Assessing Patient Needs During Natural Disasters: Mixed Methods Analysis of Portal Messages Sent During Hurricane Harvey

Abstract

Background Patient portals play an important role in connecting patients with their medical care team, which improves patient engagement in treatment plans, decreases unnecessary visits, and reduces costs. During natural disasters, patients’ needs increase, whereas available resources, specifically access to care, become limited. Objective This study aims to examine patients’ health needs during a natural crisis by analyzing the electronic messages sent during Hurricane Harvey to guide future disaster planning efforts. Methods We explored patient portal use data from a large Greater Houston area health care system focusing on the initial week of the Hurricane Harvey disaster, beginning with the date of landfall, August 25, 2017, to August 31, 2017. A mixed methods approach was used to assess patients’ immediate health needs and concerns during the disruption of access to routine and emergent medical care. Quantitative analysis used logistic regression models to assess the predictive characteristics of patients using the portal during Hurricane Harvey. This study also included encounters by type (emergency, inpatient, observation, outpatient, and outpatient surgery) and time (before, during, and after Hurricane Harvey). For qualitative analysis, the content of these messages was examined using the constant comparative method to identify emerging themes found within the message texts. Results Out of a total of 557,024 patients, 4079 (0.73%) sent a message during Hurricane Harvey, whereas 31,737 (5.69%) used the portal. Age, sex, race, and ethnicity were predictive factors for using the portal and sending a message during the natural disaster. We found that prior use of the patient portal increased the likelihood of portal use during Hurricane Harvey (odds ratio 13.688, 95% CI 12.929-14.491) and of sending a portal message during the disaster (odds ratio 14.172, 95% CI 11.879-16.907). Having an encounter 4 weeks before or after Hurricane Harvey was positively associated with increased use of the portal and sending a portal message. Patients with encounters during the main Hurricane Harvey week had a higher increased likelihood of portal use across all five encounter types. Qualitative themes included: access, prescription requests, medical advice (chronic conditions, acute care, urgent needs, and Hurricane Harvey–related injuries), mental health, technical difficulties, and provider constraints. Conclusions The patient portal can be a useful tool for communication between patients and providers to address the urgent needs and concerns of patients as a natural disaster unfolds. This was the first known study to include encounter data to understand portal use compared with care provisioning. Prior use was predictive of both portal use and message sending during Hurricane Harvey. These findings could inform the types of demands that may arise in future disaster situations and can serve as the first step in intentionally optimizing patient portal usability for emergency health care management during natural disasters.

Pharmacy Deserts and Pharmacies’ Roles Post-Extreme Weather and Climate Events in the United States: A Scoping Review

“…The studies that assessed the role of pharmacies post-EWCEs (N = 13) showed the importance of pharmacists in providing care to individuals impacted by EWCEs ( Table 2 ). 5 - 17 However, these studies also revealed that many pharmacies were not equipped with disaster preparedness protocols despite the existence of statewide policies to help pharmacies lead disaster recovery efforts. 8 This lack of disaster preparedness affected the functionality and accessibility of pharmacies in times when care was most needed.…”

“…Studies have shown that issues with accessing pharmacies and medications post-EWCEs are often due to pharmacy closures, inability to contact prescribers, and insurance challenges. 5 - 7 , 9 , 12 , 13 In 1 paper, barriers that prevented patients from accessing medications included restrictive insurance benefits, patients’ resistance to mail order, and higher copayments for larger prescription units. 6 A study interviewed patients of community pharmacies in Puerto Rico after Hurricane Maria to assess patients’ medication needs and level of satisfaction with community pharmacy services.…”

“… 5 Patients described situations in which their medications were destroyed or unreachable because of flooding and requested a prescription refill. 5 Additionally, some patients struggled to get their medication because of weather-related pharmacy closures or lack of medications available at their local pharmacy. 5 Messages from patients often included context related to disruption of care due to difficulties in acquiring medications from a pharmacy or a delayed prescription approval from a provider during the hurricane.…”

“… 5 Additionally, some patients struggled to get their medication because of weather-related pharmacy closures or lack of medications available at their local pharmacy. 5 Messages from patients often included context related to disruption of care due to difficulties in acquiring medications from a pharmacy or a delayed prescription approval from a provider during the hurricane. 5 To alleviate issues like this, emergency federal declarations issued during Hurricanes Harvey and Irma granted pharmacists the authority to dispense up to a 30 day supply of a patient’s medications without a prescriber’s authorization.…”

“…13 Patient portal messages during Hurricane Harvey showed that patients frequently messaged providers regarding prescription needs due to their inability to acquire their medications and limited access to pharma cies. 5 Patients described situations in which their medica tions were destroyed or unreachable because of flooding and requested a prescription refill. 5 Additionally, some patients struggled to get their medication because of weatherrelated pharmacy closures or lack of medications available at their local pharmacy.…”