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

Abstract

BackgroundAlthough primary health care, and in particular, general practice will be at the frontline in the response to pandemic influenza, there are no frameworks to guide systematic planning for this task or to appraise available plans for their relevance to general practice. We aimed to develop a framework that will facilitate planning for general practice, and used it to appraise pandemic plans from Australia, England, USA, New Zealand and Canada.Methodology/Principal FindingsWe adapted the Haddon matrix to develop the framework, populating its cells through a multi-method study that incorporated the peer-reviewed and grey literature, interviews with general practitioners, practice nurses and senior decision-makers, and desktop simulation exercises. We used the framework to analyse 89 publicly-available jurisdictional plans at similar managerial levels in the five countries. The framework identifies four functional domains: clinical care for influenza and other needs, public health responsibilities, the internal environment and the macro-environment of general practice. No plan addressed all four domains. Most plans either ignored or were sketchy about non-influenza clinical needs, and about the contribution of general practice to public health beyond surveillance. Collaborations between general practices were addressed in few plans, and inter-relationships with the broader health system, even less frequently.ConclusionsThis is the first study to provide a framework to guide general practice planning for pandemic influenza. The framework helped identify critical shortcomings in available plans. Engaging general practice effectively in planning is challenging, particularly where governance structures for primary health care are weak. We identify implications for practice and for research.

Capacity and Adaptations of General Practice during an Influenza Pandemic

“…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].…”

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

“…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.…”

“…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.…”

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

“…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.…”

“…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].…”