Table 4.
Thematic summary of results and studies
| Theme/ Sub-theme | Epidemic | Lessons/ recommendations |
|---|---|---|
| 1. Improve collaboration, communication and integration between public health and primary care | SARS | Improve collaboration between government, primary care, public health and hospitals (11,12,30,33–36) Provincial/ Territorial governments need to work closely with local health systems to develop and integrate community pandemic preparedness plans (33) Develop mechanisms to deploy personnel between PC and acute care institutions (11) |
| H1N1 | Improve collaboration and communication between government, public health and primary care (13,14,16,29,37,38) Ensure appropriate incorporation of primary care in pandemic preparedness plans (14) The public health role of primary care needs to be integrated into public health national plans (29) Improve integration of public health and general practice responses (13) Pandemic response plans need to be contextualized to meet local needs and circumstances, informed by systematic and rigorous consultation with PCPs (15,29,38,39) Engage primary care early and effectively in planning and implementation (increased PH/ PC collaboration), and collaborate with all local stakeholders (16) Local coordination/ national liaison between PC, PHUs and other sectors (38) Local health systems need to work with the PH, PC and the community to develop pandemic preparedness. Need to consider local health networks and PH Unit geographic boundaries (16) Review of public health strategies for communication and workforce protection (13) |
|
| MERS | Improve integration of PC and PH through political and financial support and on the job professional programs for both (40) | |
| EVD | Engage extensively with communities to build trust (41) Build intersectoral relationships with education, transport, food, labour markets to manage the impact of infectious disease outbreaks on all areas of health and life (19,41) |
|
| Involve PC clinicians in pandemic response planning | SARS | Involve GPs in pandemic planning (25,34,36) |
| H1N1 | Increase input into pandemic planning by frontline clinicians, especially general practitioners (37) Direct involvement of primary care clinicians in pandemic planning will recognize and ensure adequate support and protection when undertaking these roles (29) The sense of separation that PC clinicians have from public health officials/ agents (real life/ on the ground) is something that needs to be considered as a barrier to collaboration (31) The commitments and on the ground knowledge of general practices can be harnessed and incorporated into response planning (31) |
|
| EVD | Affected communities need to be treated as essential partners in preparedness and response planning (19) Establish a structure for community-based response prior to the emergency, and then engage again with community actors early in the emergency response (19) |
|
| Improve everyday communication between PH, PC and the rest of the health system | SARS | Improve everyday communication between family physicians and the rest of the health system as a foundation for crucial involvement in outbreaks (33,34) Improve day to day communication between public health officials and clinicians, including pharmacists (30) and primary care doctors (33,35) Improve communication within and between health agencies (25) Review public health strategies for communication and workforce protection (13) |
| 2. Strengthen the primary health care system | SARS |
A shortfall in ambulatory care capacity in a system that relied almost solely on ED resulted in a call for PC reform (33) Address human resource shortages in both sectors (primary and tertiary) (34) Increase the number of family doctors, and attract students and residents (34) |
| EVD | Investment in primary health and public health systems to strengthen response to infectious diseases as well as the core capabilities of these systems. These include the management of endemic infectious diseases, which will be strengthened through enhanced surveillance and response systems, and non-infectious diseases (32) Develop a strong primary and community care system, which includes building a strong network of community health workers and PC facilities, including in remote areas (41) Need for formal recognition of traditional birth attendants (TBAs) and community health committee (CHC) members, including development of a role in planning, implementing, financing and monitoring community health initiatives (19) Provide adequate support for community health workers, including paid salaries and motivators such as opportunities for scholarships to support career development, preferential selection to work on health campaigns, education for children, micro-financing for small businesses (19) Find solutions to the financing, scale up and institutionalization of community health services, including increased government funding (19) |
|
| Support PC services in their key role as sentinel systems | SARS | Assembly of electronic surveillance data for a range of providers, including PC (33,36) Develop an active and collaborative disease surveillance system that integrates frontline and public health systems (11) Extend the sentinel surveillance system in PC (35) Support PC doctors’ role in situation monitoring and assessment – case reporting and monitoring (38) Support family doctors in their key role of sentinels through the provision of an early warning system that can be activated when needed and enable coordination between PC, emergency departments and assessment clinics (34) Create and coordinate real-time alert systems that extend to all health care facilities, including PC (33,36) Assign public health nurses to family care offices to support health promotion, disease prevention and surveillance activities (34) |
| H1N1 | Address clinician’s concerns about patient privacy to optimize comfort with data sharing (24) | |
| EVD | Parallel strengthening of primary health care and public health will enable planning and mobilization of a response at the scale required, and will enable sentinel case detection and a health system equipped to respond. Public health and PC both have capacity to act as sentinels (32) Development of a strong network of CHWs and PC facilities will enhance the sentinel role in the community (41) |
|
| 3. Provide consistent, coordinated and reliable information emanating from a trusted source | SARS | One source of consistent and accurate advice (34,35) Provide timely information and, detailed guidelines and protocols for general practice (25,26,36) and pharmacies (30) Providing accurate, prompt and transparent guidelines and information updates supports psychological needs of HCWs (27) |
| H1N1 | Provide consistent, accurate information from one single authoritative source (16,23,39) Collaborate to develop consistent messages (16) Reduce duplication of information and increase clarity (23) Need to develop specific guidelines for First Nations people (16) Designate the role of information coordinator (13) Provide multidisciplinary messaging, with linkages between clinical groups such as obstetricians, gynaecologists, GPs and infectious diseases experts and public health (39) Improve communication within and between health agencies (25) |
|
| EVD | Provision of clear and consistent guidance to CHWs and other community actors; with roles, responsibilities and lines of reporting delineated during the planning phase (19) Provide information and awareness for the public to understand why HCWs use PPE (26) The government should provide more public education during an infectious disease outbreak (25) |
|
| Provide clear and consistent guidance for the community | SARS | GPs are in a strong position to unpack some of the fear about a pandemic for their patients, while encouraging them to prepare realistically (31) |
| H1N1 | GPs are well placed to communicate with, role model and educate patients and the community regarding infection control and reducing disease spread (38) In order to meet the needs of the public need for information from a trusted source, PC providers need to receive information from health authorities ahead of the media (15) The provision of targeted messaging for distribution in general practice to the public would described some of the statistics that they see in the media and assist in allaying some fears (31) GPs are a local community resource, and can also feed community concerns back to national authorities (38) |
|
| EVD | Establish a network of community health workers embedded in communities prior to disease outbreaks, to ensure established relationships that can be relied on during emergencies (41) | |
| 4. Define the role of PC during pandemics | SARS & H1N1 | PC physicians need to be fully informed from the outset of their roles and the support they will be provided to implement the response (16,29,30,35,36) |
|
PC clinicians need to be aware of pandemic preparedness plans |
H1N1 | PC clinicians need to have access to a PC action plan prior to a disease outbreak. All staff - administrative and clinical need to understand their roles in these plans (38) PC clinicians need to be aware of and familiar with pandemic guidelines in order to conform (15) Implementation of business continuity plans is best supported through familiarity with the national pandemic preparedness plan (17) Leadership within general practice is important, in particular in relation to ensuring practice plans are in place and implemented and identifying and supporting vulnerable patients and staff (39) Clinics should assess practice capacity to perform both PH and PC roles, including hygiene protocols and disaster plans, and a ’flu champion’ (13) |
| Provide pandemic preparedness training | SARS | Provide staff education via face-to-face workshops (25) |
| H1N1 | Opportunities to test pandemic plans can lead to improved links between policy makers and clinicians (37) | |
| Provide PC-tailored infection prevention and control training | SARS | Develop guidelines for infection prevention and control for PC (12) Provide timely and relevant information and training for PCPs regarding the infectious disease outbreak and associated requirement for use of PPE (26,30,34) Incorporate infection prevention and control training for PC practitioners and staff of residential aged care facilities (35) Include infection prevention and control training in ongoing medical education (11) |
| H1N1 | Elucidate the education needs of PC providers and provide relevant education about how to deal with the infectious disease outbreak (28) Infection prevention and control guidelines need to consider the infrastructure and resource capacity of PC, including the importance of personalized communication between clinicians and patients (15) Explore the reasons for a lack of handwashing amongst doctors and find ways to reduce this risky behaviour (28) |
|
| MERS | Increase education about handwashing among frontline doctors (28) | |
| SARS | Increased availability of infectious disease education and training and find ways to increase attendance (22) | |
| Clarify pathways of care for potential and diagnosed cases, and maintain access to regular health care | H1N1 | Set up screening stations away from clinics, and suspected or diagnosed patients sent straight to hospital for treatment (27) Use of centralized assessment centres (25) Planning to enable effective segregation of suspected cases from others (15) Set up designated influenza assessment centres (13,16) |
| EVD | Reduce spread of disease - maintain regular health care alongside flu-like illnesses, home care when possible, management of stable patients released early from hospital (38) Divert influenza like illnesses to ensure maintenance of routine care, e.g. assign worried well to a nurse (13) It is essential to consider the unintended consequences of putting aside usual care during disease outbreaks (21) The consequences of a pandemic on all aspects of health care need to be considered, so as to avoid preventable morbidity and mortality (18) Continuation of proven effective health interventions needs to be considered to mitigate poor outcomes for babies, mothers and families (18) Trusted community based health workers are essential in providing continued access to PC are essential during a pandemic (20) |
|
| 5. Protect the PC workforce and the community Promote health protective behaviours, psychological wellbeing and business continuity |
SARS | Provide government support for PC doctors in the form of financial support and a centrally organized contingency plan to mitigate their exposure to risks during infectious disease outbreaks (12) The psychological wellbeing of HCWs is supported through clarity of information and guidelines, pathways of care and availability of personal protective equipment PPE (27,34) Support PC clinicians to work to their best to avoid unwarranted psychological stress (16) Need for simple and timely approval processes for laboratory tests and rapid provision of results (13) |
| Identify vulnerable and at risk groups | H1N1 | Identify vulnerable and at risk patients and staff for health protection (38,39) |
| Ensure access to personal protective equipment (PPE) | SARS | Ensure access to adequate supplies of PPE to PC (27,33–35) Reliable sources of supplies and equipment required (34) Provide financial and practical support for family doctors to obtain PPE (25,26) |
| H1N1 | Ensure access to adequate supplies of PPE to PC (31,39), particularly for vulnerable staff and patients (39) Transparency of the size of the PPE stockpile and process for distribution, including development of a mechanism to ensure ready release of PPE to general practices in the states and territories (14) |
|
| Ensure access to antiviral treatments and influenza vaccines | SARS | Provide staff vaccinations (25) |
| H1N1 | Address the need for personal and family protection of HCP during a pandemic (16) Need for availability of antiviral therapies as requested, in particular before staff become symptomatic (14) Ensure adequate access to antivirals, particularly for vulnerable staff and patients (39) |
|
| Provide clear guidance for use of antiviral treatments | H1N1 | Guidelines for use of antiviral therapy would be improved if they were adjusted to consider severity of cases (15) Provide guidelines to ensure that PC clinicians are familiar with antiviral therapies (15) The provision of clear guidelines to alleviate GPs’ burden of having to make decisions/ choices when it came to the provision of antivirals and possibly other treatments (31) |
| 6. Evaluate the effectiveness of interventions | H1N1 | Conduct clinical audits to assess structure, process and outcomes of PC action plans (38) Determine effective interventions to increase uptake of the influenza vaccine amongst HCWs (28) |
| EVD | Routine, rigorous assessment of the program should be included in countries’ monitoring and evaluation plans (e.g. training, supervision, drug supplies, accessibility) (19) |