title: Katrina's Legacy: Processes for Patient Disaster Preparation Have Improved but Important Gaps Remain.
abstract: BACKGROUND
  Ensuring continuity of care for patients with chronic illness, who are elderly or indigent presents unique challenges after disasters; this population has fewer financial resources, is less likely to evacuate, has limited access to recovery resources and is significantly dependent on charitable and government-funded institutions for care. This study expands a previous investigation of the extent to which healthcare providers in coastal Mississippi and Alabama have made changes to facilitate continued care to these populations after disasters.
  
  
  METHODS
  Key informants representing healthcare and social services organizations serving health-disparate residents of the Mississippi and Alabama Gulf Coast were interviewed regarding disaster preparation planning for the period of 2009-2012. Interview transcripts were qualitatively coded and analyzed for emerging themes using ATLAS.ti software.
  
  
  RESULTS
  Participant organizations have implemented changes to ensure continuity of care for patients with chronic illness in case of disasters. Changes include patient assistance with predisaster preparation and training; evacuation planning and assistance; support to find resources in evacuation destinations; equipping patients with prescription information, diagnoses, treatment plans and advance medications when a disaster is imminent; multiple methods for patients to communicate with providers and more mandated medical needs shelters. Patients whose chronic conditions were diagnosed post-Katrina are more likely to underestimate the need to prepare. Further, patients' lack of compliance tends to increase as time passes from disasters.
  
  
  CONCLUSIONS
  Although changes were implemented, results indicate that these may be inadequate to completely address patient needs. Thus, additional efforts may be needed, underscoring the complexity of adequate disaster preparation among disparate populations.
authors.affiliation: Department of Management, Mitchell College of Business, University of South Alabama, Mobile, Alabama.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Icenogle
authors.affiliation: Research Office, Center for Healthy Communities, University of South Alabama, Mobile, Alabama.
authors.forename: Sasha
authors.initials: S
authors.lastname: Eastburn
authors.affiliation: Research Office, Center for Healthy Communities, University of South Alabama, Mobile, Alabama. Electronic address: marrieta@southalabama.edu.
authors.forename: Martha
authors.initials: M
authors.lastname: Arrieta
mesh_terms: D002908:Chronic Disease; D004189:Disaster Planning; D060447:Emergency Shelter; D006801:Humans
keywords: Chronic disease; Continuity of care; Health disparity; Patient disaster preparation