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标题：Primary Care Emergency Preparedness Network, New York City, 2015: Comparison of Member and Nonmember Sites
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作者：Marsha D. Williams , MPH ; Marc C. Jean , MPH ; Bei Chen , MBBS, MAS 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2017
卷号：107
期号：Suppl 2
页码：S193-S198
DOI：10.2105/AJPH.2017.303954
语种：English
出版社：American Public Health Association
摘要：Objectives. To assess whether Primary Care Emergency Preparedness Network member sites reported indicators of preparedness for public health emergencies compared with nonmember sites. The network—a collaboration between government and New York City primary care associations—offers technical assistance to primary care sites to improve disaster preparedness and response. Methods. In 2015, we administered an online questionnaire to sites regarding facility characteristics and preparedness indicators. We estimated differences between members and nonmembers with natural logarithm–linked binomial models. Open-ended assessments identified preparedness gaps. Results. One hundred seven sites completed the survey (23.3% response rate); 47 (43.9%) were nonmembers and 60 (56.1%) were members. Members were more likely to have completed hazard vulnerability analysis (risk ratio [RR] = 1.94; 95% confidence interval [CI] = 1.28, 2.93), to have identified essential services for continuity of operations (RR = 1.39; 95% CI = 1.03, 1.86), to have memoranda of understanding with external partners (RR = 2.49; 95% CI = 1.42, 4.36), and to have completed point-of-dispensing training (RR = 4.23; 95% CI = 1.76, 10.14). Identified preparedness gaps were improved communication, resource availability, and train-the-trainer programs. Public Health Implications. Primary Care Emergency Preparedness Network membership is associated with improved public health emergency preparedness among primary care sites. The primary care sector has an essential role in public health emergency preparedness. Facilities providing primary care can directly augment and support crises medical surges because they routinely deliver clinical care for a large segment of the population across a broad spectrum of medical services. Primary care facilities and practitioners can also provide adequate medical evaluation and care during large-scale events that exceed the limits of the typical emergency medical infrastructure in an affected community. 1 In addition, in a public health emergency, primary care can assist hospital emergency departments with the appropriate disposition of patients who might require emergency care. Evident during the 2009 pandemic H1N1 influenza outbreak, primary care sites were used to reduce influenza caseload on hospitals’ emergency departments by providing vaccines and medical professionals to care for patients. 2–4 Primary care sites must also be able to function after a disaster, continuing to provide care to the populations they serve as well as those displaced by the disaster. However, to do so, primary care centers must be prepared to handle emergencies and have plans in place to prepare for, respond to, and recover from disasters. Formed in 2009, the Primary Care Emergency Preparedness Network (PCEPN) is a pioneer cooperative partnership between the Community Health Care Association of New York State and Primary Care Development Corporation, which represents a coalition of primary care providers in the New York City metropolitan area. 5–7 Working in partnership with the New York City Department of Health and Mental Hygiene and New York City Emergency Management, PCEPN’s mission is to enhance the New York City primary care community’s capacity to prepare for, respond to, and recover from man-made and natural disasters, and to facilitate primary care’s representation in citywide planning and response. Currently, PCEPN has 49 member networks comprising more than 400 sites located across the 5 boroughs of New York City (Bronx, Brooklyn, Manhattan, Queens, and Staten Island). 5–7 The PCEPN was established during the height of pandemic H1N1 influenza, when primary care sites provided medical surge capacity to dispense vaccines to the community. These activities underscored the important role primary care sites serve during a public health emergency. Primary care safety nets played an essential role in the pandemic influenza response by reducing the number of patients with H1N1 cared for in emergency department settings and by having individuals seek care at federally qualified health centers (FQHCs), which frequently serve underserved and uninsured populations. 2 To support providers’ emergency management programs, PCEPN provides technical assistance, including emergency plan templates, training, and exercise development and facilitation. Through its efforts, PCEPN works to ensure that primary care is incorporated into citywide emergency planning, and during a citywide emergency it provides activation liaisons to staff the emergency support function 8 (public health and medical) emergency response desk when it is activated. In addition, PCEPN supports information sharing among city agencies, the local health department, and New York City’s primary care sector. They also provide situational awareness on primary care sector resources and needs before, during, and after disasters. The Health Resources and Services Administration (HRSA) Emergency Management Expectations for Health Centers describes 4 main expectations for health centers: (1) emergency management planning, (2) linkages and collaborations, (3) communications and information sharing, and (4) maintaining financial and operational stability. 8 To assist primary care sites in meeting these expectations, PCEPN was designed to (1) facilitate emergency preparedness in the primary care sector by providing technical assistance to primary care sites to better prepare for, respond to, and recover from disasters and (2) ensure that primary care is represented in citywide planning and response. 9 In infectious disease surveillance activities for the community, PCEPN represents the larger New York City’s primary care sector. Participating primary care sites receive technical assistance with emergency management protocols and policies development, risk assessments, trainings, and disaster preparedness drills and exercises; they are also assessed to determine their level of preparedness to target technical assistance to sites on the basis of their needs. Primary care sites that provide comprehensive primary health care services are eligible to join PCEPN if they meet any of the following criteria: (1) a single location or facility where primary care services are delivered (primary care center); (2) an organization that encompasses multiple service sites, including primary care centers (primary care network) 10 ; (3) FQHCs, which include all organizations receiving grants under Health Center Program statutes (Section 330 of the Public Health Service Act) 11 ; or (4) FQHC “look-alike” organizations that provide primary care services but do not carry FQHC designation. 10–12 Membership of primary care sites in PCEPN is voluntary; there are no mandates or regulatory rules that bind primary care sites to participate in PCEPN. The objective of this study was to conduct an evaluation of the PCEPN program by using collected baseline data, to compare member sites with nonmember sites on reported indicators of preparedness for public health emergencies, and to identify gaps in emergency preparedness to inform program development.