Subject(s)
Ambulatory Care Facilities/organization & administration , Hyperbilirubinemia/diagnosis , Efficiency, Organizational , Electronic Health Records/organization & administration , Humans , Medical Order Entry Systems/organization & administration , Time Factors , Time-to-Treatment , WorkflowABSTRACT
Training and planning for medical stability operations, to include humanitarian assistance, disaster relief, and medical readiness training exercises, has taken on new importance for today's military forces. Deployed medical forces providing care to local populations are presented with the challenge of limited resources and complex public health needs. In this paper, we review the epidemiology of diarrhea as one of the leading causes of mortality in these settings and provide an evidence based-approach for management within the framework of military medical stability operations.
Subject(s)
Diarrhea/therapy , Dysentery/therapy , Military Medicine/methods , Rehydration Solutions/therapeutic use , Salts/therapeutic use , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Chronic Disease , Diarrhea/microbiology , Diarrhea/parasitology , Dysentery/diagnosis , Dysentery/microbiology , Fluid Therapy , Humans , Zinc/therapeutic useABSTRACT
BACKGROUND: Prior review of pediatric malaria cases in the Washington, DC area raised concern that there may be systematic barriers to the timely procurement of antimalarial medications for those patients being treated for malaria as outpatients. We hypothesized that the local availability of antimalarial medications was not consistent across communities of differing socioeconomic status. METHODS: We administered a blinded telephone questionnaire to pharmacists in the Maryland suburbs of Washington, DC and assessed the in-stock availability of antimalarial medication. Pharmacies were stratified into categories of population risk, disease incidence, and income. RESULTS: Pharmacies in high-income ZIP codes were more likely to stock first-line therapy medications (93%, p = 0.03) than pharmacies in moderate-income, low-incidence, low-risk ZIP codes (50%). Moderate-income ZIP codes with high-malaria incidence and a high-risk population (67%, p = 0.35) were no more likely to stock first-line antimalarial medications than pharmacies in moderate-income, low-incidence, low-risk areas (50%). In all, only four (9%) pharmacies stocked quinine. Many pharmacists stated the reason for this discrepancy was that they believed the Food and Drug Administration (FDA) had "pulled quinine off the market." CONCLUSIONS: In the United States, disparities exist in the availability of outpatient-antimalarial medications. We recommend that a complete outpatient treatment course is dispensed, or the availability of the medication at the pharmacy that the patient will use is verified prior to departure from the clinic or emergency department. Pharmacists and physicians should be aware that the FDA restrictions on the use of quinine sulfate do not apply to its use for the treatment of malaria.
