title: Critical challenges and impediments affecting rural physicians during a public health emergency.
abstract: OBJECTIVE
  Disaster preparedness has become a health policy priority for the United States in the aftermath of the anthrax attacks, 9/11, and other calamities. It is important for rural health care professionals to be prepared for a bioterrorist attack or other public health emergency. We sought to determine the barriers impeding rural physicians from being prepared for a human-induced disaster such as a bioterrorist attack.
  
  
  METHODS
  This study employed a qualitative methodology using key informant interviews followed by grounded theory methods for data analysis. Semistructured interviews were conducted with 6 physicians in the state of Florida from federally designated rural areas.
  
  
  RESULTS
  The interview participants articulated primary barriers and the associated factors contributing to these barriers that may affect rural physician preparedness for human-induced emergencies. Rural physicians identified 3 primary barriers: accessibility to health care, communication between physicians and patients, and rural infrastructure and resources. Each of these barriers included associated factors and influences. For instance, according to our participants, access to care was affected by a lack of health insurance, a lack of finances for health services, and transportation difficulties.
  
  
  CONCLUSIONS
  Existing rural organizational infrastructure and resources are insufficient to meet current health needs owing to a number of factors including the paucity of health care providers, particularly medical specialists, and the associated patient-level barriers. These barriers presumably would be exacerbated in the advent of a human-induced public health emergency. Thus, strategically implemented health policies are needed to mitigate the barriers identified in this study.
authors.affiliation: Saint Leo College of Business, Saint Leo and University of Central Florida, College of Medicine, Gainesville, Florida, USA. gputzer@mail.ucf.edu
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Putzer
authors.forename: Mirka
authors.initials: M
authors.lastname: Koro-Ljungberg
authors.forename: R Paul
authors.initials: RP
authors.lastname: Duncan
mesh_terms: D023482:Bioterrorism; D003144:Communication Barriers; D004189:Disaster Planning; D004190:Disasters; D005431:Florida; D058005:General Practitioners / Q000458:organization & administration* / Q000523:psychology; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D020380:Needs Assessment; D011320:Primary Health Care; D011634:Public Health; D012423:Rural Health; D019035:Rural Health Services / Q000458:organization & administration*