title: Planning for chronic disease medications in disaster: perspectives from patients, physicians, pharmacists, and insurers.
abstract: BACKGROUND
  Recent US disasters highlight the current imbalance between the high proportion of chronically ill Americans who depend on prescription medications and their lack of medication reserves for disaster preparedness. We examined barriers that Los Angeles County residents with chronic illness experience within the prescription drug procurement system to achieve recommended medication reserves.
  
  
  METHODS
  A mixed methods design included evaluation of insurance pharmacy benefits, focus group interviews with patients, and key informant interviews with physicians, pharmacists, and insurers.
  
  
  CONCLUSIONS
  Most prescriptions are dispensed as 30-day units through retail pharmacies with refills available after 75% of use, leaving a monthly medication reserve of 7 days. For patients to acquire 14- to 30-day disaster medication reserves, health professionals interviewed supported 60- to 100-day dispensing units. Barriers included restrictive insurance benefits, patients' resistance to mail order, and higher copay-ments. Physicians, pharmacists, and insurers also varied widely in their preparedness planning and collective mutual-aid plans, and most believed pharmacists had the primary responsibility for patients' medication continuity during a disaster.
  
  
  CONCLUSIONS
  To strengthen prescription drug continuity in disasters, recommendations include the following: (1) creating flexible drug-dispensing policies to help patients build reserves, (2) training professionals to inform patients about disaster planning, and (3) building collaborative partnerships among system stakeholders.
authors.affiliation: University of California Los Angeles, School of Public Health, Los Angeles.
authors.forename: Kelley A
authors.initials: KA
authors.lastname: Carameli
authors.affiliation: University of California Los Angeles, Division of General Internal Medicine and Health Services Research, Los Angeles.
authors.forename: David P
authors.initials: DP
authors.lastname: Eisenman
authors.affiliation: Los Angeles County Department of Public Health, Emergency Preparedness and Response Program, Los Angeles.
authors.forename: Joy
authors.initials: J
authors.lastname: Blevins
authors.affiliation: University of California Los Angeles, School of Public Health, Los Angeles.
authors.forename: Brian
authors.initials: B
authors.lastname: d'Angona
authors.affiliation: University of California Los Angeles, School of Public Health, Los Angeles.
authors.forename: Deborah C
authors.initials: DC
authors.lastname: Glik
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000188:drug therapy*; D004190:Disasters; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D010821:Physicians, Family; D055553:Prescription Drugs / Q000600:supply & distribution*; D036301:Qualitative Research; D055815:Young Adult
chemical_list: D055553:Prescription Drugs