General Practice and Pandemic Influenza: A Framework for Planning and Comparison of Plans in Five Countries

Patel, Mahomed; Phillips, Christine; Pearce, Christopher; Kljakovic, Marjan; Dugdale, Paul; Glasgow, Nicholas

doi:10.1371/journal.pone.0002269

Cited by 48 publications

(63 citation statements)

References 31 publications

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“…In many countries general practitioners (GPs) play a major role in influenza epidemics, and most patients with ILI are treated in general practice or by primary care doctors on duty in OOH services [8]–[11]. Accordingly, the extra workload of influenza patients puts pressure on the primary care service during epidemics, and this is added to normal activity [10].…”

Section: Introductionmentioning

confidence: 99%

Capacity and Adaptations of General Practice during an Influenza Pandemic

et al. 2013

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BackgroundGPs play a major role in influenza epidemics, and most patients with influenza-like-illness (ILI) are treated in general practice or by primary care doctors on duty in out-of-hours services (OOH). Little is known about the surge capacity in primary care services during an influenza pandemic, and how the relationship between them changes.AimTo investigate how general practice and OOH services were used by patients during the 2009 pandemic in Norway and the impact of the pandemic on primary care services in comparison to a normal influenza season.MaterialsData from electronic remuneration claims from all OOH doctors and regular GPs for 2009.MethodsWe conducted a registry-based study of all ILI consultations in the 2009 pandemic with the 2008/09 influenza season (normal season) as baseline for comparison.ResultsThe majority (82.2%) of ILI consultations during the 2009 pandemic took place in general practice. The corresponding number in the 2008/09 season was 89.3%. Compared with general practice, the adjusted odds ratio for ILI with all other diagnoses as reference in OOH services was 1.23 (95% CI, 1.18, 1.27) for the 2008/2009 season and 1.87 (95% CI, 1.84, 1.91) for the pandemic influenza season. In total there was a 3.3-fold increase in ILI consultations during the pandemic compared to the 2008/09 season. A 5.5-fold increase of ILI consultations were observed in OOH services in comparison to the 2008/09 season. Children and young adults with ILI were the most frequent users of OOH services during influenza periods.ConclusionsThe autumn pandemic wave resulted in a significantly increased demand on primary care services. However, GPs in primary care services in Norway showed the ability to increase capacity in a situation with increased patient demand.

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Section: Introductionmentioning

confidence: 99%

Capacity and Adaptations of General Practice during an Influenza Pandemic

et al. 2013

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“…In 2008, Patel et al 3 developed a framework that can be used to facilitate the systematic planning of the primary care response to pandemic influenza and to appraise the coverage of key elements in the preparedness to deal with a pandemic. This framework consists of four functional domains that include clinical care, the internal and macro-environment of the primary care/general practice, and the public health responsibilities of doctors.…”

Section: Introductionmentioning

confidence: 99%

“…It was subsequently used to evaluate 89 publicly available jurisdictional plans in five countries. 3 Since the provision of primary care is organized differently in different countries, studying how each primary care system responds to a pandemic may generate transferable learning for other primary care systems.…”

Section: Introductionmentioning

confidence: 99%

Primary care physicians’ response to pandemic influenza in Hong Kong: a mixed quantitative and qualitative study

Wong¹,

Kung²,

Wong³

et al. 2012

International Journal of Infectious Diseases

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“…Plans elsewhere [9,10,26] and pandemic-specific ethical frameworks [19,20,27,28] encourage that preparedness decision making be deliberative and all-inclusive, with public consultations [29], and that all planned actions including social distancing and other restrictions on individual liberties be adequately explained and justified. These issues are not explicitly addressed in NISPPI.…”

Section: Planning and Coordinationmentioning

confidence: 99%

“…Thomas et al analyzed the US federal and state plans for evidence of ethical guidance [19]. Patel et al proposed a framework, which they used to appraise pandemic plans from Australia, England, USA, New Zealand and Canada [20]. DeBruin et al, drawing on their experiences from the public engagement process of Minnesota Pandemic Ethics Project, share strategies on how to achieve social justice goals in pandemic response [21].…”

Section: Introductionmentioning

confidence: 99%

Ethics-sensitivity of the Ghana national integrated strategic response plan for pandemic influenza

Laar

DeBruin

2015

BMC Med Ethics

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BackgroundMany commentators call for a more ethical approach to planning for influenza pandemics. In the developed world, some pandemic preparedness plans have already been examined from an ethical viewpoint. This paper assesses the attention given to ethics issues by the Ghana National Integrated Strategic Plan for Pandemic Influenza (NISPPI).MethodsWe critically analyzed the Ghana NISPPI’s sensitivity to ethics issues to determine how well it reflects ethical commitments and principles identified in our review of global pandemic preparedness literature, existing pandemic plans, and relevant ethics frameworks.ResultsThis paper reveals that important ethical issues have not been addressed in the Ghana NISPPI. Several important ethical issues are unanticipated, unacknowledged, and unplanned for. These include guidelines on allocation of scarce resources, the duties of healthcare workers, ethics-sensitive operational guidelines/protocols, and compensation programs. The NISPPI also pays scant attention to use of vaccines and antivirals, border issues and cooperation with neighboring countries, justification for delineated actions, and outbreak simulations. Feedback and communication plans are nebulous, while leadership, coordination, and budgeting are quite detailed. With respect to presentation, the NISPPI’s text is organized around five thematic areas. While each area implicates ethical issues, NISPPI treatment of these areas consistently fails to address them.ConclusionsOur analysis reveals a lack of consideration of ethics by the NISPPI. We contend that, while the plan’s content and fundamental assumptions provide support for implementation of the delineated public health actions, its consideration of ethical issues is poor. Deficiencies include a failure to incorporate guidelines that ensure fair distribution of scarce resources and a lack of justification for delineated procedures. Until these deficiencies are recognized and addressed, Ghana runs the risk of rolling out unjust and ethically indefensible actions with real negative effects in the event of a pandemic. Soliciting inputs from the public and consultation with ethicists during the next revision of the NISPPI will be useful in addressing these issues.

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General Practice and Pandemic Influenza: A Framework for Planning and Comparison of Plans in Five Countries

Cited by 48 publications

References 31 publications

Capacity and Adaptations of General Practice during an Influenza Pandemic

Capacity and Adaptations of General Practice during an Influenza Pandemic

Primary care physicians’ response to pandemic influenza in Hong Kong: a mixed quantitative and qualitative study

Ethics-sensitivity of the Ghana national integrated strategic response plan for pandemic influenza

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