Table 2. Implemented changes to foster continuity of care for patients with chronic diseases after a disaster and related remaining challenges.

Area of Improvement	Remaining Challenges
Pre-disaster preparation training
Provision of flyers, checklists or pamphlets on disaster preparation Provision of “Grab and Go” disaster preparedness bags as a means to initiate disaster preparedness discussions with patients One-on-one disaster preparedness training adopted by Dialysis Services Group meetings and one-on-one discussions on disaster preparedness for persons living with HIVa Individualized assistance to generate a disaster plan and contact medical needs shelters for some home care patients	Written materials not useful for patients of limited literacy and/or English language skills Financial constraints limit numbers of “Grab and Go” bags available Limited contact with patients precludes timely disaster preparedness training Patients' limited interest on planning for disaster preparedness Patients' lack of compliance with training
Evacuation support
Transportation support enhanced Mechanisms in place to register for transportation support Agencies serving persons living with HIV are capable of providing some transportation, as well as some resources for evacuation (gas allowance)	Transportation needs are likely to exceed current transportation capacity
Provisions for post-disaster care
Some institutions ask for phone numbers of relatives or friends who may help locate displaced patients In Mississippi, 1-800 Community Center number patients can use to find out what clinics are open post-disaster Medical, dialysis and HIV social services providers proactively furnish their patients with information on medical and other resources they can access along their intended evacuation route	Because evacuation plans may change, relatives of friends may not be able to facilitate contact with patients
Patients' prescriptions and knowledge of treatments
Medical, dialysis and HIV social services providers proactively furnish their patients with written records of their prescribed medications and any relevant treatment details. Some progress made with the provision of advance prescription medications	Some patients may still have difficulty procuring prescription medications in advance to properly prepare for disaster.
Medical needs shelters
Mandates to open medical needs shelters in Alabama, and enhancement to the capacity of medical needs shelters in Mississippi as a direct result of the experience with Hurricane Katrina In Alabama, efforts to coordinate cross-county lines to enhance medical needs shelters capacity	Specially in Alabama, concern that demand will most likely exceed current medical needs shelter capacity Patients with special medical needs, such as those with cerebral palsy, muscular dystrophy, etc. cannot be housed at medical needs shelters

^aHIV: Human Immunodeficiency Virus