title: pH1N1 - a comparative analysis of public health responses in Ontario to the influenza outbreak, public health and primary care: lessons learned and policy suggestions.
abstract: 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.
  
  
  CONCLUSIONS
  "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.
authors.affiliation: Department of Community Health Sciences, John Buhler Research Centre, University of Manitoba, Room 564, 715 McDermot Ave, Winnipeg, MB R3E 3P4, Canada. masottip@queensu.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Masotti
authors.forename: Michael E
authors.initials: ME
authors.lastname: Green
authors.forename: Richard
authors.initials: R
authors.lastname: Birtwhistle
authors.forename: Ian
authors.initials: I
authors.lastname: Gemmill
authors.forename: Kieran
authors.initials: K
authors.lastname: Moore
authors.forename: Kathleen
authors.initials: K
authors.lastname: O'Connor
authors.forename: Adrienne
authors.initials: A
authors.lastname: Hansen-Taugher
authors.forename: Ralph
authors.initials: R
authors.lastname: Shaw
mesh_terms: D003142:Communication; D004196:Disease Outbreaks; D006076:Government; D006285:Health Planning; D006291:Health Policy; D006801:Humans; D007114:Immunization; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D009864:Ontario / Q000453:epidemiology; D058873:Pandemics; D011320:Primary Health Care; D011634:Public Health
references.citation: Med Educ. 1999 Jan;33(1):8-13
references.pmid: 10211270
references.citation: Am J Community Psychol. 2001 Apr;29(2):277-84
references.pmid: 11446282
references.citation: Healthc Q. 2006;9(2):72-6
references.pmid: 16640136
references.citation: BMJ. 1995 Aug 5;311(7001):376-80
references.pmid: 7640549