Download Engaging Health Care Professionals in BT Preparedness and

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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Why do health care professionals reject participation
in BT preparedness planning?
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Why do health care professionals reject participation
in BT preparedness planning?
Competing Priorities
Engaging Health Care Professionals in Bioterrorism
Preparedness & Response Planning
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
Engaging Health Care Professionals in Bioterrorism
Preparedness & Response Planning
Competing priorities
• 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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Competing priorities
• Health care professionals prioritize management of
individual patients, not populations
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not trained to manage populations
may not want to do this
no expectations to do this
not paid to do this
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Competing priorities
• Information overload/avalanche for subjects directly
relevant to clinical practice
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new diseases
new treatments and drugs
new tests
new technologies
new management strategies
changing administrative procedures, rules and regulations
Engaging Health Care Professionals in Bioterrorism
Preparedness & Response Planning
Competing priorities
• Lack of funding to support participation of medical
professionals despite allocations for public health, fire, law
enforcement, pharmaceutical stockpile, research
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Competing priorities
• The bottom line: bioterrorism, and public health in
general, are not priorities in either the academic or private
health care sectors
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Competing priorities
• The challenge: how can we change this?
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Competing priorities
“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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
The role of health care professionals
• What is the role of the clinician in bioterrorism response?
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
The role of health care professionals
• 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
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Relevance
Credibility
Value
Efficiency
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Relevance
• Emphasize concept of biological disaster planning:
relevance of BT planning to other common, naturallyoccurring 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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Relevance
• Emphasize concept of biological disaster planning:
relevance of BT planning to other common, naturallyoccurring 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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
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. Crosby
America’s Forgotten Pandemic - The Influenza of 1918
Cambridge University Press, 1989
Deaths By Week due to Pneumonia & Influenza
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
Population: 1,761,371
Total deaths: 15,785
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Deaths
October, 1918 through March, 1919 - Philadelphia, PA
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Relevance
Pandemic 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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Credibility
• Peer driven process
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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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Value
• Provide practical resources that allow clinicians to fulfill role
defined for them
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Value
• Preparedness and planning
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Value
• Preparedness and planning
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authoritative resources and references
training and tabletops
tools for improving recognition and management of biological terrorism
communication methods
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Value
• Outbreak response
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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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Value
• Public health must be visible in the clinical community
• Regular, ongoing presence at:
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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.anesoft.com/demo/bio/bio.html
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
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
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
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 postgraduate education
Engaging Health Care Professionals in
Bioterrorism Preparedness & Response Planning
Summary
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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 Section
Public Health - Seattle & King County
Contact us for additional information and to report
suspected cases.
24-hour communicable disease line:
206-296-4774
Public Health - Seattle & King County Web Site
http://www.metrokc.gov/health/bioterrorism