The requirement to respect autonomy - The Royal New Zealand ...

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improving performanceFigure 1. Canterbury Pandemic CIMS structureREGIONAL CDEMCDHB INCIDENTCONTROLLERADVISORY GROUPCOMMUNICATIONSPLANNING /INTELLIGENCE(CPH)OPERATIONSLOGISTICSMANAGERWORKFORCECOMMUNITY &PUBLIC HEALTHSECONDARYPRIMARY1. Minimise transmission—‘flatten the curve’Text Box 1. Stages of the New Zealand influenza pandemicaction plan 20062. Minimise infection rate in primary health care workers3. Maintain safe, quality care within general practice and the rest of the health systemfor non-’flu patients1. Plan for it2. Keep it out (border management)3. Stamp it out (cluster control)4. Manage it5. Recover from itText Box 2. Aims of the Canterbury response4. Provide safe and accessible care for patients with ’fluit was clear that H1N1 09 was spreading extensivelyin Canterbury and a shift to ‘manage it’was announced, coinciding with the opening ofthe central city ’Flu Centre. 6From May to October 2009 there were 595 confirmedcases of pandemic influenza A (H1N1 09)in Canterbury, with 187 hospitalisations andthree deaths. Confirmed cases were only asmall minority of community cases. A randomtelephone survey of 600 households in Augustestimated that 25% of Canterbury residentshad developed an influenza-like illness in thepreceding 10 weeks, a finding consistent with asubsequent national serosurvey. 7The aim of this paper is to describe the strategiesdeveloped by range of Canterbury agenciesto work together in a co-ordinated health-ledresponse with the goal of minimising the impactof H1N1 09 in the community and maintainingeffective health care services for both influenzaand non-influenza patients.StrategiesResponse co-ordinationFrom 25 April, Canterbury District HealthBoard’s (CDHB’s) Chief Medical Officer assumedoverall leadership of the response andestablished a CIMS structure that included allmajor operations groups (see Figure 1). The responsegroup met daily throughout the response.Significant CDHB funding (up to $2.8 million)was approved to support proactive managementby the sector.324 VOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE
improving performanceThe Primary Care Coordination Room (PCCR),led by general practitioners and based at PegasusHealth—Christchurch’s largest IndependentPractitioner Organisation (IPA)—co-ordinatedpandemic activity for primary care throughoutCanterbury.Sector intelligenceThroughout the response CDHB’s public healthdivision, Community and Public Health (CPH),provided a regular web-based intelligence reportto the DHB responses in Canterbury, South Canterburyand the West Coast. The report includedinput from all local response agencies, as well asnational and international information. Accesswas available to all involved in the response, includinglinks from general practitioner intranets.CommunicationsConsistent community messages about infectioncontrol, isolation, and when and where to seekmedical advice were critical to managing patientnumbers. Canterbury’s pandemic communicationswere co-ordinated by the CDHB Communicationsteam. Key spokespeople included the ChiefMedical Officer, Medical Officers of Health andPrimary Care leaders. Prior involvement of localmedia in pandemic planning meant that most hada good understanding of the rationale for Canterbury’sH1N1 09 response, and media coveragewas largely supportive.CDHB’s influenza website www.fluinfo.org.nz wasupgraded, and between 28 April and 31 Augustthere were 21 185 site visits and 87 074 page views.Email updates, media releases and other backgroundinformation were disseminated to a widerange of community organisations. A public awarenesscampaign promoted a series of simple, brightlyillustrated messages (see Text Box 3) via a variety ofmedia, including bus shelter advertising, posters,newspaper advertising, and other print media.From 19 June to 21 August Canterbury peoplewere advised not to go to their general practitionerif they had ’flu-like symptoms but to call an0800 line which offered recorded information andthe option to speak to an operator for advice or a’Flu Centre appointment. Over two months theWhat gap this fillsWhat we already know: Influenza pandemics occur on average threetimes each century and cause significant morbidity and mortality. Reviews ofoverseas pandemic response structures have suggested that stronger linksbetween primary care and other parts of the health sector are required. Theinitial wave of the H1N1 09 pandemic was the first real test of New Zealand’spandemic preparedness.What this study adds: Canterbury’s H1N1 09 response showed thatsignificant reconfiguration of health care services, including universal red/green streaming, can be achieved if there is effective sector-wide planningand co-ordination.Text Box 3. Community messages• Stop the ’flu (accompanied all other messages)• Sick? Stay home• Cover coughs and sneezes• Wash hands• If you are worried about your ’flu symptoms call 0800 37 30 37• For more information visit www.fluinfo.org.nzFigure 2. Calls to 0800 lineline received 33 080 calls, with a daily maximumof 2183 calls and a daily late-morning peak (seeFigure 2). The call centre was managed by CDHBand staffed by a mix of contracted call centrestaff, CDHB staff, and primary care nurses.Logistics supportOnce the response was under way sector-wideprocurement became a logical extension of theVOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE 325
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