Meeting Report
03/01/2007

Residents in disaster areas face medication adherence dilemmas

Abstract P156

ORLAND, Fla., March 1 — Many New Orleans residents had problems with prescription drugs for high blood pressure after Hurricane Katrina, researchers reported today at the American Heart Association’s 47^th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

“The results of our study generally represent patients who were able to return for clinic visits in an establishment that was undamaged,” said Marie A. Krousel-Wood, M.D., M.S.P.H., lead author of the study, director of the Center for Health Research at the Ochsner Clinic Foundation and clinical professor of Epidemiology and Community Medicine at Tulane Health Sciences Center in New Orleans.  “It is possible that medication adherence was affected much more in patients who were unable to return to their homes and their home-based facilities.   If that is so, these results could underestimate the real issue and the potential for improvement in disaster planning.”

First, researchers surveyed 215 patients treated at Ochsner, using the Hill-Bone medication adherence subscale questionnaire and general questions about the extent of hurricane damage the patients experienced.

A subset of 78 patients then answered a more detailed questionnaire that sought to pinpoint barriers to medication adherence, defined as taking their medication as prescribed without missing doses.

Researchers found that while 55 percent of the 215-person study group reported perfect medication adherence, the 78-patient subset reported substantial barriers to taking their medications as prescribed following the hurricane and flood.   Those problems included:

• 10 percent didn’t bring their medicines with them when they evacuated;
• 32 percent didn’t bring enough medicine and ran out;
• 15 percent reported trouble getting their prescriptions filled after the disaster;
• 30 percent reported a medication change post-disaster for reasons that could have included a change in their condition or cases in which they had no medication or prescriptions when they evacuated.  This may have resulted in medical personnel in other cities guessing at what the patients had been taking prior to the disaster.

Of the entire study group, 75 percent reported damage to their residences.  After adjusting for age, gender and race, those who reported their houses destroyed were nearly twice (1.97 times) more likely to report failing to completely follow their medicine regimen, researchers said.

Krousel-Wood’s group was uniquely positioned to conduct the study because Ochsner’s 473-bed hospital in New Orleans and hospitals and health centers on the north shore of Lake Pontchartrain and in Baton Rouge escaped flooding and lost no medical records. 

Ochsner set up a command center at the Baton Rouge facility.  From there, Ochsner doctors could access all electronic medical records, which helped patients identify prescriptions, get them filled and aided continuity of care.

“We were lucky in our location, and within a couple of weeks we were at full operation with regards to our clinic and hospital facilities,” Krousel-Wood said.  “We saw patients coming to the clinic who were having issues with their medications, particularly patients with chronic diseases like high blood pressure.  Access to health care, pharmacies and communications systems was distorted in the period immediately after the hurricane.”

Her team had been studying barriers to medication adherence in patients with chronic conditions for several years prior to the disaster, and had received a $2 million grant from the National Institute on Aging just two weeks before the hurricane and flood. 

The researchers’ work, part of an ongoing four-year study, has expanded in New Orleans since the hurricane.   Now they are collecting data on post traumatic stress, depression, personal and financial losses, and how long the damage to patients’ properties persists.  Some patients still don’t have their properties repaired.

To better plan for disasters:

• Electronic medical and prescription records should be kept.  Patients whose prescriptions were filled at national pharmacy chains before the hurricane often were able to get their prescription data after the hurricane, while those who went to local, community pharmacies had more difficulty getting prescriptions refilled.
• Patients should take at least a month supply of medications when they evacuate.
• Patients in disaster-prone areas should develop a plan with their physicians for refilling prescriptions in the event of an evacuation.

“We have a lot of drugs that work very well for high blood pressure, but if you don’t take them correctly, you don’t get the full benefits of the treatment,” she said.  “Our study shows that opportunities exist to improve disaster planning and prescription refill processes to increase medication adherence after disasters in older adults.”

The study was funded in part by a grant from National Institute on Aging.

Co-authors are Paul Muntner, Ph.D.; Erin Stanley, M.P.H.; Tareq Islam, M.P.H.; Ashli Phillips, M.D.; Larry Webber, Ph.D.; Edward Frohlich, M.D.; and Richard Re, M.D.

NR07-1123 (EPI 07/Krousel-Wood)

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