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Int. J. Environ. Res. Public Health 2012, 9(10), 3384-3397; doi:10.3390/ijerph9103384

Prediction of Unmet Primary Care Needs for the Medically Vulnerable Post-Disaster: An Interrupted Time-Series Analysis of Health System Responses

1
Nell Hodgson School of Nursing, Emory University, Atlanta, GA 30322, USA
2
Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
3
Health Services, Policy, and Management, University of South Carolina, Columbia, SC 29208, USA
4
South Carolina Rural Health Research Center, Columbia, SC 29210, USA
5
Department of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
*
Author to whom correspondence should be addressed.
Received: 31 May 2012 / Revised: 6 September 2012 / Accepted: 17 September 2012 / Published: 25 September 2012
(This article belongs to the Special Issue Preparedness and Emergency Response)
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Abstract

Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances (i.e., technological disasters) to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster. View Full-Text
Keywords: technological disaster; vulnerable populations; access to care; ambulatory care sensitive conditions; secondary surge capacity; recovery; health system; forecast modeling technological disaster; vulnerable populations; access to care; ambulatory care sensitive conditions; secondary surge capacity; recovery; health system; forecast modeling
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This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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MDPI and ACS Style

Runkle, J.D.; Zhang, H.; Karmaus, W.; Martin, A.B.; Svendsen, E.R. Prediction of Unmet Primary Care Needs for the Medically Vulnerable Post-Disaster: An Interrupted Time-Series Analysis of Health System Responses. Int. J. Environ. Res. Public Health 2012, 9, 3384-3397.

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