Managing pandemic influenza in general practice


A guide for preparation, response and recovery

7.6 Clinical management and comorbidities

☰ Table of contents


Refer to Section 6.6 Clinical management and comorbidities for key preparedness activities.

General practices may face a surge of potential cases, contacts and worried people (the ‘worried well’) during a pandemic. Practices risk being overwhelmed with additional influenza work, the challenges of sick patients with other chronic and complex disease, as well as staff absenteeism from sickness, fear or family care needs.

Referral pathways are likely to change during a pandemic. Suspected cases may be sent to designated hospitals and patients who might usually be referred may need to be cared for in primary care.


7.6.1 Managing the ‘worried well’


Where staffing allows, consider designating a practice nurse to manage worried people who are not ill. Having clear patient education materials available across a number of platforms may reduce anxiety based on the unknown.

Point-of-care testing may not always be reliable but it may be useful for managing the worried well.

 


7.6.2 Managing patients in their own home


During a pandemic, it might not be possible or desirable to care for all patients at the practice location. Patients may need to be cared for in their home due to illness, frailty, disability, quarantine or anxiety over attending the practice and potentially becoming exposed to pandemic influenza. Some of these patients may require support from other social services (eg. mobile meal services).

State and territory health authority planning will differ across state borders, but each jurisdiction will nominate a level of service delivery and healthcare to patients within their own home. Practices need to know what assistance will be delivered to their patients.

There are established hospital-in-the-home (HITH) services across many parts of Australia that provide domiciliary acute care as a substitute for traditional inpatient care. These services may have a specific role during a pandemic either by assisting with non-influenza-related conditions or by managing some patients with influenza and its associated complications. Services are commonly linked to public hospitals and community health services with some private services in operation in metropolitan areas. Some general practices already play a role within these services, and familiarity with HITH may provide GPs with additional support during the response and recovery phases.

Patients with pandemic influenza may be avoided by their family and friends and therefore require additional support. This may depend on the clinical severity of the pandemic as well as other factors such as irrational fears. During the H1N1 pandemic, in the United States, H1N1 was the most stigmatised disease, more so than cancer or HIV/AIDS.55

Telephone follow-up could be used to manage patients with mild symptoms at home.



7.6.3 Managing patients with known or suspected pandemic influenza


Management will largely depend on:

  • the clinical severity of the virus (eg. a mild virus may mean treating similar to seasonal influenza, whereas a severe virus may mean immediate referral to a designated setting)
  • any present comorbidities, such as COPD
  • the role of antivirals.
  1. Earnshaw VA, Quinn DM. Influenza stigma during the 2009 H1N1 pandemic. J Appl Soc Psychol 2013;43:e109–14.