Department of Health Policy Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
BMC Fam Pract. 2013 Nov 19;14:174. doi: 10.1186/1471-2296-14-174.
Cases of emerging infectious diseases, including H5N1 influenza, H7N9 influenza, and Middle East Respiratory Syndrome, have been reported in recent years, and the threat of pandemic outbreaks persists. In Japan, primary care is the frontline against emerging infectious diseases in communities. Although the importance of pandemic preparedness in primary care has been highlighted previously, few studies have thus far investigated the preparedness among primary care practices (PCPs) or differences in the preparedness of different institutional settings. We examined PCP preparedness and response to the 2009 influenza pandemic in Japan, and explored the role of a pandemic preparedness plan during the pandemic.
We used a survey questionnaire to assess how well individual PCPs in Okinawa, Japan, were prepared for the 2009 influenza pandemic. The questionnaire was mailed to all eligible PCPs (N = 465) in Okinawa, regardless of their institutional setting. In addition, we assessed the differences in the preparedness of clinics and hospitals and determined whether the national preparedness plan affected individual preparedness and response. Data were analyzed using descriptive and logistic regression analyses.
A total of 174 (37.4%) PCPs responded to our survey. In general, high-level personal protective equipment (PPE) such as N95 masks (45.4%), gowns (30.5%), and eye protection (21.3%) was stocked at a low rate. Clinic-based PCPs were significantly less prepared than hospital-based PCPs to provide N95 masks (OR 0.34), gowns (OR 0.15), and eye protection (OR 0.18). In addition, only 32.8% of PCPs adopted an adequate business continuity plan (BCP). After controlling for institutional setting, reading the national preparedness plan was significantly associated with establishment of a BCP (OR 5.86), and with knowledge of how to transfer a swab specimen to a local medical laboratory (OR 5.60).
With regard to PPE availability, PCPs (especially clinic-based PCPs) were not adequately prepared for the influenza pandemic. Awareness of the national pandemic preparedness plan is likely to promote prefecture-wide implementation of BCPs and surveillance activity.
近年来，包括 H5N1 流感、H7N9 流感和中东呼吸综合征在内的新发传染病病例时有报告，大流行爆发的威胁依然存在。在日本，基层医疗是社区应对新发传染病的第一线。虽然基层医疗在大流行防范中的重要性此前已得到强调，但迄今为止，很少有研究调查基层医疗机构（PCP）的准备情况或不同机构设置之间的准备情况差异。我们调查了日本 2009 年流感大流行期间 PCP 的准备情况，并探讨了大流行防范计划在大流行期间的作用。
我们使用问卷调查评估了日本冲绳的个体 PCP 对 2009 年流感大流行的准备情况。问卷寄给了冲绳所有符合条件的 PCP（N=465），无论其机构设置如何。此外，我们评估了诊所和医院的准备情况差异，并确定国家准备计划是否影响个体准备情况和反应。使用描述性和逻辑回归分析对数据进行分析。
共有 174 名（37.4%）PCP 对我们的调查做出了回应。一般来说，个人防护设备（PPE）的高等级物品，如 N95 口罩（45.4%）、长袍（30.5%）和眼部保护装置（21.3%）的库存率较低。基于诊所的 PCP 提供 N95 口罩（OR 0.34）、长袍（OR 0.15）和眼部保护装置（OR 0.18）的准备情况明显不如基于医院的 PCP。此外，只有 32.8%的 PCP 采用了充分的业务连续性计划（BCP）。在控制了机构设置后，阅读国家准备计划与制定 BCP（OR 5.86）以及了解如何将拭子标本转移到当地医疗实验室（OR 5.60）显著相关。
在 PPE 可用性方面，PCP（尤其是基于诊所的 PCP）对流感大流行的准备不足。对国家大流行防范计划的认识可能会促进全州范围内实施 BCP 和监测活动。
