Background GPs play a major role in influenza epidemics, and most patients with influenza-like-illness (ILI) are treated in general practice or by primary care doctors on duty in out-of-hours services (OOH). Little is known about the surge capacity in primary care services during an influenza pandemic, and how the relationship between them changes. Aim To investigate how general practice and OOH services were used by patients during the 2009 pandemic in Norway and the impact of the pandemic on primary care services in comparison to a normal influenza season. Materials Data from electronic remuneration claims from all OOH doctors and regular GPs for 2009. Methods We conducted a registry-based study of all ILI consultations in the 2009 pandemic with the 2008/09 influenza season (normal season) as baseline for comparison. Results The majority (82.2%) of ILI consultations during the 2009 pandemic took place in general practice. The corresponding number in the 2008/09 season was 89.3%. Compared with general practice, the adjusted odds ratio for ILI with all other diagnoses as reference in OOH services was 1.23 (95% CI, 1.18, 1.27) for the 2008/2009 season and 1.87 (95% CI, 1.84, 1.91) for the pandemic influenza season. In total there was a 3.3-fold increase in ILI consultations during the pandemic compared to the 2008/09 season. A 5.5-fold increase of ILI consultations were observed in OOH services in comparison to the 2008/09 season. Children and young adults with ILI were the most frequent users of OOH services during influenza periods. Conclusions The autumn pandemic wave resulted in a significantly increased demand on primary care services. However, GPs in primary care services in Norway showed the ability to increase capacity in a situation with increased patient demand.
References
[1]
Hope-Simpson RE (1981) The role of season in the epidemiology of influenza. J Hyg (Lond) 86: 35–47.
[2]
Temte JL, Prunuske JP (2010) Seasonal influenza in primary care settings: review for primary care physicians. WMJ 109: 193–200.
[3]
Peiris JS, Poon LL, Guan Y (2009) Emergence of a novel swine-origin influenza A virus (S-OIV) H1N1 virus in humans. J Clin Virol 45: 169–173.
[4]
Waalen K, Kilander A, Dudman S, Krogh G, Aune T, et al.. (2010) High prevalence of antibodies to the 2009 pandemic influenza A(H1N1) virus in the Norwegian population following a major epidemic and a large vaccination campaign in autumn 2009. Euro Surveill 15(31) :pii = 19633. Available: http://www.eurosurveillance.org/ViewArti？cle.aspx?ArticleId=19633. Accessed 2013 June 19.
[5]
Simonsen KA, Hunskaar S, Wensaas KA, R？rtveit S, Cox R, et al. (2012) Influenza-like illness in Norway: clinical course, attitudes towards vaccination and preventive measures during the 2009 pandemic. Fam Pract 29: 139–146.
[6]
Kacelnik O, L？voll ？, Iversen B, Aavitsland P [Report on the deaths of influenza A (H1N1) pandemic in 2009–2010, 14 March 2011]. The Norwegian Institute of Public Health. Available: http://www.fhi.no/dokumenter/6cbae0eece.？pdf. Accessed 2013 Jun 19.
[7]
Ministry of Health and Care Services (2009) Press release, 23.10.2009 No.: 66/09 Joint statement on the expanded use of self-certification. Available: http://www.regjeringen.no/en/dep/hod/pre？ss-center/pressemeldinger/2009/felles-ut？talelse-om-utvidet-bruk-av-egen.html?id=？582689. Accessed: 2013 June 19.
[8]
Bocquet J, Winzenberg T, Shaw KA (2010) Epicentre of influenza - the primary care experience in Melbourne, Victoria. Aust Fam Physician 39: 313–316.
[9]
Pitman RJ, Melegaro A, Gelb D, Siddiqui MR, Gay NJ, et al. (2007) Assessing the burden of influenza and other respiratory infections in England and Wales. J Infect 54: 530–538.
[10]
Sauro A, Barone F, Blasio G, Russo L, Santillo L (2006) Do influenza and acute respiratory infective diseases weigh heavily on general practitioners’ daily practice? Eur J Gen Pract 12: 34–36.
[11]
Patel MS, Phillips CB, Pearce C, Kljakovic M, Dugdale P, et al. (2008) General practice and pandemic influenza: a framework for planning and comparison of plans in five countries. PLoS One 3: e2269.
[12]
Hansen EH, Hunskaar S (2008) Development, implementation, and pilot study of a sentinel network (“The Watchtowers”) for monitoring emergency primary health care activity in Norway. BMC Health Serv Res 8: 62.
[13]
The Norwegian Directorate of Health (2012) [Regular GP Scheme Statistics 2011]. Available: http://helsedirektoratet.no/finansiering？/refusjonsordninger/tall-og-analyser/fas？tlege/Sider/fastlegestatistikken-2011.as？pxhttp://helsedirektoratet.no/finansieri？ng/refusjonsordninger/tall-og-analyser/f？astlege/Sider/fastlegestatistikken-2011.？aspx. Accessed 2013 June 19.
[14]
Nossen J (2007 ) [NAV Report 04/07: What happens at the GP practices?] Available: http://www.nav.no/OmNAV/Talloganalyse/An？alyser/NAVrapportserie/Andrerapporter/Hv？aforeg%C3%A5rp%C3%A5legekontorene%3F.202？430.cms. Accessed 2013 June 19.
[15]
Gran JM, Iversen B, Hungnes O, Aalen OO (2010) Estimating influenza-related excess mortality and reproduction numbers for seasonal influenza in Norway, 1975–2004. Epidemiol Infect 138: 1559–1568.
[16]
The Norwegian Institute of Public Health (2013) [Surveillance of influenza activity in Norway]. Available: http://www.fhi.no/tema/influensa/influen？saaktivitet. Accessed 2013 June 19.
[17]
Aldaz P, Loayssa JR, Apezteguia J, Oscariz M, Dronda MJ, et al. (2011) [Increased primary care consultations for upper respiratory tract infections and for fever coinciding with a wave of influenza]. Rev Esp Salud Publica 85: 113–120.
[18]
R？rtveit S, Hunsk？r S, Wensaas KA, Simonsen KA, Rortveit G (2011) [The influenza pandemic in a Norwegian municipality autumn 2009]. Tidsskr Nor Laegeforen 131: 675–679.
[19]
Press K, Hansen EH, Hunsk？r S (2010) [Pandemic influenza during the fall season 2009; Encounters to the out-of-hours services in Norway. Report No. 3–2010]. Bergen: National Centre for Emergency Primary Health Care, Uni Health. Available: http://helse.uni.no/Publications.aspx?si？te=8&publication=914. Accessed 2013 June 19.
[20]
Miller E, Hoschler K, Hardelid P, Stanford E, Andrews N, et al. (2010) Incidence of 2009 pandemic influenza A H1N1 infection in England: a cross-sectional serological study. Lancet 375: 1100–1108.
[21]
Molbak K, Widgren K, Jensen KS, Ethelberg S, Andersen PH, et al. (2011) Burden of illness of the 2009 pandemic of influenza A (H1N1) in Denmark. Vaccine 29 Suppl 2B63–69.
[22]
Anestad G, Nordbo SA (2011) Virus interference. Did rhinoviruses activity hamper the progress of the 2009 influenza A (H1N1) pandemic in Norway? Med Hypotheses 77: 1132–1134.
[23]
Michiels B, Thomas I, Van Royen P, Coenen S (2011) Clinical prediction rules combining signs, symptoms and epidemiological context to distinguish influenza from influenza-like illnesses in primary care: a cross sectional study. BMC Fam Pract 12: 4.
