How infectious disease outbreaks affect community-based primary care physicians: Comparing the SARS and H1N1 epidemics

R. Liisa Jaakkimainen; Susan J. Bondy; Meredith Parkovnick; Jan Barnsley

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Figure 1.
Percentage of respondents who reported various concerns about the effects of a serious infectious disease outbreak on their personal lives: Comparison between 2003 and 2010 respondents.

^*P<.01.

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Table 1.

Characteristics of the 2003 and 2010 GP and FP respondents, as well as those of all GPs and FPs practising in Ontario in 2011

CHARACTERISTICS	GPs AND FPs
CHARACTERISTICS	2003 RESPONDENTS (N = 707), %^*	2010 RESPONDENTS (N = 183), %^*	PRACTISING IN ONTARIO IN 2011 (N = 11 385), %^*
Age, y
• ≤ 39	22.1	25.1	23.3
• 40–49	34.6	27.3	24.4
• 50–59	26.3	29.0	32.1
• ≥ 60	15.9	18.0	20.2
Female sex	40.6	57.4	40.0
Location of primary medical education
• Canada	77.3	84.2	76.7
• United States	1.2	0.5	0.6
• International	19.6	15.3	22.7
Primary practice type
• Solo practice	32.9	15.3	17.1
• Family health team, family health organization, or family health network	NA	35.0	37.2
• Family health group	NA	31.1	29.1
• Teaching practice	7.2	3.8	NA
• Community health centre	2.2	2.7	NA

NA—not available.
↵* Percentages might not add to 100 owing to rounding.

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Table 2.

Comparison of how the 2003 and 2010 respondents’ office-based care was affected during serious infectious disease outbreaks: Proportion of respondents who indicated yes when asked about behaviour in office practice and precautionary measures in clinic.

STATEMENTS	FPs AND GPs
STATEMENTS	2003 RESPONDENTS WHO INDICATED YES, %	2010 RESPONDENTS WHO INDICATED YES, %
Behaviour in office practice
• Insist every patient wear a mask	14.1	59.0^*
• Keep a greater distance between yourself and patients	27.1	48.6^*
• Request more blood tests or chest x-ray scans	9.5	42.6^*
• Postpone or cancel family practice appointments	60.6	63.9
• Postpone or cancel surgical procedures	62.6	49.2^*
• Prescribe more antiviral medications	NA	84.7
• See some patients faster	19.6	71.0^*
• Have long wait times for laboratory and investigation results (eg, computed tomographic scans)	60.0	54.1
• Test patient temperature as a routine procedure	38.5	69.4^*
• Avoid physical examinations	62.0	18.0^*
• Advise patients not to travel to affected areas	50.3	86.3^*
• Postpone or cancel specialist appointments	75.2	49.2^*
• Find it difficult, are you unable, to make specialty referrals	63.6	54.6
• Prescribe more antibiotics	NA	48.6
• Perform more nasopharyngeal or throat swabs	NA	76.5
• Overprescribe antibiotics	62.0	NA
Precautionary measures taken
• Wash your hands between every patient encounter	47.3	68.9^*
• Always wear a mask during consultations	29.5	42.1^*
• Wear goggles for patient encounters	15.8	79.8^*
• Clean work surfaces with antiseptic at least once daily	45.2	59.6^*
• Ask all support staff to wear masks	53.9	56.8
• Insist that temperature be measured for all patients	NA	29.0
• Insist staff members wear gowns during patient encounters	20.7	39.3^*
• Ask all staff to wear disposable gloves	18.9	23.5
• Ask all staff members to have their temperatures measured	16.6	3.3^*

NA—not available.
↵* P < .01.

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Table 3.

Comparison of how the 2003 and 2010 respondents’ out-of-office care was affected during serious infectious disease outbreaks: Proportion of respondents who indicated no change when asked about changes to their out-of-office care.

OUT-OF-OFFICE CARE	FPs AND GPs
OUT-OF-OFFICE CARE	2003 RESPONDENTS WHO INDICATED NO CHANGE, %	2010 RESPONDENTS WHO INDICATED NO CHANGE, %
Obstetrics	87.7	0.0^*
Palliative care	86.5	14.9^*
Housecalls	71.4	25.5^*
Well-baby visits	70.7	12.6^*
Psychotherapy or counseling	68.7	9.4^*
Emergency department shifts	68.6	35.7^*
Nursing home visits	65.4	40.0^*
Hospital inpatient care	33.6	28.6

↵* P < .01.

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Table 4.

Comparison between the 2003 and 2010 respondents’ perceived value of various sources of information about serious community-based outbreaks

SOURCES OF INFORMATION	EXTREMELY VALUABLE		VALUABLE		SOMEWHAT VALUABLE
SOURCES OF INFORMATION	2003 RESPONDENTS, %	2010 RESPONDENTS, %	2003 RESPONDENTS, %	2010 RESPONDENTS, %	2003 RESPONDENTS, %	2010 RESPONDENTS, %
Ontario Ministry of Health and Long-Term Care	23.0	23.5	42.3	48.6	14.6	17.5
Ontario Medical Association	32.0	14.2^*	43.6	43.2	15.2	21.9
Ontario Agency for Health Protection and Promotion	NA^†	9.3	NA^†	20.2	NA^†	16.4
Telehealth Ontario	6.3	3.8	14.9	9.3	17.1	12.0
World Health Organization	6.6	11.5	20.3	25.1	18.9	26.8
Medical journals	5.2	7.1	16.9	33.3^*	20.9	25.7
Internet medical resources (eg, UpToDate)	7.5	12.6	20.0	31.1^*	17.1	21.9
Television news or programs	7.4	9.3	28.1	20.2	36.2	33.9
Local hospital	19.3	13.1	27.4	31.1	16.1	16.4
Newspapers or magazines	6.9	4.9	28.7	18.6^*	34.5	29.5

NA—not available.
↵* P < .01.
↵† Not available because the Ontario Agency for Health Protection and Promotion did not exist at this time.

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Table 5.

Proportion of 2010 respondents who rated their interest in various types of resources during infectious disease outbreaks in their community

VARIOUS TYPES OF RESOURCES FOR GPs AND FPs	VERY INTERESTED, %	INTERESTED, %	SOMEWHAT INTERESTED, %
Resources to protect and support you, your staff, and your family (eg, masks)	74.9	19.7	3.3
Protocols for the management of screening and treatment of patients	73.2	21.3	3.8
Accurate information on protective measures	69.9	24.6	1.6
E-mail or fax communications describing what public health measures are taking place	69.4	22.4	5.5
Ongoing disease status reports	63.9	26.8	7.1
Patient information sheets	57.4	32.8	6.6
Information to align efforts with public health (eg, fact sheets)	55.7	32.2	9.3
List and location of emergency vaccination clinics	54.6	33.9	7.1
Recipient groups recommended for vaccinations	54.6	32.2	8.7
Collective purchase and secure distribution of supplies	50.8	28.4	11.5
Physician hot-line	50.3	28.4	15.3
Additional nursing resources for your clinic	47.0	26.2	15.8
Advice on developing a work flow plan for yourself and your staff during an outbreak	44.8	31.1	15.8