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Pilot Model: Judging Alternate Modes of Dispensing Prophylaxis in Los Angeles County

In large metropolitan areas such as Los Angeles County (LAC), public health departments must supplement their traditional methods of dispensing prophylaxis to the general public in their jurisdictions during mass biological and chemical events. Although many alternate modes of dispensing are being discussed, a quantitative model to compare their relative advantages and disadvantages does not exist. We use multicriteria decision analysis to help the LAC Department of Public Health (DPH) assess the trade-offs associated with these alternate modes of dispensing oral prophylaxis. We found that one of the most hyped methods (drive-thru dispensing) is not a good choice for LAC. Our baseline analysis shows that the top two alternatives, dispensing through commercial pharmacies and dispensing through the United States Postal Service, are equally effective. Either alternative would be acceptable; the final decision could be made on either legal or political grounds. Our analysis provided the DPH with much insight into to its decision problem. It could become part of the justification of proposals for alternate dispensing plans to the Centers for Disease Control and Prevention. In addition, the DPH has hired a consulting firm to pursue business participation, including commercial pharmacies, for dispensing mass prophylaxis.