Simple, school-based mass distribution as a small-town strategy

Abstract

Objective: Test a radically simple school-based point-of-dispensing model.
Design: Prospective study.
Setting: Community
Participants: Community residents with children at one middle school.
Interventions: Rapid dispensing of medication.
Main Outcome Measure(s): 1) Measure and extrapolate ability to distribute medications to Darien residents through school-based distribution model; 2) assess if using a limited staffing model with limited training was functional. Identify stress points; 3) understand the existing school communication model; 4) track and extrapolate the breakdown of adult-tochild doses distributed and compare to existing census data; and 5) measure throughput of school-based distribution model in the 50-minute drop-off period.
Results: 1) This exercise supported the concept that rapid medication distribution through the public schools is an appropriate strategy for health departments, particularly departments with limited resources. 2) Just-in-time briefing worked well as a training strategy. The primary stress points identified were in restock—if medication was in blister packs, we would not be able to stock vests with 100 of each as they are substantially bigger than mints. 3) The secure Darien Public School notification system was ideal for distributing information to parents since they tend to receive school communication on a regular basis and by definition, access is limited to town residents. 4) When asked about household size, most drivers indicated “two adults and two (or more) children.”We distributed medication for 784 adults and 963 children. This ratio was higher than the 2010 Census, which had an average household size of 3.08 in Darien. 5) In 50 minutes, using a mix of Health Department and school staff, medication was distributed to 1,747 residents, almost 10 percent of the population. The hourly throughput from this model was distribution to 2,096 people per hour or 699 people per distributor per hour. This compares favorably to almost every other nonmedical distribution model.
Conclusions: Using four Health Department staff and six public school staff, we distributed medication to 784 adults and 963 pediatric residents in 50 minutes at one school. If we extrapolated that across the six other public schools in Darien, we could provide medication to more than 10,000 residents within 8 hours. While we are cognizant of the limitations and drawbacks of this model, we strongly believe that it is the only practical solution to the problem of rapid distribution of medication to the entire community.