Public health communication with frontline clinicians during the first wave of the 2009 influenza pandemic

Context—During public health emergencies, office-based frontline clinicians are critical partners in the detection, treatment, and control of disease. Communication between public health authorities and frontline clinicians is critical, yet public health agencies, medical societies, and healthcare delivery organizations have all called for improvements. Objectives—Describe communication processes between public health and frontline clinicians during the first wave of the 2009 novel influenza A (H1N1) pandemic; assess clinicians’ use of and knowledge about public health guidance; and assess clinicians’ perceptions and preferences about communication during a public health emergency. Design and Methods—During the first wave of the pandemic, we performed a process analysis and surveyed 509 office-based primary care providers in Utah. Setting and Participants—Public health and healthcare leaders from major agencies involved in emergency response in Utah and office-based primary care providers located throughout Utah. Main Outcome Measure(s)—Communication process and information flow, distribution of emails, proportion of clinicians that accessed key websites at least weekly, clinicians’ knowledge about recent guidance and perception about email load, primary information sources, and qualitative findings from clinician feedback. Results—The process analysis revealed redundant activities and messaging. The 141 survey respondents (28%) received information from a variety of sources: 68% received information from state public health; almost 100% received information from healthcare organizations. Only 1/3 visited a state public health or institutional website frequently enough (at least weekly) to obtain updated guidance. Clinicians were knowledgeable about guidance that did not change during the first wave; however, correct knowledge was lower after guidance changed. Clinicians felt overwhelmed by email volume, preferred a single institutional email for clinical guidance, and suggested new information be concise and clearly identified. Conclusion—Communication between public health, healthcare organizations, and clinicians was redundant, overwhelming, and can be enhanced considering clinician preferences and institutional communication channels.