Vaccination strategies for high-risk and fragile populations in Lombardy (Italy): a region-wide assessment of hospital-based models and best practices.

IF 1.5 Q3 HEALTH CARE SCIENCES & SERVICES Annali di igiene : medicina preventiva e di comunita Pub Date : 2024-03-01 Epub Date: 2024-01-31 DOI:10.7416/ai.2024.2607
Anna Odone, Riccardo Vecchio, Luisa Brogonzoli, Elisa Sala, Giacomo Pietro Vigezzi, Alba Muzzi, Catia Rosanna Borriello, Danilo Cereda, Giuliano Rizzardini, Alessandro Venturi, Rosaria Iardino
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Abstract

Background: Subjects with selected underlying medical conditions are at higher risk of infection and severe outcomes from vaccines preventable diseases. While most countries adopt life-course approaches to vaccination, high-risk group immunization programmes could maximize individual protection, while contributing to population health. The COVID-19 pandemic stimulated the planning and implementation of successful hospital-based high-risk groups' immunization models. However, in Italy, high-risk subjects' vaccine coverage is not actively monitored at the national or regional level, nor shared guidelines exist yet on hospital-based immunization programmes.

Study design: The study reports findings from a region-wide assessment of the availability, characteristics, and setting-specific features of hospital-based immunization programmes for high-risk subjects in the Lombardy region.

Methods: Fondazione The Bridge a not-for-profit organization based in Milan, in collaboration with the Prevention Unit of the Lombardy Region Directorate for Welfare, and the University of Pavia coordinated a project aimed at bringing together regional health institutions, key stakeholders, academic experts, scientific societies and patients' associations to assess high-risk subjects' barriers to vaccine uptake and inform preventive programmes and policies. In this context, we designed and implemented a survey to systematically map the existence and characteristics of hospital-based immunization programmes targeting high-risk subjects. The survey was proposed to all 115 hospital medical directions of the Lombardy region.

Results: We collected data from 97 hospital medical directions, with a response rate of 85%. Among respondents, 24% were publi-cly managed hospitals, 17% were Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) and 59% accredited private hospitals. Overall, 51.5% facilities in the Lombardy Region reported to actively administer vaccines to high-risk subjects in hospital settings, the prevalence being 89.6% in public hospitals. Among hospitals where vaccines are actively administered, 46% reported to have centralized vaccines ambulatory clinics, while 54% reported to administer vaccines in the context of inpa-tient care, within clinical wards. In 14% of hospitals vaccination counselling is carried out at the hospital level, while patients are referred to community services for the vaccine administration, 58% have established clinical pathways and formalized internal procedures to integrate vaccine prevention within the clinical care.

Conclusions: Half of hospital facilities in the Lombardy Region administer vaccines to high-risk patients. Hospital-based im-munization models vary widely by vaccines programmes, organizational aspects, vaccines procurement and workforce involved. Identifying best practices and effective models can help tackle current challenges and improve immunization coverage for at-risk groups.

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针对伦巴第大区(意大利)高危和脆弱人群的疫苗接种策略:对以医院为基础的模式和最佳做法进行全区评估。
背景:患有特定基础疾病的受试者感染疫苗可预防疾病并导致严重后果的风险较高。虽然大多数国家都采用终生接种的方法,但高危人群免疫计划可以最大限度地保护个人,同时促进人口健康。COVID-19 大流行促进了以医院为基础的高危人群免疫模式的成功规划和实施。然而,在意大利,国家或地区层面并没有对高危人群的疫苗覆盖率进行积极监控,也没有关于医院免疫计划的共享指南:该研究报告了伦巴第大区针对高危人群的医院免疫计划的可用性、特点和特定环境的评估结果:位于米兰的非营利组织 "桥 "基金会与伦巴第大区福利局预防部门和帕维亚大学合作,协调开展了一个项目,旨在将地区卫生机构、主要利益相关者、学术专家、科学协会和患者协会聚集在一起,评估高危人群接种疫苗的障碍,并为预防计划和政策提供信息。在此背景下,我们设计并实施了一项调查,以系统地了解针对高危人群的医院免疫计划的存在情况和特点。调查对象为伦巴第大区的所有 115 家医院医务处:我们从 97 家医院的医务处收集了数据,回复率为 85%。受访者中,24%为公共管理医院,17%为科研、住院和医疗保健研究所(IRCCS),59%为经认证的私立医院。总体而言,伦巴第大区有 51.5% 的机构报告在医院环境中积极为高危人群接种疫苗,其中公立医院的接种率为 89.6%。在积极接种疫苗的医院中,有 46% 的医院报告有集中疫苗流动诊所,54% 的医院报告在住院治疗的临床病房内接种疫苗。14%的医院在医院层面开展疫苗接种咨询,同时将患者转介到社区服务机构进行疫苗接种,58%的医院建立了临床路径和正式的内部程序,将疫苗预防纳入临床护理:结论:伦巴第大区有一半的医院为高危患者接种疫苗。医院免疫模式因疫苗计划、组织方面、疫苗采购和所涉及的劳动力而有很大不同。确定最佳实践和有效模式有助于应对当前的挑战,提高高危人群的免疫覆盖率。
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Annali di igiene : medicina preventiva e di comunita
Annali di igiene : medicina preventiva e di comunita HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.40
自引率
0.00%
发文量
69
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