Healthcare Infection Prevention

Docs: Pandemic plans poor for nonhospitals settings

Devil is in the lack of details for outpatients

The limited consideration for treating patients outside of hospitals and the lack of guidance to nonhospital health care providers is the "greatest weakness" of the federal government's pandemic influenza plan, a leading physician group charges.

"The Health Care Response to Pandemic Influenza," a new policy paper from the American College of Physicians (ACP) urges in particular that primary care physicians in nonhospital settings be fully integrated into the Department of Health and Human Services (HHS) pandemic flu response plans. An effective health care response to pandemic influenza will require utilizing all nonhospital-based health care providers to counsel, diagnose, treat and monitor patients outside of hospital settings in order to decrease the likelihood of surges that would overwhelm hospital capacity, the ACP emphasizes.

The lack of surge capacity in the nation's hospitals has been well described and discussed, but the planning deficit discovered by ACP underscores that considerable preparedness gaps remain. "Most hospitals do not have a reserve of staff, isolation beds or equipment to treat a large increase of patients with pandemic influenza," the ACP states. "The HHS plan notes that even a less-severe pandemic could overwhelm the surge capacity of the nation's hospitals. Yet planning for the health care response focuses on hospitals as the source of care not only for the most ill patients, but also the source of access to treatment. If the public perceives that treatment and medications during a pandemic are only available in hospitals, overwhelming surges on hospitals may be inevitable."

A pandemic will place extraordinary and sustained demands on the U.S. health care system. All nonhospital-based health care providers (particularly internists and family practice physicians) will need to be prepared to counsel, diagnose, treat and monitor patients outside of hospital settings in order to decrease the likelihood of patient surges that would overwhelm hospital capacity, the ACP warns.

The ACP report acknowledges that the HHS plan includes a supplement providing some guidance for nonhospital health care settings. However, directives for the planning process are hospital-based and encourage planning committees to work with public health offices at all levels and to include representatives on the planning committees from "safety-net" providers in the local community, the report notes. "Physicians in ambulatory care settings are mentioned only within this context in the planning process recommendations," the ACP states.

In addition, the HHS pandemic plan has little discussion of designing systems for home health care and follow-up of patients who return home, the ACP found. Recommendations in the report include:

  • insuring that vaccine is available, with safeguards insuring access by high-risk and high-priority groups first, in settings outside of hospitals in every locality;
  • insuring that antiviral medications are available to health care providers in all care settings;
  • consulting with local physicians to identify alternative community-based care sites for the provision of patient diagnosis, counseling and treatment;
  • identifying community-based physician leadership for staffing alternative care sites and insure sites have access to public safety communications systems and security;
  • insuring that alternative care sites are provided with medical supplies and diagnostics tools;
  • working closely with all health care providers in ambulatory care and hospital-based care settings in every locality to increase coordination of care management plans for patients inside and outside of hospitals;
  • assisting physicians and other health care providers in developing community-based care management plans incorporating protocols for treating and monitoring patients at home;
  • consulting with local physicians to develop risk communications tailored to each county and city to inform the public of when, how, and where to seek health care in the event of pandemic influenza.


  1. American College of Physicians. The Health Care Response to Pandemic Influenza. Position Paper. Philadelphia: American College of Physicians; 2006.