Editor's Note: CIDRAP's Promising Practices: Pandemic Influenza Preparedness Tools (http://www.cidrap.umn.edu/public-health-practices) online database showcases peer-reviewed practices, including useful tools to help others with their planning. This article is one of a series exploring the development of these practices. We hope that describing the process and context of these practices enhances pandemic planning.
Apr 6, 2009 (CIDRAP News) – When dispensing a large number of medications during an emergency, one site might not be enough. Many US communities are seeking alternate methods of dispensing. One such method, which involves distributing medication through some agencies to reduce the influx at public sites, is called the "Push Partner Program."
The Centers for Disease Control and Prevention (CDC) has identified the need for communities to provide prophylaxis to 100% of their population within 48 hours. Some planners feel general public point-of-dispensing (POD) sites could not meet such high demand in a short time. The Push Partner Program, which is being used in several states, is one way to ease the burden on public POD sites.
This dispensing strategy involves "pushing" medications to partner agencies, such as community-based organizations and private businesses. These agencies then dispense the medication to the people in their organizations such as employees, employee family members, and even clients, if applicable. Unlike the general PODs, partner agencies are not open to dispense to the general public during an emergency.
The National Association of County and City Health Officials (NACCHO) is conducting a survey on the partnership between local health departments and their push partner agencies, said Katie Dunkle, a NACCHO program manager. She said she believes the alternate dispensing option is becoming increasingly popular.
"It is pretty overwhelming to hand out medications to the entire public within such a short period of time. A lot of health departments have started looking to community organizations and businesses to partner with to better accomplish this task in the event of an emergency," Dunkle said.
The Oklahoma and Oregon departments of health have had Push Partner Programs for more than 2 years, which may reduce demand at the regular PODs during an emergency.
Mark Schultz, LPN, MSM, is the western district coordinator for the Oklahoma State Department of Health. "Our largest push partner is Oklahoma University. They are able to dispense medication to up to 60,000 people during an emergency," he said.
Addressing the need
The CDC can deploy a large shipment from the Strategic National Stockpile (SNS) of drugs to the public PODs in 12 to 24 hours, which leaves no more than 36 hours for local health departments to dispense medications to the entire population.
Schultz and his colleagues realized they did not have the capacity for those crowds.
"We just don't have enough staff even with our volunteers," he explained.
They launched the Push Partner Program in rural Oklahoma in 2007 and have identified partners capable of providing medications to more than 60,000 people in their region. They continue to seek new partners.
How the Push Partner Program works
Criteria for partner agencies depend on local needs. Schultz said agencies with medical staff are ideal but not required. He added that there is no set number of partners.
"In Oklahoma City," he said, "a company that has 50 people isn't going to help me out; but such a company in rural Oklahoma will help a lot, because sometimes our health departments are only two people strong. Fifty less people coming into the dispensing site really helps them out."
The criteria also vary among departments. The Cities Readiness Initiative (CRI) Program in the Portland metropolitan region started a Push Partner Program 3 years ago. Planners divided their target audience into sections and began with community-based organizations serving vulnerable populations.
Cristin Corcoran, the program coordinator, said her department looks not only at the quantity of people but the type of people who would be served. "So if we are to look at a residential home, for example, it doesn't make sense to pull those people out of the residential facility and require them to navigate a public POD site," she said.
Private industries play an important role as well.
It doesn’t take long for an organization to become a partner, according to Schultz. "All they need to do is sign the memorandum of understanding, provide 24/7 emergency contact information, and receive a couple hours of free training, " he said, adding that partners are also encouraged to participate in local health department exercises to test their plans.
Mutually beneficial partnerships
Corcoran and her colleagues continue to seek more organizations. "The hardest part is getting our foot in the door; we need to let them know about the program and how it can benefit them," she said. "Once we are able to do this, they typically show great interest in the program."
The Oklahoma Federal Executive Board started to partner with the state department of health a couple years ago. It serves all federal agencies in Oklahoma.
LeAnn Jenkins, the board's executive director, said she found it appealing that the federal agencies could take care of themselves during an emergency. "In addition, people from both federal agencies and state agencies could also work together to get through an emergency, which is truly a partnership," Jenkins added.
Adrienne Donner, MBA, the Portland CRI senior program coordinator, told CIDRAP that having an organization dispense the needed medication during an emergency improves staff efficiency. "For a business, maintaining productive staff directly impacts their bottom line, and a push partner relationship can avoid staff having to leave work to find a POD," Donner said.
Both health departments and partners are benefiting from the Push Partner Program. Schultz from Oklahoma said that public health departments would have fewer people at regular dispensing sites, which could allow them to accelerate the dispensing process.
Another benefit of the program is that it can prepare agencies to assist with other local public health efforts, Schultz said. "Partners could come and support us once they have finished their obligations during an emergency, which is truly a win-win situation," he said.
Building fruitful collaborations
In addition to alleviating the burden on POD sites during an emergency, this program can bring a health department closer to a common goal of strengthening collaborations with community members, the private sector, and other organizations.
The program helps forge a meaningful and trusting connection before an actual emergency, Jenkins said. "Last year, there was a health issue up to the northeast Oklahoma. I sent the information I got from the state health departments out to my agency leaders," she said. Later, agency leaders underscored how helpful it was for them to receive the message.
Push Partner Programs could also help to reach people with special needs. "For example, we are working with our state department of aging to reach the senior citizens isolated within their homes, which can be a very vulnerable population," said Schultz.
But he also explained that being a partner does not mean the agency receives priority to get the medications first. That depends on the amount contained in the first shipment.
"It's not a very good idea to push all the meds out to the push partners if that leaves little left for our public POD sites. The public POD sites will always be the primary and fundamental method to dispense medications to the public," Schultz said.
View tools and reviewers' comments from Oregon's "Push Partner Registry" practice