|Implemented in this survey?|
The Ministry of Health (MOH) has roped in primary care physicians to help treat flu cases and mitigate against community spread. “Pandemic Preparedness Clinics” (PPCs), recruited on a voluntary basis and rewarded with incentives, now form a vital part of the Singapore’s National Flu Pandemic Response Framework.
Whenever there is sustained community transmission of an infectious disease such as SARS or Influenza, hospitals can be expected to be overwhelmed and unable to cope with the large numbers who fall sick. Learning from the experience of the 2003 SARS outbreak, when the involvement of primary healthcare providers (especially from the private sector) in mounting the national response was less than satisfactory, the Ministry of Health has decided to mobilize primary care clinics early as part of its national response to the ongoing Influenza A (H1N1) global pandemic.
Since May 2009, participating primary care clinics are being designated as"Pandemic Preparedness Clinics" (PPCs) to signify that they are supported by the Ministry of Health with Personal Protection Equipment and antivirals (e.g. Tamiflu) from the national stockpile, and enlisted to help manage the flu outbreak in the community. All government polyclinics (which see 20% of daily outpatient cases) are automatically part of the PPC framework, but the participation of private clinics (which see the majority of outpatients) is voluntary.
PPC doctors and staff undergo training seminars and workshops to update themselves on the recommended clinical protocols and practices, including N95 mask fitting. They are required to adhere to MOH's prevailing guidelines, which in the case of the present H1N1 outbreak, include stocking up on at least a week's supply of Personal Protection Equipment and ensuring their clinic set-up is such that they are able to separate flu and fever cases from the other patients. Members of the public who develop flu-like symptoms or influenza-like illness (e.g. fever, cough, sore-throat, runny nose) are advised to visit the nearest PPC or polyclinic for initial assessment and treatment. A government website ( http://www.street-directory.com/hpb.ppc) identifies the exact location of these clinics so that the public are able to go to the ones nearest to their homes.
Primary care doctors would exercise their clinical judgment in prescribing anti-virals (e.g. Tamiflu) on a case by case basis, taking into account the patient's risk of developing influenza related complications, the prevalence of Influenza A (H1N1) in the community and after weighing the risks and benefits of treatment. Depending on the severity of their illness and other risk factors, patients may be referred to the hospital for further management. The hospitals would focus on managing more complex cases.
The decision to activate or stand down this framework will be made by MOH based on surveillance data.
Figure 1: H1N1 ready symbol of Pandemic Preparedness Clinics
Being scattered throughout the island, PPCs help ensure easy access of patients with flu-like illnesses to medical assessment and treatment. The public can recognise PPC clinics through a prominent decal displaying a "H1N1 ready" symbol, pasted in front of the clinic (see figure 1).
Since there are 18 polyclinics throughout the island, the GP clinics are also being organised into groups according to 18 clinic zones created around the 18 polyclinics, according to geographical location. Each polyclinic will provide advice and logistical support to the GP clinics within the zone.
As incentive, PPCs receive the following:
|Per week per clinic||Per re-supply (4 wks) per clinic|
|N 95 Mask||40||160|
Commitment from Pandemic Preparedness Clinics
In return, PPCs are expected to:
|Medienpräsenz||sehr gering||sehr hoch|
Singapore responded successfully to the SARS crisis of 2003 and even earned open praise from the World Health Organization for its swift and decisive measures to contain the SARS outbreak, including:
Since then, significant investments have been made to strengthen institutional capabilities for the surveillance, detection, diagnosis, emergency mechanism and treatment of emerging infectious diseases.
But mistakes there were, and among the lessons learnt is the importance of involving the frontline general practitioners (GP) early in any national response plan. GPs see 80% of daily outpatient attendances in Singapore and therefore act as forefront fighters - no less than specialists in the hospitals - in infectious disease outbreaks.
|Implemented in this survey?|
The approach of the idea is described as:
The Singapore Medical Association and College of Family Physicians are enthusiastic and supportive of the idea, as are the majority of general practitioners, who see it as part of their role to step up in times of crisis and to serve the community.
The public is also assured that their neighbourhood clinics are well prepared, and the healthcare workers in the small clinics (usually numbering 3-4) also feel assured that they are receiving the same level of personal protection as their counterparts in the government polyclinics.
|Ministry of Health||sehr unterstützend||stark dagegen|
|College of General Practitioners||sehr unterstützend||stark dagegen|
|Private GP´s||sehr unterstützend||stark dagegen|
|Government Polyclinics||sehr unterstützend||stark dagegen|
|General Public||sehr unterstützend||stark dagegen|
|Ministry of Health||sehr groß||kein|
|College of General Practitioners||sehr groß||kein|
|Private GP´s||sehr groß||kein|
|Government Polyclinics||sehr groß||kein|
|General Public||sehr groß||kein|
Within the first week of the scheme's introduction in May 2009, 800 clinics (out of a total of about 1200) had signed up. The first workshop in May 2009 attracted a full house of over 200 participants despite the short notice given. Experts from both the MOH and the Professional Associations (SMA and CFPS) gave presentations on the latest H1N1 updates, pointers on how to deal with suspected cases, and tips on how to organise a PPC clinic, and explained the logistics supply chain and Health Check System. There was also on-site mask fitting by N95 suppliers. By September 2009, 603 clinics had been designated "pandemic ready".
Singapore confirmed its first case of Influenza A (H1N1) on 27 May 2009. As of October 2009, an estimated 700,000 Singaporeans have been infected and 18 deaths have been attributed to the virus.
At the time of writing, the Ministry of Health (MOH) has secured supplies from GlaxoSmithKline (GSK) for one million doses of its Influenza A (H1N1) vaccine. This is part of a phased and diversified approach in securing sufficient quantities of the vaccine for the Singapore population. The vaccines are expected for delivery by the end of this year, but no decision has been taken on mass immunization yet.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
The exercise served to connect the MOH directly with general practitioners who were required to respond through the Health Check System, which is an important communication tool in times of crisis. For instance, they will play a crucial role should vaccination become a national policy.
Lim Meng Kin
National Univrsity of Singapore