Fletcher Malaya, Puerini Raymond, Caum Jessica, Alles Steven J
Biosecur Bioterror. 2014 May-Jun;12(3):151-9. doi: 10.1089/bsp.2013.0087.
Using a simulated anthrax scenario, the Philadelphia Department of Public Health tested the readiness of a nonmedical closed point-of-dispensing (POD) site to see how rapidly and accurately it could provide medication to its internal population. This closed POD had developed and exercised its mass prophylaxis plan in conjunction with the local health department twice before, and the department was interested in assessing the impact of having no onsite department involvement. Two sessions were conducted as part of the overall exercise. In session 1, agency staff ran POD operations with no department involvement. During session 2, department staff provided an hour-long training session and oversaw POD operations. Mean throughput and accuracy rates of the 2 sessions were then compared to a previous health department public POD exercise staffed by department personnel and medical volunteers. The closed POD would be able to process the entire internal population in an estimated mean time of 23.9 hours. The accuracy rates for dispensing the correct medication during session 1 was 84.7% and 92.4% during session 2 (p=0.0012). Overall accuracy was significantly higher in a previous local health department public POD exercise (88.6% vs. 96.9%, p < 0.0001), as was pediatric dosing accuracy (p < 0.0001). We concluded that nonmedical closed PODs are a valuable strategy during a public health emergency that requires large segments of a population to receive medication rapidly. They must be activated judiciously, however, as their use may increase adverse events and potentially result in discontinuation of antibiotic prophylaxis should people choose not to finish the course. Local health department training and oversight reduce errors but may not always be available.
费城公共卫生部利用一个模拟炭疽病场景，测试了一个非医疗封闭式药品分发点（POD）的应急准备情况，以了解其向内部人员提供药物的速度和准确性。这个封闭式POD此前已与当地卫生部门联合制定并演练了两次大规模预防计划，该部门有兴趣评估在没有现场部门参与的情况下会产生怎样的影响。作为整体演练的一部分，进行了两次模拟。在第一次模拟中，机构工作人员在没有部门参与的情况下进行POD操作。在第二次模拟中，部门工作人员提供了为期一小时的培训课程并监督POD操作。然后将这两次模拟的平均吞吐量和准确率与之前由部门人员和医疗志愿者参与的卫生部门公共POD演练进行比较。该封闭式POD预计平均需要23.9小时才能为全体内部人员完成药物分发。第一次模拟中分发正确药物的准确率为84.7%，第二次模拟中为92.4%（p = 0.0012）。在之前当地卫生部门的公共POD演练中，总体准确率显著更高（88.6%对96.9%，p < 0.0001），儿科用药准确率也是如此（p < 0.0001）。我们得出结论，在公共卫生紧急情况下，非医疗封闭式POD是一种有价值的策略，此时需要大量人群迅速获得药物。然而，必须谨慎启用它们，因为使用它们可能会增加不良事件，并且如果人们选择不完成疗程，可能会导致抗生素预防用药中断。当地卫生部门的培训和监督可以减少错误，但可能并非总能实现。
