As the Foundation of Health Care, Family Physicians Need to Plan Now for Pandemic Flu

Although the official start of the 2009-10 flu season is pegged at Oct. 4, the long-anticipated novel influenza A (H1N1) pandemic influenza is here now. For the week of Sept. 13-19, the CDC reported that 26 states had geographically widespread influenza activity; 11 states had regional influenza activity; and 12 states, the District of Columbia and Puerto Rico had local influenza activity.

Visits to doctors for influenza-like illness have been higher than expected for the past six weeks. Nationwide, 4.6 percent of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network were attributed to influenza-like illness -- well above the national baseline of 2.4 percent. Many of these visits were related to H1N1 infection rather than to seasonal flu.

Obviously, H1N1 has arrived in physician's offices around the country, and family physicians need to respond.

As FPs, we will face multiple challenges during this period, and we should strive to prevent infection among our patients and staff members and morbidity and mortality among those who are infected. We also need to continue to provide care for all our patients while dealing with this influenza surge. And high on our list of priorities is the necessity to make sure our clinics are not spreading H1N1 to all of our patients. To that end, there are a number of steps we can take.

It's important to note that providing timely care for sick patients will be critical. For those who are at high risk for complications, antiviral treatment is most effective if it is started before 48 hours of onset of symptoms. Also, for family members of infected individuals who are themselves at high risk of complications from influenza, the sooner chemoprophylaxis is started, the better.

To address the timeliness factor when your practice may be overwhelmed with patients, consider developing telephone triage protocols for your staff members. These protocols should allow staff to rapidly place patients into one of four categories:

The protocols should include appropriate advice for individuals in each of the four categories. Remember, not all patients who should receive antiviral medications need to be seen in person.

For us FPs to be maximally effective in our role as the foundation of the health care system, it is critical that we stay current on the evolving pandemic epidemiology and on public health recommendations regarding vaccine prioritization, disease reporting, specimen collection, and treatment and chemoprophylaxis. Watch for communications from state and local health departments, as well as from the CDC.

In addition, the CDC and AAFP Web sites offer much advice and many useful tools for dealing with the pandemic flu. These sites also list current recommendations for each of the points emphasized here. The time to read this information and to plan is now, before H1N1 overwhelms your practice.

Doug Campos-Outcalt, M.D., M.P.A., is the AAFP's liaison to the CDC's Advisory Committee on Immunization Practices. He also is the associate head of the department of family and community medicine at the University of Arizona College of Medicine, Phoenix.