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

improving performanceFigure 3. ‘Flu Centre attendanceCDHB logistics role. CDHB also co-ordinatedsome sector-wide workforce requirements, includingprovision of clinical staff for the 0800 line.Border and cluster controlDuring the containment phase, CDHB’s CPH undertookborder and cluster control. Public healthnurses met all international flights arriving inChristchurch from 28 April to 3 July. While fewpassengers presented at the airport, subsequentpresentation of recent travellers to general practicewas more common, and a combined public health /primary care screening clinic was established toassess patients who met the suspect case definitioneither at the border or in the community.During this phase, public health staff also arrangedisolation of patients meeting the casedefinition. This included an arrangement witha Christchurch hotel to accommodate travellersnot able to be quarantined at home. Once acase was confirmed, their in-flight and domesticcontacts were traced, asked to remain in homequarantine, and provided with prophylacticOseltamivir (Tamiflu ® ). By 19 June, Oseltamivirhad been provided to over 780 cases and contactsin Canterbury.Aranui ClinicThe initial large cluster of cases in Christchurch’sSamoan community stretched resources. Inresponse to this, Christchurch’s first ’Flu Centrewas set up in Aranui, at the heart of the affectedcommunity. The centre saw 141 patients overthree days, and was primary care–led with strongsupport from CPH and local Samoan communityleaders. The clinic bridged the ‘stamp it out’ and‘manage it’ phases, and for the first time in theresponse, patient and contact management wasbased largely on clinical diagnosis, rather thanrelying on laboratory confirmation.Central city ’Flu CentreThe formal move to ‘manage it’ on 19 June wasmarked by the initiation of the 0800 line andthe opening of the central city ’Flu Centre. Asthe pandemic progressed, the severity of illnessin patients seen at the ’Flu Centre also increased,requiring additional staff resources and equipment.Staffing was initially a mix of primary andsecondary care doctors, nurses and administrationstaff, but clinical staffing drew more heavily fromprimary care as the pandemic progressed. Thededicated information system was populated withdemographic data from the primary care database.Patient volume and patient characteristics at the’Flu Centre were reported daily in the CDHB intelligencereport, and were an important indicatorof the progression of the pandemic and of overalldemand for services. The centre worked closelywith the Emergency Department, 24 Hour Surgeryand other after-hours clinics and saw 5092individual patients with a total of 6227 visitsbetween 19 June and 18 August (see Figure 3).Rural ’flu centresEight other ’flu centres were opened in ruralareas as demand required. These generally weresmall community cooperative ventures with localauthority support operating in close associationwith the local general practices. Between22 June and 11 August they saw 706 patients.Logistic support, communications, and sometimesappointment bookings for these rural centres occurredthrough the PCCR and 0800 line.Institutionalised and high risk patientsImmobile institutionalised patients and patientswith risk factors qualifying them for Osel-326 VOLUME 2 • NUMBER 4 • DECEMBER 2010 J OURNAL OF PRIMARY HEALTH CARE