Hassan Saria, Wiciak Michelle Teresa, Escobar Karla, Richards Tess, Villanueva Hector, Evans Dabney P, Nunez-Smith Marcella, Cattamanchi Adithya
Emory University School of Medicine, Atlanta, GA, USA.
Emory Rollins School of Public Health, Atlanta, GA, USA.
J Prim Care Community Health. 2025 Jan-Dec;16:21501319251371090. doi: 10.1177/21501319251371090. Epub 2025 Sep 19.
This study examines disaster preparedness and response in Federally Qualified Health Centers (FQHCs), which serve vulnerable populations, including individuals with non-communicable diseases (NCDs). Hurricanes Irma and Maria revealed gaps in chronic disease management, contributing to significant mortality. Climate change will likely exacerbate these challenges, necessitating a deeper understanding of preparedness factors.
Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we conducted a qualitative study of 2 FQHCs in Puerto Rico and the U.S. Virgin Islands, analyzing inner (leadership, organizational culture, and staff dynamics) and outer (funding, networks, and policies) contextual factors. Twenty-four semi-structured interviews were analyzed thematically utilizing the EPIS framework.
Interviews with 24 staff members highlighted strong leadership valuing both employees and patients, prior disaster experience, and a culture of continuous improvement as essential for preparedness. Personal support systems improved staff engagement, while external collaborations with relief organizations enhanced response efforts. Flexible policies allowing access to medication and healthcare services beyond insurance coverage were critical for NCD patients during disasters.
The EPIS framework successfully contextualized chronic disease management in extreme weather events, identifying strategies to mitigate climate-related health disparities. Strengthening inter-organizational networks and policy adaptability can enhance FQHC resilience, ensuring continued care for at-risk populations during disasters.
本研究考察了联邦合格医疗中心（FQHC）的灾难准备和应对情况，这些中心服务于包括非传染性疾病（NCD）患者在内的弱势群体。飓风“厄玛”和“玛丽亚”暴露出慢性病管理方面的差距，导致了大量死亡。气候变化可能会加剧这些挑战，因此有必要更深入地了解准备因素。
我们使用探索、准备、实施、维持（EPIS）框架，对波多黎各和美属维尔京群岛的两家联邦合格医疗中心进行了定性研究，分析内部（领导力、组织文化和员工动态）和外部（资金、网络和政策）背景因素。利用EPIS框架对24次半结构化访谈进行了主题分析。
对24名工作人员的访谈强调，重视员工和患者的强有力领导、先前的灾难经验以及持续改进的文化对准备工作至关重要。个人支持系统提高了员工的参与度，而与救援组织的外部合作增强了应对努力。允许在保险范围之外获取药物和医疗服务的灵活政策在灾难期间对非传染性疾病患者至关重要。
EPIS框架成功地将极端天气事件中的慢性病管理置于具体情境中，确定了减轻与气候相关的健康差距的策略。加强组织间网络和政策适应性可以提高联邦合格医疗中心的复原力，确保在灾难期间继续为高危人群提供护理。
