The Role of General Practitioners in Disaster Health Management

Abstract

Disasters are a time of excess demand for medical care overwhelming available medical services. General Practitioners (GPs) are local healthcare professionals already onsite managing the ongoing health of the majority of the community when disaster strikes. They are a medical resource, knowledgeable about the local community context, and remain to share the journey of adaptation and recovery with their local community in the days to years of aftermath. Early observations at commencement of this research demonstrated that whether GPs chose to or not, as local community health professionals they will be involved in some way in any disaster that strikes their community either during, and/or after the event. In most countries, including Australia, GPs are excluded from disaster response systems. The research aim was to identify the role of GPs in disaster health management, and to propose a system of involvement that aligns with: - the epidemiological evidence of disaster healthcare needs relevant to GPs, - the perceptions of GPs and Disaster Managers (DM) experts, and - the current All Hazards All Agencies Prevention-Preparedness-Response-Recovery (PPRR) international framework of disaster management The first study was a systematic literature review utilising PRISMA guidelines to categorise the epidemiology of physical health consequences of disasters relevant to GPs. Following this the thesis reports a series of three qualitative studies employing a constructivist grounded theory approach: two using semi-structured interviews, and one using a focus group, with disaster-experienced GPs and DMs. These studies explored barriers and facilitators to inclusion of GPs and investigated current and future roles. Research findings led to a conceptual representation for future integration of GPs, utilising the PPRR framework. Ultimately the thesis proposes a strategy for integration of GPs into existing disaster health management systems that addresses some of the barriers highlighted by the research, and elucidates the roles of GPs. The researchers sought to synthesise the emerging knowledge and facilitate implementation by key stakeholders with the intention of closing the gap between what is known and what is practiced. Findings were disseminated as per Graham's Knowledge to Action framework. Key outputs were enacted through peer-reviewed journal publications, textbook sections, guidelines for a broad range of practitioners, presentations internationally and nationally, policy revision through professional committee memberships, and advocacy for GP involvement at international, national, and local levels. To manage the challenges of disasters, countries require a resilient healthcare system that maximises capacity of all levels of local health resources, accommodates the surge in demand, and continues to sustain the local health services response in the aftermath. Comprehensive, people-focused coordination & continuity of care has the potential to improve the holistic health outcomes of disaster-affected people. Examination of the evidence from this doctorate suggests clear roles for GPs in disaster healthcare across all phases of disasters, with sustained contributions over the recovery. A knowledge of the temporal epidemiological patterns of health effects provides an opportunity for surveillance for emerging conditions over time, prevention of deterioration of existing conditions, and promotion of patient preparedness for future events, all roles within the usual realm of General Practice healthcare. An important element of GP integration is ongoing research on disaster healthcare needs presenting to GPs to continue to evaluate, justify and support ongoing GP involvement. The future challenge is to change the focus of disaster health management to person-centred healthcare integrated across all levels of usual healthcare, including evidence-based General Practice primary care contributions.