title: Influenza pandemic 2009/A/H1N1 management policies in primary care: a comparative analysis of three countries.
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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The School of Primary Health Care, Monash University, Notting Hill, Australia. marina.kunin@monash.edu
authors.forename: Marina
authors.initials: M
authors.lastname: Kunin
authors.forename: Dan
authors.initials: D
authors.lastname: Engelhard
authors.forename: Shane
authors.initials: S
authors.lastname: Thomas
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
authors.forename: Leon
authors.initials: L
authors.lastname: Piterman
mesh_terms: D001315:Australia; D015706:Bibliometrics; D003431:Cross-Cultural Comparison; D004189:Disaster Planning / Q000379:methods / Q000592:standards; D004739:England; D006291:Health Policy; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D007557:Israel; D008875:Middle Aged; D058873:Pandemics / Q000517:prevention & control*; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D014739:Victoria