Influenza pandemic 2009/A/H1N1 management policies in primary care: a comparative analysis of three countries
Marina Kunin A E , Dan Engelhard B , Shane Thomas B , Mark Ashworth C and Leon Piterman DA The School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia.
B Paediatric Infectious Diseases and Paediatric AIDS, Hadassah University Hospital, Hadassah University Hospital, Ein-Kerem Jerusalem 91120, Israel. Email: engelhard@hadassah.org.il
C Faculty of Medicine, Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia. Email: shane.thomas@monash.edu
D Department of Primary Care and Public Health Sciences, School of Medicine, King’s College London, 9th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK. Email: mark.ashworth@kcl.ac.uk
E Berwick and Peninsula, Monash University, Building 901, 100 Clyde Road, Berwick, Vic. 3806, Australia. Email: leon.piterman@monash.edu
F Corresponding author. Email: marina.kunin@monash.edu
Submitted: 7 November 2012 Accepted: 11 April 2013 Published: 4 June 2013
Abstract
Background. During the influenza pandemic 2009/A/H1N1, the main burden of managing patients fell on primary care physicians (PCP). This provided an excellent opportunity to investigate the implications of pandemic policies for the PCP role.
Aim. To examine policies affecting the role of PCP in the pandemic response in Australia (in the state of Victoria), Israel and England.
Methods. Content analysis of the documents published by the health authorities in Australia, Israel and England during the pandemic 2009/A/H1N1.
Results. The involvement of PCP in the pandemic response differed among the countries in timing and allocated responsibilities. The Israeli approach during the containment phase was to maximise the protection of PCP at the expense of putting pressure on hospitals where the suspected cases were tested and treated. In Australia and England, PCP managed the suspected patients from the beginning of the pandemic. The work of PCP in England was supported by the introduction of the National Pandemic Flu Service during the mitigation phase, whereas Australian PCP had no additional support structures and their role was constant and intensive throughout the pandemic period.
Conclusion. Health authorities need to engage with representatives of PCP to evaluate policies for pandemic planning and management. Adequate support and protection for PCP during different stages of pandemic management should be provided.
What is known about the topic? During the influenza pandemic 2009/A/H1N1, the main burden of diagnosing and managing the patients fell on PCP. The prominent role of PCP in the 2009/A/H1N1 pandemic presents an excellent opportunity to investigate implications of pandemic policies for primary care and to tackle the possible problems that these policies may impose on the ability of PCP to effectively participate in the public health response.
What does this paper add? This paper examines policies that affected the roles of PCP in managing the influenza pandemic 2009/A/H1N1 in three countries: Australia, Israel and England. Although general evaluations of the pandemic response in different countries have previously been reported, this is the first study that focuses on policies for pandemic management at the primary care level.
What are the implications for practitioners? Practitioners (PCP and primary care workers in general) would benefit if pandemic preparedness plans were constructed to provide an adequate system of support and protection to primary care workers during different stages of pandemic management. For policy makers, this analysis may help to overhaul the strategies for primary care engagement in the pandemic response.
Additional keywords: emergency preparedness, health policy, primary health care.
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