Family Practice Vol. 20, No. 4, 441-442
© Oxford University Press 2003
International Health Care Research |
Patient and family physician preferences for care and communication in the eventuality of anthrax terrorism
Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv and
a Department of Family Practice, Central Emek Hospital, Afula and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Correspondence to Ernesto Kahan; E-mail: ekahan{at}post.tau.ac.il
Kahan E, Fogelman Y, Kitai E and Vinker S. Patient and family physician preferences for care and communication in the eventuality of anthrax terrorism. Family Practice 2003; 20: 441-442.
Received 22 July 2002; Revised 12 December 2002; Accepted 28 March 2003.
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Abstract |
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Background. The threat of bioterrorism consequent to the September 11, 2001 attack in the USA generated suggestions for improved medical response mainly through hospital preparedness.
Objectives. The aim of the present study was to investigate the impact of this period of tension on patients’ first choice for care and for receiving relevant information, and on primary care doctors’ feelings of responsibility in the eventuality of an anthrax attack.
Methods. During October 11–31, 2001, 500 patients from 30 clinics throughout Israel were asked to complete a questionnaire on their awareness of the anthrax threat, measures taken to prepare for it, and preferred sources of care and information. Their 30 physicians, and an additional 20, completed a questionnaire on knowledge about anthrax and anthrax-related patient behaviours and clinic visits.
Results. The outstanding finding was the low rate (30%) of patients who chose the hospital emergency department as their first choice for care or information if they were worried about an anthrax attack or the media communicated that an attack was in progress. The other two-thirds preferred their family doctor or the health authorities. Most of the physicians (89%) felt it was their responsibility to treat anthrax-infected patients and that they should therefore be supplied with appropriate guidelines.
Conclusion. This study suggests that in Israel, a country with a high degree of awareness of civil defence aspects, both patients and primary care doctors believe that family physicians should have a major role in the case of bioterrorist attacks. This must be seriously considered during formulation of relevant health services programmes.
Keywords. Anthrax, bioterrrorism, family practice, preparedness, primary care.
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Introduction |
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On September 11, 2001 a terrorist attack destroyed the World Trade Center in New York City as well as part of the Pentagon in Washington. During the next days, a wave of anthrax-contaminated letters were sent to several US government offices. It was communicated that 1 month after the attacks, one in every four people was unable to concentrate at work and one in five suffered from anxiety, panic and lack of energy,1 and that medical demands for antibiotics, vaccines and reassurance increased.2,3 Reports called for "proper planning by hospitals and the community, good communication among the health, home-front, defense and intelligence agencies, and sufficient financial support for a realistic state of preparedness". 3–5 Our analysis of this literature clearly highlights the fact that bioterrorism, which has occupied media headlines since September 2001, will continue to be a very ‘hot’ topic for both the medical world and the public, and that the major emphasis for preparedness is placed on hospital emergency departments.5–7
The aim of the present study was to investigate the impact of the threat of anthrax terrorism on patients’ preferred source of care and information, and on primary care physicians’ feelings of responsibility in the event of an anthrax attack.
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Methods |
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The study was conducted during the high-tension period from October 11 to 31, 2001. The duration was short to avoid bias due to possible changes in the political situation. The study sample consisted of 500 consecutive patients from 30 participating family medicine clinics. The patients were asked by their doctor to fill out a questionnaire on their awareness of the anthrax threat, preparations for it, preferred sources of care in the event of an attack, and the reason for the present visit (related to the prevailing tension or not). Patients under age 14 years were included only if they were with their parents; the questionnaire was completed with parental help. The physicians were also asked to fill out a similar questionnaire on knowledge and sources of information about anthrax and anthrax-related patient behaviours and clinic visits. To achieve a total sample of 50 physicians, an additional 20 primary care physicians, whose patients were not included in the study, were also asked to complete the questionnaire.
The minimum sample size (250 x 2 = 500) was calculated according to the proportion of patients who would prefer to receive information on anthrax from their family physician, as determined in a pilot study of 20 patients.
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Results |
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Patients’ responses
Of the 495 patients who participated in the survey, 329 (66.5%) reported no tension due to the anthrax threat, 8% felt uneasy, 24% were worried and 2% did not answer the question. Regarding their preparations, if any, for a possible anthrax attack, 16% had had their gas masks inspected, 4% had filled their monthly prescription for chronic treatment in advance (drug hoarders), 3% had hoarded drinking water and/or food, and 2% had asked for prescriptions for antibiotics that were supposed to be effective against anthrax (antibiotic hoarders). However, none of the patients claimed that the main reason for the present clinic visit was related to tension caused by the anthrax threat or to seek information on anthrax.
Sixty-four percent of the patients would seek treatment from their family physician if they were worried about an anthrax attack or the media communicated that an attack was in progress, and 30% preferred a hospital emergency department; 6% did not know. Accordingly, 60% preferred their family doctor as the major source of information regarding the prevention and care of anthrax or other biological hazards, whereas 14% would turn to a representative of the Ministry of Health, 10% to the media, 9% to a representative of the Israel Defence Forces and the rest did not know.
Physicians’ responses
Most of the physicians (89%) believed that they were responsible for treating anthrax-infected patients and, as such should be armed with appropriate guidelines. Sixty-seven percent were partially to completely satisfied with the information related to the anthrax crisis they had received from their superiors. Their preferred sources of information on bioterrorism (first or second place) were as follows: Internet (68%), textbooks (54%), medical journals (52%), official government reports (41%), continuing medical education (28%), colleagues (24%), scientific congresses (24%) and the media (19%).
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Discussion and conclusion |
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TopAbstractIntroductionMethodsResultsDiscussion and conclusionReferences |
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The outstanding finding in our study is the low rate of patients whose first choice for care or information if they were worried about an anthrax attack or the media communicated that an attack was in progress was the hospital emergency department (30%). The other two-thirds of patients preferred their family doctor or the national health authority as the source of care and of information on prevention and care of anthrax or other biological threats. Indeed, most of the family physicians believed it their duty to treat anthrax infections in their patients and that they therefore needed appropriate guidelines. Most were partially to completely satisfied with the information they had received from their superiors, and most used the Internet, textbooks and medical journals as their major source of information. The recent anthrax attack in the USA generated suggestions for improved medical response mainly through hospital preparedness.3,8,9 In this study, the unexpectedly high rate of patients who would seek help and advice in primary care clinics suggests that these resources should also be considered in the formulation of health services programmes for responding to bioterrorist attacks.
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References |
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1 Editors. September 11, 2001. N Engl J Med 2001; 345: 1126.
2 Gore T. Depression after attacks. ABC Good Morning America. Oct 10 http://abcnews.go.com.
3 O’Toole T. Hearing on FEMA’s role in managing bioterrorist attacks and the impact of public health concerns on bioterrorism preparedness. Congressional Testimonies. Congress of the United States Senate. Government Affairs Subcommittee on International Security, Proliferation and Federal Services. The Center for Civilian Biodefense Studies. July 2001 www.hopkins-biodefense.org/pages/library/fema.html
4 Khan AS, Ashford DA. Ready or not—preparedness for bioterrorism. N Engl J Med 2001; 345: 287–289.
5 Danzig R, Berkowsky PB. Why should we be concerned about biological warfare? J Am Med Assoc 1997; 278: 431–432.[CrossRef][ISI][Medline]
6 Zalewski S, Vinker S, Monnickendam S et al. Israel under threat of biological warfare—the reactions of our patients during the 1998 Persian Gulf crisis. Fam Med 2000; 32: 342–345.[ISI][Medline]
7 Inglesby TV, O’Toole T, Henderson DA et al. Anthrax as a biological weapon, 2002. Updated recommendations for management. J Am Med Assoc 2002; 287: 2236–2252.
8 Wetter DC, Daniell WE, Treser CD. Hospital preparedness for victims of chemical or biological terrorism. Am J Publ Health 2001; 91: 710–716.[Abstract]
9 Simon JD. Biological terrorism: preparing to meet the threat. J Am Med Assoc 1997; 278: 428–430.[Abstract]
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