Regional public health preparedness teams in North Carolina: an analysis of their structural capacity and impact on services provided.

In December 2001, the North Carolina Division of Public Health established Public Health Regional Surveillance Teams (PHRSTs) to build local public health capacity to prevent, prepare for, respond to, and recover from public health incidents and events. Seven PHRSTs are colocated at local health departments (LHDs) around the state. The authors assessed structural capacity of the PHRSTs and analyzed the relationship between structural capacity and the frequency of support and services provided to LHDs by PHRSTs. Five categories of structural capacity were measured: human, fiscal, informational, physical, and organizational resources. In addition, variation in structural capacity among teams was also examined. The most variation was seen in human resources. Although each team was originally designed to include a physician/epidemiologist, industrial hygienist, nurse/epidemiologist, and administrative support technician, team composition varied such that only the administrative support technician is common to all teams. Variation in team composition was associated with differences in the support and services that PHRSTs provide to LHDs. Teams that reported having a medical doctor or a doctor of osteopathic medicine (chi2 = 9.95; p < 0.01) or an epidemiologist (chi2 = 5.35; p < 0.02) had larger budgets and provided more support and services, and teams that housed a pharmacist reported more partners (chi2 = 52.34; p < 0.01). Teams that received directives from more groups (such as LHDs) also provided more support and services in planning (Z = 21.71; p < 0.01), communication and liaison (Z = 12.11; p < 0.01), epidemiology and surveillance (Z = 5.09; p < 0.01), consultation and technical support (Z = 2.25; p = 0.02), H1N1 outbreak assistance (Z = 10.25; p < 0.01), and public health event response (Z = 2.19; p = 0.03). In the last 10 years, significant variation in structural capacity, particularly in human resources, has been introduced among PHRSTs. These differences explain much of the variation in support and services provided to LHDs by PHRSTs.