September – October 2008 http://pdm.medicine.wisc.edu Prehospital and Disaster Medicine ORIGINAL RESEARCH Abstract Introduction: Chronic diseases are major causes of death and disability and often require multiple prescribed medications for treatment and control. Public health emergencies (e.g., disasters due to natural hazards) that disrupt the availability or supply of these medications may exacerbate chronic disease or even cause death. Problem: A repository of chronic disease pharmaceuticals and medical supplies organized for rapid response in the event of a public health emergency is desirable. However, there is no science base for determining the contents of such a repository. This study provides the first step in an evidence-based approach to inform the plan- ning, periodic review, and revision of repositories of chronic disease medications. Methods: Data from the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to examine the prescription medication needs of persons presenting to US hospital emergency departments for chronic dis- ease exacerbations. It was assumed that the typical distribution of cases for an emergency department will reflect the patient population treated in the days after a public health emergency. The estimated numbers of prescribed drugs for chronic conditions that represent the five leading causes of death, the five leading primary diagnoses for physician office visits, and the five leading caus- es of disease burden assessed by disability-adjusted life years are presented. Results: The 2004 NHAMCS collected data on 36,589 patient visits that were provided by 376 emergency departments. Overall, the five drug classes mentioned most frequently for emergency department visits during 2004 were narcotic analgesics (30.7 million), non-steroidal anti-inflammatory drugs (25.2 million), non-narcotic analgesics (15.2 million), sedatives and hypnotics (10.4 million), and cephalosporins (8.2 million). The drug classes mentioned most frequently for chronic conditions were: (1) for heart disease, antianginal agents/vasodilators (715,000); (2) for cancer, narcotic analgesics (53,000); (3) for stroke, non-narcotic analgesics (138,000); (4) for chronic obstructive pul- monary disease, anti-asthmatics/bronchodilators (3.2 million); and (5) for diabetes, hypoglycemic agents (261,000). Ten medication categories were common across four or more chronic conditions. Conclusions: Persons with chronic diseases have an urgent need for ongoing care and medical support after public health emergencies. These findings pro- vide one evidence-based approach for informing public health preparedness in terms of planning for and review of the prescription medication needs of clin- ically vulnerable populations with prevalent chronic disease. Brown DW, Young SL, Engelgau MM, Mensah GA: Evidence-based approach for disaster preparedness authorities to inform the contents of repos- itories for prescription medications for chronic disease management and con- trol. Prehospital Disast Med 2008;23(5):447–457. 1. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia USA 2. Independent contractor, Decatur, Georgia USA Correspondence: David W. Brown Centers for Disease Control and Prevention 4770 Buford Highway NE (MS K67) Atlanta, Georgia 30341 USA E-mail: dbrown6@cdc.gov The f indings and conclusions in this report are those of the authors and do not necessarily represent the views of the [US] Centers for Disease Control and Prevention. Keywords: chronic disease; disaster planning; emergencies; medication systems Abbreviations: ICD-9-CM = International Classif ication of Diseases, 9th Revision, Clinical Modif ication NHAMCS = National Hospital Ambulatory Medical Care Survey Received: 11 January 2008 Accepted: 23 May 2008 Revised: 27 May 2008 Web publication: 30 October 2008 Evidence-Based Approach for Disaster Preparedness Authorities to Inform the Contents of Repositories for Prescription Medications for Chronic Disease Management and Control David W. Brown, MScPH, MSc; 1 Stacy L. Young, MPH; 2 Michael M. Engelgau, MD; 1 George A. Mensah, MD 1 Introduction Chronic diseases are a major cause of death and disability worldwide. In 2005, the World Health Organization estimated that 58 million persons died of chronic diseases worldwide, representing about 61% of global mortality. 1,2 In