An increasing number of patients today have chronic diseases that require regular access to healthcare professionals and medications. An estimated 50 percent of global healthcare expenditures go to the care of patients with chronic heart disease, cancer or lung disease.
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Unfortunately, natural disasters such as earthquakes and hurricanes are on the rise (see Figure 1) as well. These two converging trends mean that many patients are in danger of poor health or even death if their access to care is disrupted for even a short amount of time.
Nizar N. Zein, MD, Endowed Chair in Liver Diseases and Director, Mikati Center of Liver Diseases, and Medical Director of Global Patient Services at Cleveland Clinic addressed this global health challenge at the Ana G. Mendez Health Symposium in San Juan in May in a presentation entitled “Caring for Patients with Chronic Diseases During Natural Disasters.”
At the time he gave his address, official government numbers showed that only about 70 people had died when Hurricane Maria hit Puerto Rico in the fall of 2017. That data was greeted skeptically by many people, and that skepticism was validated later in the May issue of the New England Journal of Medicine. This study reported a mortality rate of 14.3 deaths per 1000 persons, a rate that yielded a total of 4645 excess deaths compared with the previous year when there was no major hurricane. Asubstantial number of the excess deaths was attributed to lack of access to care or medications in the setting of chronic diseases.
“Minimizing deaths of patients from chronic conditions after a natural disaster requires planning,” Dr. Zein says.
One way to help is to have registries of these patients and a care plan in advance of a natural disaster, since the ability to accurately predict major natural disasters has significantly improved. The Renal Disaster Relief Taskforce, established in 1989 by the International Society of Nephrology after an earthquake in Armenia, has proven effective in providing renal care after large-scale disasters, says Dr. Zein. Its success depends for in part on having a record of those in need for ongoing dialysis care and facilities in an area of a disaster.
Another important step is to educate patients about ways they can improve their own chances of receiving appropriate medical care in a crisis, including urging them to wear any medical alert bracelets or have information about their chronic condition ready to share in an emergency.
Patients need to be encouraged to have at least a few days’ medication on hand at all times, readily accessible in case they need to change locations quickly. They should also be educated about modifications they can make to their routine medical care with major compromise of their health. Examples include knowledge of essential medication or adopting a low-salt diet to extend the safe interval between two kidney dialysis sessions.
“If a patient can reduce the number of times that they need dialysis from three times a week to one time a week, it makes it easier for facilities that survived the crisis to meet everyone’s needs,” says Dr. Zein.
Role of government
Preparedness also requires the cooperation of government agencies, Dr. Zein says. One way the government can help is to adopt more flexible policies in times of disaster. For example, when Hurricane Katrina hit New Orleans, people who entered government-sponsored emergency shelters were not allowed to bring in their medications without the original packaging. This policy mirrors that of U.S. hospitals, in which patients are only allowed to take medications provided by the facility, as a way of controlling quality and safety.
This may be acceptable in regular conditions, but in an extreme situation like Katrina, new medications were not delivered in a timely way. Drugs that could have saved lives sat in trash cans.
“Policies that let patients keep their own medications and allow for them to get refills ahead of schedule when an emergency is expected can help reduce these problems,” Dr. Zein says.
A group effort
Dr. Zein stresses that making sure patients with chronic diseases continue to receive healthcare during a natural disaster is a group effort.
“No one group can do it on their own. Healthcare professionals, government agencies and patients must all work together before a crisis hits to be sure that everyone’s needs are met,” he says. “Current preparedness efforts often pay inadequate attention to patients with chronic diseases and other vulnerable populations.”