pH1N1 - a comparative analysis of public health responses in Ontario to the influenza outbreak, public health and primary care: lessons learned and policy suggestions

BMC Public Health

Ralph Shaw¹  Adrienne Hansen-Taugher⁴  Kathleen O’Connor⁴  Kieran Moore⁴  Ian Gemmill⁴  Richard Birtwhistle³  Michael E Green⁵  Paul Masotti² 

[1] Centre for Health Services and Policy Research, Queen’s University, Abramsky Hall 3rd Floor, 21 Arch Street, Kingston, Ontario, Canada K7L 2N6;Department of Community Health Sciences, John Buhler Research Centre, University of Manitoba, Room 564, 715 McDermot Ave, Winnipeg, MB R3E 3P4, Canada;Departments of Family Medicine and Public Health Sciences, Centre for Studies in Primary Care, Queen’s University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, Canada K7L 5E9;Kingston, Frontenac and Lennox & Addington Public Health, 221 Portsmouth Ave, Kingston, Ontario, Canada K7M 1V5;Departments of Family Medicine and Public Health Sciences, Queen’s University, Abramsky Hall 3rd Floor, 21 Arch Street, Kingston, Ontario, Canada K7L 2N6

关键词: Public health policy;    Mass immunization;    Primary care;    Public health;    Influenza responses;    Pandemic influenza plans;    pH1N1;   

Others  :  1161995
DOI  :  10.1186/1471-2458-13-687

 received in 2013-02-20, accepted in 2013-07-26,  发布年份 2013

【 摘 要 】

Background

Ontario’s 36 Public Health Units (PHUs) were responsible for implementing the H1N1 Pandemic Influenza Plans (PIPs) to address the first pandemic influenza virus in over 40 years. It was the first under conditions which permitted mass immunization. This is therefore the first opportunity to learn and document what worked well, and did not work well, in Ontario’s response to pH1N1, and to make recommendations based on experience.

Methods

Our objectives were to: describe the PIP models, obtain perceptions on outcomes, lessons learned and to solicit policy suggestions for improvement. We conducted a 3-phase comparative analysis study comprised of semi-structured key informant interviews with local Medical Officers of Health (n = 29 of 36), and Primary Care Physicians (n = 20) and in Phase 3 with provincial Chief-Medical Officers of Health (n = 6) and a provincial Medical Organization. Phase 2 data came from a Pan-Ontario symposium (n = 44) comprised leaders representing: Public Health, Primary Care, Provincial and Federal Government.

Results

PIPs varied resulting in diverse experiences and lessons learned. This was in part due to different PHU characteristics that included: degree of planning, PHU and Primary Care capacity, population, geographic and relationships with Primary Care. Main lessons learned were: 1) Planning should be more comprehensive and operationalized at all levels. 2) Improve national and provincial communication strategies and eliminate contradictory messages from different sources. 3) An integrated community-wide response may be the best approach to decrease the impact of a pandemic. 4) The best Mass Immunization models can be quickly implemented and have high immunization rates. They should be flexible and allow for incremental responses that are based upon: i) pandemic severity, ii) local health system, population and geographic characteristics, iii) immunization objectives, and iv) vaccine supply.

Conclusion

“We were very lucky that pH1N1 was not more severe.” Consensus existed for more detailed planning and the inclusion of multiple health system and community stakeholders. PIPs should be flexible, allow for incremental responses and have important decisions (E.g., under which conditions Public Health, Primary Care, Pharmacists or others act as vaccine delivery agents.) made prior to a crisis.

【 授权许可】

   
2013 Masotti et al.; licensee BioMed Central Ltd.

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