title: Assessing Patients' Disaster Preparedness in Home-Based Primary Care.
abstract: BACKGROUND
  Chronic conditions paired with normal aging put home-bound individuals at risk of harm during a disaster. Because of their high rate of comorbidities, veterans receiving care from the Veterans Health Administration (VHA)'s home-based primary care (HBPC) program are especially vulnerable, which may prevent them from being prepared for disaster. With intimate knowledge of their patients' home environments, medical needs, resources, and limitations, HBPC practitioners are uniquely positioned to assess and improve disaster preparedness of patients.
  
  
  OBJECTIVE
  This study explored issues regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support routine assessment of disaster preparedness for patients as well as patient education activities.
  
  
  METHODS
  This project involved 32 semi-structured interviews with practitioners and leadership at 5 VHA HBPC programs - 3 urban and 2 rural. Transcripts of the interviews were analyzed using content analysis techniques.
  
  
  RESULTS
  Three themes emerged regarding the assessment of a patient's disaster preparedness: (1) assessment tools are rudimentary and, in some cases, individually developed by practitioners; (2) comprehension of criteria for assigning risk categories varies among practitioners, and (3) patients' cognitive impairment, limited resources, and out-of-date or inaccessible materials are the primary challenges to their preparedness. A fourth additional theme emerged as well: (4) the interdisciplinary nature of the HBPC team allows for unique innovative practices, such as a central focus on caregiver support and personal safety, as it relates to assessment and preparedness of the patient.
  
  
  CONCLUSIONS
  Health and functional limitations may prevent home-bound patients from being adequately prepared for disasters. Standardized strategies and tools concerning disaster preparedness assessment for HBPC patients, which allow flexibility in consideration of factors such as local hazards, could assist in creating more comprehensive planning approaches and, in turn, more prepared persons.
authors.affiliation: Veterans Emergency Management Evaluation Center, Sepulveda, Calif., USA.
authors.forename: Tamar
authors.initials: T
authors.lastname: Wyte-Lake
authors.forename: Maria
authors.initials: M
authors.lastname: Claver
authors.forename: Aram
authors.initials: A
authors.lastname: Dobalian
mesh_terms: D002959:Civil Defense; D004189:Disaster Planning; D004190:Disasters; D006282:Health Personnel; D006699:Home Care Services; D018577:Homebound Persons; D006801:Humans; D011320:Primary Health Care; D036301:Qualitative Research; D012424:Rural Population; D014481:United States; D014493:United States Department of Veterans Affairs; D014505:Urban Population