Background
More than 70 US cities participate in the Cities Readiness Initiative (CRI), which is funded by CDC to develop programs that ensure medication is available to a city's entire population within 48 hours of a bioterrorist event. Given the scale of resources and time needed to plan for this massive undertaking, many cities are looking for creative and cost-effective solutions as they develop strategies for Points of Dispensing (PODs).
Specific issues
- Inefficient operations and bottlenecks. Open PODs, intended to dispense medications to the public in a first-come, first-serve manner, may require individuals to stand in line for hours.
- Vulnerable populations. Open PODs may not be accessible or ideal for vulnerable populations who cannot wait in line for long periods of time or who do not have the ability to transport themselves to the POD location.
- Need for assessment. Public health staff and volunteers at a POD must spend significant time and effort to ensure that clients' forms are completed and that the correct antibiotics for those individuals are provided in a timely way.
The practice
The Johnson County Department of Health and Environment (JCDHE), in conjunction with Kansas City metro partners, developed an online system that allows individuals to screen themselves for prophylaxis eligibility/requirements, print vouchers to take to PODs, and receive medication in a quick and error-free manner.
After determining that an online system was appropriate for screening the county's 550,000 residents during an emergency, JCDHE created the Dispense Assist online screening tool. Dispense Assist provides online screening forms for prophylactic medications used in event of exposure to anthrax, tularemia, and plague, as well as forms for seasonal influenza vaccination. Questions are intended to screen out any false positives (eg, an inaccurate claim to have an egg allergy) with secondary questions that verify specific information.
Completed forms can be printed and used as a voucher at a POD. The voucher clearly states which (if any) medication an individual should receive and bears a unique QR code that POD workers can use to scan and immediately input the form's data. The process is intended to move one person through a POD in approximately 35 seconds, as POD workers need only scan the form and dispense appropriate medications and fact sheets without having to focus on/screen for eligibility or contraindications. The basis for this is a medical algorithm vetted by over 63 physicians in partnership with Yolo County and the San Francisco Bay area.
The Dispense Assist Web site includes everything POD workers need to make the process run smoothly: copies of vouchers for individuals who cannot fill them out online, disease planning guides to ensure that using the Dispense Assist system works properly, antibiotic labels and crushing instructions, and CDC fact sheets for all medications.
Dispense Assist was designed to aid in operating different types of PODs, including:
- Open PODs (ie, PODs open to the public on a first-come first-serve basis): Members of the public would fill out and print a voucher before arriving at the POD. Responders and computers are made available for people who are unable to print completed forms. Designated screening staff are unneeded, because the vouchers indicate which medication (if any) an individual should receive.
- Drive-thru PODs: These PODs would only be targeted to those able to complete the voucher at home and bring it to the drive-thru location.
- Closed PODs (ie, PODs hosted by a business or hospital for their employees): If medications are being distributed at the site of the closed POD, employees can complete vouchers for themselves and their families. If medications are requested from a public health agency rather than available on-site, a member of the business/hospital staff can collect vouchers, obtain medications, and distribute them to his/her staff.
JCDHE built Dispense Assist to function dependably in an emergency, and the site is able to accommodate 2 million hits per hour. Once personal health information is scanned, it can be transferred to a spreadsheet, but it is not stored by the Dispense Assist program. Because of this feature, the system can be used for exercises without any need for health agency staff to process or delete fictitious data.
Dispense Assist is also useful for agencies wanting to reach vulnerable populations with emergency medication. By using the online voucher system, a representative from a long-term care home, prison, or other institution would be able to complete forms for his/her clients, obtain medications, and distribute them without worrying about access or travel issues.
What made this practice possible?
- Low overhead. The creation of Dispense Assist only required $4,000 of JCDHE staff Information Technology (IT) hours.
- Input from a development team. JCDHE staff in a variety of disciplines contributed to creating a multifaceted system. Members of the development team included the CRI coordinator, IT specialists, and people who would serve as responders during an emergency (eg, mass dispensing and immunization staff) from several health department jurisdictions.
- Adaptable design. Program questions and format are easy to revise quickly, if eligibility guidelines change during an emergency.
- Various program formats. Although Dispense Assist is intended primarily for those able to complete and print a voucher at home, planners also realize that there will be a segment of the population that cannot or will not follow this process. Planning guides describe how POD workers can help those needing to fill out a form manually. Likewise, the program's Web site offers a downloadable desktop version of Dispense Assist for people to use at the POD site. The desktop version does not require Internet access.
Results
- Lowers staff effort and time burden. In exercises, JCDHE found that Dispense Assist required 75 public health agency staff to operate a county open POD, rather than the usual 120 employees.
- Encourages public engagement. The program offers members of the public a clear action they can take to help themselves and their families during an emergency, and it also facilitates their participation during exercises.
- Improves planning for at-risk populations. Because vouchers can be completed by an agency representative and redeemed for numerous clients without the need of presenting in person at a POD, the system has benefits for people who have mobility and transportation issues or physical and developmental disabilities. The program can also make it easier for businesses, hospitals, or governmental employers to hold closed PODs for their employees.
Notes
JCDHE is planning several enhancements/developments to the Dispense Assist program, including building databases for inventory management and client records. Activities to incorporate the program into routine service delivery/activities at immunization clinics, pediatric offices, and hospitals are also in progress.
