据中出现了六个主题：（1）关于将备灾评估纳入常规HBPC评估的国家政策仅以框架形式存在，各个HBPC项目负责制定自己的政策；（2）初始评估时使用的工具很简陋，在某些情况下是由提供者自行开发的；（3）提供者对风险类别（即 acuity水平）分配标准的理解各不相同；（4）受访者确定的患者参与应急准备活动的主要挑战包括认知障碍、患者对应急准备活动的投入意愿以及资源有限；（5）提供者接受的关于如何让患者为灾难做准备的正规培训有限，以及（6）提供者的建议包括培训应侧重于采用更好的策略让患者参与、在患者教育上花费更一致的时间、使初始评估正规化以及使应急准备在更一致的基础上得到正式处理。
关于HBPC患者备灾评估的正式标准化策略，在考虑当地因素时留有灵活性空间，有助于制定更全面的应急管理规划议程和社区协作。
