Open Access Research article

Coordination and resource-related difficulties encountered by Quebec's public health specialists and infectious diseases/medical microbiologists in the management of A (H1N1) - a mixed-method, exploratory survey

Charles Nhan1, Réjean Laprise2, Monique Douville-Fradet34, Mary Ellen Macdonald5 and Caroline Quach16*

Author Affiliations

1 Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, C1242 - 2300 Tupper Street, Montreal, QC H3H 1P3, Canada

2 Office of Continuing Professional Development, Fédération des médecins spécialistes du Québec, 2 Complexe Desjardins, Rm 3000, P.O. Box 216, Desjardins Station, Montreal, QC H5B 1G8, Canada

3 Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, 2400 D'Estimauville Street, Room U-3141, Quebec City, QC G1E 7G9, Canada

4 Continuing Medical Education Unit, Association des médecins spécialistes en santé publique et médecine préventive du Québec, 2 Complexe Desjardins, Rm 3000, P.O. Box 216, Desjardins Station, Montreal, QC H5B 1G8, Canada

5 Division of Oral Health and Society, Faculty of Dentistry, McGill University, 3550 University Street, Montreal, QC H3A 2A7, Canada

6 Continuing Medical Education Unit, Association des médecins microbiologistes et infectiologues du Québec, 2 Complexe Desjardins, Rm 3000, P.O. Box 216, Desjardins Station, Montreal, QC H5B 1G8, Canada

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BMC Public Health 2012, 12:115  doi:10.1186/1471-2458-12-115

Published: 10 February 2012



In Quebec, the influenza A (H1N1) pandemic was managed using a top-down style that left many involved players with critical views and frustrations. We aimed to describe physicians' perceptions - infectious diseases specialists/medical microbiologists (IDMM) and public health/preventive medicine specialists (PHPMS) - in regards to issues encountered with the pandemics management at the physician level and highlight suggested improvements for future healthcare emergencies.


In April 2010, Quebec IDMM and PHPMS physicians were invited to anonymously complete a web-based learning needs assessment. The survey included both open-ended and multiple-choice questions. Descriptive statistics were used to report on the frequency distribution of multiple choice responses whereas thematic content analysis was used to analyse qualitative data generated from the survey and help understand respondents' experience and perceptions with the pandemics.


Of the 102 respondents, 85.3% reported difficulties or frustrations in their practice during the pandemic. The thematic analysis revealed two core themes describing the problems experienced in the pandemic management: coordination and resource-related difficulties. Coordination issues included communication, clinical practice guidelines, decision-making, roles and responsibilities, epidemiological investigation, and public health expert advisory committees. Resources issues included laboratory resources, patient management, and vaccination process.


Together, the quantitative and qualitative data suggest a need for improved coordination, a better definition of roles and responsibilities, increased use of information technologies, merged communications, and transparency in the decisional process. Increased flexibility and less contradiction in clinical practice guidelines from different sources and increased laboratory/clinical capacity were felt critical to the proper management of infectious disease emergencies.

Influenza; Pandemic; Public health emergency; Management; Physicians' perceptions; Mixed methods exploratory survey