A bitter pill to swallow: nonadherence with prophylactic antibiotics during the anthrax attacks and the role of private physicians.

To generate recommendations for improving adherence to public health advice during public health crises, we conducted semi-structured interviews with employees at the Brentwood Road Postal Facility and on Capitol Hill to identify key themes associated with decisions to adhere to recommended antibiotic prophylaxis during the 2001 anthrax attacks. Factors used in deciding to adhere to recommended prophylactic antibiotics and concerns about the official response were similar in Brentwood and Capitol Hill employees, and in adherent and nonadherent participants. All participants used multiple sources of information and support as they weighed the risk from anthrax against the advantages and disadvantages of antibiotics. We found that nonadherent participants were commonly following the advice of private physicians, whereas adherent participants commonly described ongoing support from multiple sources when discussing their decisions. Our findings highlight the need for better integration between the public and private health care systems during public health crises and the importance of equipping private physicians for their key role in aiding decision-making during a public health crisis. Special attention also should be given to enhancing support and information from multiple sources throughout the entire period of risk.

[1]  C. Wold,et al.  Will public health's response to terrorism be fair? Racial/ethnic variations in perceived fairness during a bioterrorist event. , 2004, Biosecurity and Bioterrorism.

[2]  H. Pincus,et al.  Emotional and behavioral consequences of bioterrorism: planning a public health response. , 2004, The Milbank quarterly.

[3]  T. Daschle,et al.  Like No Other Time: The 107th Congress and the Two Years That Changed America Forever , 2003 .

[4]  Matthew K Wynia,et al.  Ready and willing? Physicians' sense of preparedness for bioterrorism. , 2003, Health affairs.

[5]  H. Bernard,et al.  Techniques to Identify Themes , 2003 .

[6]  J. Gerberding,et al.  Anthrax Bioterrorism: Lessons Learned and Future Directions , 2002, Emerging infectious diseases.

[7]  Elizabeth R. Zell,et al.  Antimicrobial Postexposure Prophylaxis for Anthrax: Adverse Events and Adherence , 2002, Emerging infectious diseases.

[8]  W. Neuman,et al.  Social Research Methods: Qualitative and Quantitative Approaches , 2002 .

[9]  David W. Conrath,et al.  Organizational Decision Making Behavior Under Varying Conditions of Uncertainty , 1967 .

[10]  Baruch Fischhoff,et al.  Evaluating the success of terror risk communications. , 2003, Biosecurity and bioterrorism : biodefense strategy, practice, and science.

[11]  A. Kunselman,et al.  Sources of bioterrorism information among emergency physicians during the 2001 anthrax outbreak. , 2003, Biosecurity and bioterrorism : biodefense strategy, practice, and science.

[12]  Lois W. Sayrs.  Interviews : an introduction to qualitative research interviewing , 1996 .

[13]  Grant Mccracken.  The long interview , 1988 .

[14]  H. Bernard.  Research Methods in Anthropology: Qualitative and Quantitative Approaches , 1988 .

[15]  R. Abelson.  Decision making and decision theory , 1985 .

[16]  Daniel Katz.  Handbook of Social Psychology. , 1955 .