| Mass Immunization Models |
| What are the characteristics of a good Mass Immunization Delivery Model? | |
During the Phase-1 key informant interviews, respondents generally indicated that they did not know the best approach for all local Public Health Units most of which had differing population demographic characteristics, local community infrastructure, and significantly different capacities to respond. One (often heatedly discussed) component of this issue was whether or not, and if so, how to best engage and utilize primary care providers as vaccine delivery agents, in the event of an influenza pandemic.
When put to the symposium participants, consensus formed around five key concepts:
Table 3.1.1: Mass Immunization Models - What are the characteristics of a good Mass Immunization Model|
Rank
|
Characteristic
(Top 4 by 42 voters)
|
Response / Comment
|
|---|
|
1
|
Communication
|
Clearly communicated plans to the target population, providers
&community stakeholders. Messages should be coordinated, clear, consistent and ideally come from one source.
| |
2
|
Sound Logistics
|
The model should have efficient delivery, easy access and defined procedures. The vaccine should be effective, safe and easily administered. (For example, use a web-based booking system that is accessible by physicians, public health, and other vaccine delivery agents.)
| |
3
|
Culture & Collaboration
|
A culture of "whole system responsibility" for immunization so that all resources in the system can be leveraged (i.e. Public Health, primary care, specialist offices, paramedics, pharmacists, etc.)
| |
4
|
Effective Pre-Planning
|
Pre-planning that includes primary care, public health, hospitals etc., and which is in place before it's needed. (e.g., a Hybrid vaccine delivery model with local engagement and integration and which maximizes accessibility and the use of existing immunizers in the community.)
| |
5
|
Consistent and Flexible
|
The model must be uniform and consistent in the principles of delivery and flexible in the operationalization of the delivery of the immunization. It must be adaptable to local needs.
|
- Communication: Any program to deliver mass immunization should clearly communicate its operational plans to the target population, to healthcare providers and to all community stakeholders. It must be two-way, in that communication should also include real time data collection to better understand infection rates, who are receiving vaccination and to quickly flag any adverse events. Messages to stakeholders that update a program's status, and might be delivered over the duration of a pandemic event, should be coordinated, clear and consistent and, ideally, should come from a single local authoritative source.
- Sound Logistics: The model should provide for efficient delivery, easy access and defined procedures. Where possible, it should avail itself of current technology, such as a web-based booking system, for example. Such as system should be accessible by physicians, who might easily identify vulnerable populations (pregnant women, asthmatics, young children) from their patient roster, and public health unit, which as the primary vaccine delivery agent (VDA), run mass immunization clinics. PHUs clinics (and other vaccine delivery agents) could then electronically receive prescriptions for those patients who qualify as members of a vulnerable population, and easily schedule specific blocks of time for the efficient inoculation of those special patients.
- Culture & Collaboration: A mass immunization model should work to cultivate a culture of "whole system responsibility" for the immunization of the subject population, so that all resources in the healthcare system can be effectively utilized (i.e.: Public Health, Primary Care, Medical Specialists, Paramedics, Pharmacists, etc.).
- Effective Pre-Planning: If the mass immunization model is to be effective, its implementation plan needs to be in place before it is needed. This is especially true in the case of a 'hybrid vaccine delivery model' that would call for the local engagement and integration of primary care, public health, hospitals, etc., in order to maximize accessibility through the use of all vaccine delivery agents in the community.
- Consistent and Flexible: The provincial model must be uniform and consistent in its overall principles for mass immunization, yet at the same time, be flexible and scalable in the delivery of vaccine. While egalitarian in its approach, it should be able to accommodate local and regional circumstances, such as variation in a given influenza's severity or the availability of vaccine, and be sufficiently adaptable to meet the specifics of local needs, as required.
| | What should we do to improve our ability to respond the next time? | |
As a corollary to the question addressing the characteristics of a mass immunization delivery model, Phase-1 key informants were asked to suggest ways to improve their existing model. Many, often diverse, ideas were forthcoming. Thus, the Phase-2 symposium participants were asked list the top four actions or activities which, if undertaken, would improve the ability to respond to a future pandemic.
The responses that emerged broadly called for more and better planning, planning that should include more community stakeholders and healthcare providers, improved communication with the public and community stakeholders and possible partners, better identification and planning for key logistical elements, improved local health system integration, and improved access to local epidemiology. Again, consensus was formed around five concepts (some of which developed earlier responses, further).
Table 3.1.2: Mass Immunization Models - What should we do to improve our ability to respond the next time?|
Rank
|
Action
(Top 4 by 40 voters)
|
Response / Comment
|
|---|
|
1
|
Pre-planning
|
Improved pre-planning that addresses areas such as: funding, waiting areas, scheduling, vulnerable populations outreach and collaborating with community partners. Develop a plan and the relationships NOW between public health and primary care - both generally and specific to pandemic planning
| |
2*
[*tied]
|
Communicate Early & Often
|
Communicate importance of vaccination even before vaccine is available. Provide information and education about the "who and why" for any priority groups. Designate a single central communication centre from the leader of the process.
| |
2*
|
Have Logistics in Place
|
The plan should be operationalized with components 'in place': electronic management system / asset database, stockpile of supplies, memorandum of understandings with partners (e.g., EMS, nursing schools etc) to assist with immunization, and mechanisms to ensure surge capacity (e.g., immunization competency training, & logistics planning methodology/ decision making trees).
| |
3
|
Communicate with Family Physicians
|
Early open communication. Simplified protocols. Ongoing and direct lines of communication for health professionals
| |
4
|
Improved Access to Local Epidemiology
|
Surveillance (international, national & local), real time with meaningful measures. Accurate tracking systems to develop a scalable response in terms of human resources and vaccine delivery at multiple levels (e.g., urban, rural, Aboriginal remote).
|
- Pre-Planning: It was broadly felt that advanced planning that specifically addresses, in detail, areas such as: funding, waiting areas, scheduling, vulnerable populations outreach and collaborating with community partners would improve the Public Health response to a pandemic. Activities designed specifically to plan and develop the relationships between public health and local primary care - both generally and specific to pandemic planning - need to be initiated now while the opportunity to nurture such relationships exist, and in ways that will not be possible in the face of an emergency.
- Communicate Early and Often: The value of communicating the importance of vaccination to the public, even before vaccine is available, was emphasized. Keeping the public well informed by providing information and education was seen as a means to reduce public anxiety in a stressful situation. It would, for example, increase public acceptance of directives about the "who and why" for any priority groups. A key element of this strategy is to designate a single communication centre so that all messages will be vetted by the leader of the process, will not be contradictory and will, thereby, minimize the potential for confusion among the public.
- Have Logistics in Place: The plan should roll out with logistic components already 'in place'. Such elements might include: electronic database, stockpile of supplies, memorandum of understandings with partners that might assist with immunization (e.g.: EMS, unions, CHCs, nursing agencies, nursing schools, etc.), and mechanisms to ensure surge capacity (e.g.: immunization competency training, operational contingency plans which would include decision making trees).
- Communicate with Family Physicians: Whether or not the mass immunization model calls for the use of family physicians as vaccine delivery agents, they remain primary healthcare providers and should, thus, be kept well informed about the PHU's operational plans for dealing with an influenza pandemic. The PHU should maintain a dedicated line of communications specifically for healthcare professionals, whether it be a password accessed website or a mass telephone messaging update service. Communication should be early and open, ongoing and direct. As well, if Primary Care are to be enlisted as VDAs, the requisite protocols should be known beforehand, and be simple to put into operation.
- Improved Access to Accurate Local Epidemiology: All surveillance of a pandemic's progress (international, national & local) should be in 'real time' and should be gathered and reported using meaningful measures. Accurate tracking systems are essential to the development of a scalable local response in terms of human resource requirements, size, capacity, location and frequency of clinics, and the specific logistics of vaccine delivery at multiple levels (e.g., urban, rural, Aboriginal remote).
|
|
| Influenza Assessment Centre |
|
While the Phase-1 interview instrument did not include questions to specifically address Influenza Assessment Centres (FACs), this problematic topic emerged as recurring theme when the key informants were asked for their 'Additional Comments or Suggestions'. FACs were therefore included as a subject for discussion at the symposium.
| What do we need to do differently to improve our ability to respond? | |
Following a facilitated discussion, the participants were asked to choose the three most important ideas from the Large Group List created in response to this question. Consensus formed around seven ideas.
Table 3.2.1: Influenza Assessment Centres - What do we need to do differently to improve our ability to respond?|
Rank
|
Action
(Top 5 by 40 voters)
|
Response / Comment
|
|---|
|
1
|
Pre-Planning!
|
Have an implementable plan, predetermine resource/financial implications and pre-arrange equitable funding for staff and equipment, etc., in order to meet established standards.
| |
2
|
Governance / Responsibility
|
Clarify accountabilities / roles /responsibilities: Determine who is responsible for operating Influenza Assessment Centres (IFCs) and delineate clear lines of responsibility. (Primary care is best equipped. LHINs should be involved / accountable.)
| |
3
|
Clearly Identify Triggers
|
Establish clearly identified triggers to implement Influenza Assessment Centre protocols. (e.g.: syndromic surveillance systems, ER visits etc.)
| |
4
|
Improved Surveillance
|
Improve the surveillance system so that impact on local health care system can be identified and timing of opening of FAC can be most appropriate. Identify resources (HR, space, funding) so that opening an FAC does not impact local healthcare community.
| |
5
|
Integrate & Coordinate Collaboration w/ Primary Care
|
Establish an integrated and coordinated collaboration with primary care and the acute care sector that includes an evaluation process ensuring economic, equitable, efficient use of resources.
| |
6
|
Contingency Funding
|
Funds for urgent situations (non-declared emergency) needs to be set aside (i.e.: budgeted) at the provincial level
| |
7
|
Evaluation
|
Let us debrief, and review the evidence for influenza assessments centers. Determine if they changed outcomes and processes?
|
- Pre-planning: If a PIP calls for the use of FACs, an implementable plan detailing the logistics for 'how' and 'where' they are to be rolled out, and the 'when and 'what to do' to be communicated to the public, should all be in place, beforehand. Since local levels of healthcare capacity and the availability of primary care resources vary across the province, the implications of deploying those local human, physical and financial resources required to run an FAC should be considered and well understood, a priori, during the planning process. Access to adequate clinic locations, availability of appropriate supplies (from proper needles and masks to the facilities for their proper disposal, etc.), as well as a commitment on the part of the province to ensure there will be sufficient additional funding to employ staff and to purchase or lease the necessary equipment, all need to be pre-arranged.
- Governance & Responsibility: It is important to establish who is responsible for operating FACs and to delineate clear lines of responsibility and authority. Currently this is not stated, explicitly, in provincial policy: Public Health has the mandate; Primary Care practitioners have the legislated authority to make diagnoses (and may be the best equipped to run FACs); LHINs have not been involved, yet may actually be accountable.
-
Clear Triggers: Clearly identified triggers need to be predetermined and agreed upon by community and healthcare stakeholders in order to clearly identify 'when' to implement FAC protocols. These triggers may be informed by syndromic surveillance systems, hospital emergency department visits, walk-in clinic volumes, etc.
- Surveillance System: An improved surveillance system should be developed and implemented so that the potential impact on local healthcare systems can be identified such that FACs can be opened at the most appropriate time. Healthcare human resources (HHR), physical space and funding that will be required should be predetermined and sourced so that opening an FAC does not negatively impact the effectiveness of the local healthcare community.
- Integrate & Coordinate Collaboration w/ Primary Care: The success of FACs in the future will lie in integrated, coordinated collaboration with primary care and the acute care sector. This will include an evaluation process to ensure future economic, equitable, and efficient use of healthcare HHR, physical and financial resources.
- Funding: At the provincial level, a policy mechanism to establish special funds to support urgent (non-declared emergency) situations needs to be enabled in order to earmark and set aside sufficient resources to permit FACs to be set-up and run as an ad hoc, 'when & where needed', short term response to future pandemics.
- Evaluation: As a post-pH1N1 activity, the Ministry should sponsor a formal, local/provincial level, debriefing process to review the evidence for Influenza Assessments Centers. Before FACs become a fixed element of any planned response to a future influenza pandemic, research should verify whether or not they actually have the potential to change response outcomes and processes.
| | Influenza Assessment Centres: Who should take the lead? | |
There was a strong perception among participants that the Public Health Units had been expected to take the lead in developing and implementing FAC policies and procedures. However, Public Health representatives expressed concerns about whether PHUs were the most appropriately entity equipped to run FACs, from a responsibility / authority point of view, noting also, that at the time, most PHUs' resources had already been stretched thin, dealing with other aspects of local plans to deal with the influenza pandemic. To further complicate the issue, participants generally agreed that the answer to 'Who should take the lead in developing FAC policies and procedures?' is not necessarily the same as the answer to 'Who should operate FACs?'. Clearly, this issue remains unresolved. There was strong consensus that policy surrounding all aspects of FACs needs to be addressed at both the local and provincial levels. When participants were asked to identify the single most appropriate organization they felt should take the lead, while LHINs garnered the most votes, there was no clear consensus.
Table 3.2.2: Influenza Assessment Centres - Who should take the lead?|
Rank
|
Vote Count
(First choice by 40 voters)
|
Response / Comment
|
|---|
|
1
|
12
|
LHINs
| |
2
|
10
|
Hybrid Model: A collaboration of multiple health system partners
| |
3
|
7
|
Public Health Units
| |
4
|
5
|
Primary Care: (e.g., Family Health Teams, Community Health Centres, Ont. College of Family Physicians, Nurse Practitioners Association of Ontario, Local Family Medicine Departments in Hospitals)
| |
5*
[*tied]
|
3
|
Acute Care (e.g., Hospital Chief of Staff, Emergency Department)
| |
5*
|
3
|
MOHLTC
| |
6
|
0
|
Emergency Management Ontario
|
30% Local health Integration Networks (LHINs)
20% Hybrid Model: A collaboration of multiple healthcare system partners
18% Public Health Units
13% Primary Care (e.g.: Family Health Teams, Community Health Centres, Ont. College of Family Physicians, Nurse Practitioners Assn of Ontario, Local Family Medicine Departments in Hospitals)
8% Acute Care: (e.g.: Hospital Chief of Staff, Emergency Department)
8% Ministry of Health and Long-Term Care (MOHLTC)
0% Emergency Management Ontario (EMO)
|
|
| Effective Partnerships: Public Health & Primary Care |
During the Phase-1 interviews, each of the Public Health and Primary Care key informants was asked to describe the role of the other group and rate the level of collaboration that they experienced during both the development and implementation stages of the local plan for an influenza pandemic. The choices available ranged from virtually no networking or information exchange to a level of solid collaboration, for each phase. Full collaboration implied a high level of trust among partners that involved a sharing of risks, resources and rewards. While there were notable exceptions, both camps indicated that, in general, there was minimal collaboration between Public Health and Primary Care during either the development of the PIP or during its implementation. Almost everyone interviewed expressed the view that there should be strong collaboration between these two groups when both developing implementing local PIPs. It was also generally agreed that these partnerships should be nurtured both locally and provincially. It was the strength and adamancy of the responses during the Phase-1 key informant interviews that placed the topic on the symposium agenda.
At the symposium, the criteria for the seating arrangements were changed so that, while the broad groupings by PHU description were held, the participants were reassigned by their affiliation with Public Health or Primary Care. The consensus process of creating small-group lists, then large-group lists, and then voting to rank the responses, remained the same.
| What can Public Health or other Government Organizations do to facilitate partnerships and better engage Primary Care? | |
The primary care participants were asked to choose the four most important ideas from the Large Group List created for this topic. Consensus formed around five ideas.
Table 3.3.1: Effective Partnerships: Public Health and Primary Care - What can Public Health or other Government Organizations do to facilitate partnerships and better engage Primary Care? [Note - This question was answered only by the Primary Care participants.]|
Rank
|
Action
(Top 5 by 13 voters)
|
Response / Comment
|
|---|
|
1
|
Be Proactive
|
Implement an approach which engages Public Health and Primary Care in areas of mutual interest for health. (E.g.: Build relationships with Primary Care - beforehand - not in the time of crisis; and, create regular opportunities to communicate and establish relationships & communication pathways.)
| |
2
|
Building Networks
|
Develop Primary Care and Public Health networks in each region (e.g., between Primary Care leaders, Associate Medical Officers of Health, and Staff)
| |
3
|
Empower Liaison
|
Identify and authorize dedicated liaison for Public Health who has the responsibility to communicate with Primary Care.
| |
4
|
Engage Primary Care
|
Engage primary care where it meets - Go to them for clinic days, family medicine rounds, and CME events.
| |
5
|
Identify Primary Care Leaders
|
Public Health could identify and engage key primary care leadership in the various local medical communities (e.g., practice groups, or physician leads of Family Health Network, Family Health Groups and Family Health Organizations.
|
- Proactive Approach: Implement an approach which engages Public Health and Primary Care in areas of mutual interest for healthcare. Build relationships with Primary Care, now, not in the time of crisis, by creating regular opportunities to communicate and establish relationships develop communication pathways. PHUs could use regular visits to FHTs, etc. as an informal avenue to create professional relationships and form bonds as a foundation for future partnerships.
- Network Building: Develop formal Primary Care and Public Health regional networks between Primary Care leaders, and Medical Officers of Health, Associate MOHs and staff.
- Liaison: Identify a dedicated liaison within the Public Health Unit who has the specific responsibility to communicate with Primary Care.
- Location & Setting: Engage Primary Care where it meets regularly by attending (and presenting) at clinic days, family medicine rounds and Continuing Medication Education events, etc.
- Leaders: Public Health could identify and engage the key primary care leadership in the various local medical communities (e.g.: practice groups, or physician leads of Family Health Teams, Family Health Networks, Family Health Groups and Family Health Organizations.)
| | What can Medical Organizations and local Primary Care do to facilitate partnerships and better engage Public Health? |
The Public Health participants were asked to choose the four most important ideas from the Large Group List created for this question. Consensus formed around seven ideas (the last four receiving an equal number of votes).
Table 3.3.2: Effective Partnerships: Public Health & Primary Care: What can Medical Organizations and local Primary Care do to facilitate partnerships and better engage Public Health? [Note - This question was answered only by the Public Health, Gov't or Other participants.]|
Rank
|
Action
(Top 4 by 23 voters)
|
Response / Comment
|
|---|
|
1
|
Establish & support networks
|
Establish and support networks - Invite Public Health to attend primary care events (meetings, rounds, etc.) and discuss common issues. Get Primary Care associations (e.g.: Association of Ontario's Health Centres), etc. working with Public Health associations (e.g.: Association of Local Public Health Agencies)
| |
2
|
Designated champion
|
Require Family Health Teams, Family Health Groups, etc., to establish a lead contact person with Public Health.
| |
3
|
Share Accountability
|
Shared accountability for guidelines documents by OMA, CPSO, OAHPP and MOHLTC
| |
4*
[*tied]
|
Structure Medical Organizations
|
Better structure for medical organizations, such as OMA, to facilitate the local integration of primary care and work as representatives in engagement with Public Health.
| |
4*
|
Create Incentives
|
Create Incentives (funding, accreditation): Participate in development of population goals and their achievement through models of compensation structure.
| |
4*
|
Partnering w/ Public Health
|
Promote partnering through the electronic health record for population-based assessments.
| |
4*
|
Market Public Health
|
Market Public Health to Primary Care - enhance awareness by building a profile of exactly what Public Health does.
|
- Networks: Primary Care practitioners should establish and actively support networks that include Public Health representatives. This might involve inviting representatives of PHUs to FHT staff meetings, to discuss common issues.
- Designated Champion: Family Health Teams, Family Health Groups, etc., should establish a lead contact person to liaise with Public Health. It is well known that the most successful programs, of all sorts, are brought about at the hands of an enthusiastic champion.
- Shared Accountability: More than merely seeking input when developing guidelines or documents for which there is an apparent shared interest, it would be mutually beneficial for health promotion and health provider organizations, such as: the Ontario Medical Associations (OMA), College of Family Physicians of Ontario (CFPO), the College of Physicians and Surgeons of Ontario (CPSO), Ontario Agency for Health Protection and Promotion (OAHPP), as well as the Ministry of Health and Long Term Care (MOHLTC) to seek out and formally establish a shared accountability and, thereby, a shared commitment, with Public Health organizing bodies such as: the Association of Local Public Health Agencies (aLPHA) and the Public Health Association of Canada (PHAC).
- Better Structure for Medical Organizations: Provincial healthcare organizational bodies, such as the OMA, and perhaps the appropriate Colleges, should use their overarching authority to create local representative bodies with the goal to better facilitate the local integration of primary healthcare, which, at the same time, could serve to represent local Primary Care in engaging with local Public Health.
- Incentives: The Ministry, the OMA and the Colleges should consider introducing funding and accreditation incentives into the structure of provincial compensation models (such as, through CME programs and the fee schedule) to reward Primary Care practitioners for participating in the development and achievement of population healthcare goals.
- Electronic Health Record: Agreements should be negotiated between Primary Care and Public Health to facilitate use of the electronic health record to quickly inform vulnerable populations, for example, in order to facilitate priority inoculation or other forms of population-based assessments.
- 'Market' Public Health: Primary Care and Public Health organizations need to work together to raise the profile and build awareness among primary care practitioners, of exactly what it is that Public Health does in the local and regional healthcare community; in effect: to 'market' Public Health to Primary Care.
|
|
| Information and Research Needs |
What additional information do we need from research or other sources to develop a better response?
Using the term 'research' implies a single project, or a set of structured projects, designed to the collect facts and data about a specific subject in order to answer one question, or a series of related questions. In the context of a pandemic, 'information' can be equated with 'intelligence gathering', or the assembling and communication of facts and knowledge. It suggests monitoring a stream of data with the aim of keeping the recipient(s) updated with the most current status of a situation or circumstance. Information is gathered to inform the decision making process.
The symposium participants chose to focus more on their 'information' needs, with healthcare data surveillance emerging was one of the main themes. In this case, surveillance included monitoring emergency department syndromic surveillance, sentinel data from primary care, local pandemic epidemiological data, real time service utilization data and data on who has been vaccinated, faster laboratory test results, and information used to trigger influenza assessment centres. They wanted surveillance to be regular, faster and better.
When asked to choose the four most important ideas from the Large Group List relating to information and research needs, consensus formed around six responses.
Table 3.4.1: Information and Research Needs - What additional information do we need from research or other sources to develop a better response?|
Rank
|
Information
(n = 30 voters)
|
Response / Comment
|
|---|
|
1
|
Surveillance / Hospital Information
|
Hospital information should to be collected on a regular basis. Implement the Kingston model (i.e., Emergency Department Syndromic Surveillance system - EDSS). Need Province-wide real- time syndromic surveillance.
| |
2
|
Clinical Guidelines / Information
|
Credible, up to date and easily interpreted information and clinical guidelines in an easily accessible medium.
| |
3
|
Indicators / Triggers
|
Defining indicators and "trigger" points to indicate when the system is overwhelmed in order to initiate emergency response.
| |
4
|
Real-time Service Utilization Data
|
Real-time service utilization data to allow for timely resource re- allocation. This could include spatial mapping and severity index
| |
5
|
Patient / Public Behaviour
|
How to change client behaviour in response to a pandemic.
| |
6
|
Sentinel Data
|
Improve sentinel data from primary care physicians. Information from Primary Care physician offices that see patients with Influenza Like Illnesses (ILI)
|
Surveillance of Hospital Information: Used province-wide on a regular basis, a comprehensive and readily deployable, real-time (i.e., within 24 hours) syndromic surveillance program to collect regional hospital information could identify outbreaks well in advance of traditional reporting systems. Implementing the Kingston model [Emergency Department Syndromic Surveillance System (EDSS)], province-wide, would provide local intelligence on a pandemic to PHUs and, when aggregated daily, would provide an accurate real-time 'snapshot' of a pandemic's status, across the province.
Clinical Guidelines & Information: Credible, up-to-date and easily interpreted information and clinical guidelines, specific to a given pandemic, should be made available in a timely fashion, by way of an easily accessible medium, such as social media or a website providing password access for healthcare workers.
Indicators / Triggers: A critical element of any plan for an influenza pandemic is to know exactly when and how it needs to be initiated. While it is vital to monitor the appropriate defining indicators (as opposed to just those indicators that are easy to monitor), it is also vital to have properly identified and predefined "trigger" points to indicate when the healthcare system is being overwhelmed and, thus, to clearly signal that it is time to initiate specified elements of the PIP. Central to this is the need for data standardization across the province, in that all regions must be gathering and aggregating data for the same set of indicators.
Real-time Service Utilization: It is important to monitor the day-to-day use of community healthcare services to allow for timely resource re-allocation. This could include spatial mapping and severity index
Patient / Public Behaviour: Research is required into how best to change client behaviour, specifically in response to a pandemic; from hand washing, to what to expect from anti-virals, to how and why to use individual isolation to curtail the propagation of a pandemic across a community.
Sentinel Data: A communication protocol needs to be instituted to create a secure two-way interface between Public Health and Primary Care that will, for example, inform physicians and the PHUs who of the physicians' patients have been vaccinated (either at the practice or at a PHU clinic), and will allow Public Health to monitor the number of patients presenting at a physician's office with 'influenza like illnesses' (ILI).
|
| Individual Comments and Policy Suggestions |
What other things do we need to consider, do differently, or improve in order to develop a better overall response?
In an effort to ensure all possible comments and policy suggestions addressing how Ontario, either provincially or at the level of the local public health unit, might improve its ability to respond to a pandemic in the future, the participants were asked to raise issues or topics not discussed during the symposium. In this instance, no consensus building exercise was undertaken. Participants produced twenty-eight suggestions (presented in the appendices) which could be grouped into seven themes.
Table 3.5.1: Individual Comments & Policy Suggestions - What other things do we need to consider, do differently, or improve in order to develop a better overall response?|
Rank
|
Themes that Emerged
( No. Comments)
|
Topics / Areas
|
|---|
|
1
|
Governance & Policy - During a Pandemic (13)
|
Roles & Responsibilities Service Delivery - Structures & Process, Resources, Funding, etc.
| |
2
|
Public Education & Information (5)
|
Modes, Technology, Content, and Continuity
| |
3
|
Research and Evaluation
(3)
|
Methods, Local Gaps/Needs, and Impact on Populations
| |
4
|
Primary Care (3)
|
Barriers that inhibit participation in planning and/or as VDAs
| |
5
|
Evidence-based Practice
(2)
|
How evidence is used in decision-making
| |
6
|
Ethics (1)
|
Inducing behavioral changes in public entitlement to healthcare
| |
7
|
Surveillance (1)
|
Integrated surveillance tools
|
Several examples of individual participant comments, presented below, provide further insight into some of the issues and concerns raised during the pH1N1 symposium discussions (and into some that were not):
- "I think that, when we talk about "Pandemic Planning", we need to be very clear where public health's responsibility lies. It seems to me that clarifying Public Health's role in primary prevention and the MOH(LTC)'s / Acute Care's role in secondary and tertiary prevention is critical. So 'mass immunization' is public health's role, antiviral distribution is MOH(LTC)'s role, etc. Having a Pandemic Plan that is joint [Public Health and MOH(LTC)] for all levels of management - primary, secondary, tertiary prevention - and that roles out at local levels [PHU (Public Health Unit) / Primary Care / Hospitals] seems really important to me."
- "Too many cooks in the kitchen (makes it); impossible to get clinical guidelines out in a timely fashion. As well these guidelines were meant to be evidence-based and ended up being vetted through the political process and looked quite different out the other end. As well, (having) no communication between federal and provincial guidelines (made for) duplication, a waste of expertise and a high confusion quotient."
- "(We) need to understand the pH1N1 impacts differently on (the) Aboriginal population"
- "Information given to a patient from the Public Health unit did not match up with the recommended guidelines at that time. How do we make sure everyone is on the same page?"
- "We need to work on getting the various parts of the PH (Public Healthcare) system in Ontario to work together better in a smooth, seamless response to urgent situations [i.e.; the field (local PHUs), the OAHPP (Ontario Agency for Health Protection and Promotion), the CMOH (Chief Medical Officer of Health) & the PHD (Public Health Division). It needs to be co-ordinated, but done in a collegial rather than a coercive way.]"
- "Have one provincial communication strategy instead of 36."
- "Health system integration is critical [so that doctors, hospitals, public health are all accountable to the same organization, and incentives are aligned]. This will only be achieved at the provincial level with significant political will."
- "We cannot forget the roles of other primary care providers as Ontario's models change - nurse practitioner led clinics, midwifery clinics, etc. I also think that including specialists in the expectation of responsibility for vaccination in their offices is not unreasonable and would significant expand the resources we would have to conduct immunizations to high risk patients [those who have significant illness, pregnant patients, etc]."
|
