Description of an onsite school-based intervention aimed at increasing influenza vaccination uptake among children in an Italian Local Health Authority.

The Russian invasion of Ukraine caused millions of Ukrainian refugees to flee to other nations. To provide the most appropriate assistance, host nations necessitate up-to-date information regarding Ukrainian refugee's demographic and epidemiological conditions. We aim to investigate the demographic composition, the COVID-19 vaccinations performed, specialist care provided and the prevalence of non-communicable diseases (NCDs) in refugees assisted by an Italian Local Health Authority (LHA). We conducted a retrospective cross-sectional analysis from March to June 2022, analyzing the demographic and epidemiological status of Ukrainians. Statistical analyses were carried out to assess possible associations between NCDs distribution, age and gender. LHA Roma 1 assisted 9349 Ukrainian refugees. Of these, 2784 (29.8%) were males and 6565 (70.2%) were females, with a median age of 25 years. Two thousand four hundred and eighty-five Ukrainian refugees were vaccinated against COVID-19. Among them, 401 (16.1%) had at least one NCD. The most frequent groups of diseases were related to the circulatory system (50.6%), the endocrine system (24.9%), and mental and behavioral disorders (6.5%). Refugees need healthcare services targeted mainly towards minors and females. It is essential to analyze and monitor the demographic and epidemiological conditions to provide evidence about patient management and the best care integrated into the health service of host countries.

The healthcare is often considered one of the sectors most prone to corruption, and transparency policies have been proposed in several countries to fight bribery and corruption. Indeed, the transparency of public bodies potentially plays a relevant role in preventing misbehaviour and favouring accountability. This study contributes to a broader understanding of the role of transparency in the healthcare sector using Italy as a case study. For this purpose, we first built a composite indicator to assess the differences in transparency, performance, and integrity between Italian local health authorities (LHAs) retrieving the administrative data available on their websites. Then, we used both non-parametric method and multivariate regression to explore the relationship between the performance of different expenditure functions (total production costs, administrative costs, and medical and non-medical-related service costs) at the LHA level and the transparency index. Our results show a wide difference in transparency, performance, and integrity among LHAs that does not always follow the classic north–south divide in Italy. In addition, we find results consistent with the idea that transparency is generally associated with a better capability of LHAs in the containment of healthcare expenditure while imposing larger administrative burdens. Overall, reforms promoting transparency impose administrative costs, which policymakers should bear in mind to develop less burdensome transparency measures, as they might not be a ‘free lunch’.

Background and aim of the work:Despite Allied Health Professions (AHPs) represent a substantial part of workforce within the health system and they might give a relevant contribution to research, literature on publication productivity of AHPs working in non-research/academic institutions is scarce. The aim of this investigation was to provide point prevalence of AHPs working in a non- research/academic setting who have written at least one article published in indexed journals, in order to describe their scientific productivity.Methods:A descriptive cross-sectional study was carried out of AHPs working in large Local Health Authority in Italy, who published in journals indexed in Scopus and/or PubMed. H-index, publications and citations number, journal name, publication year, and journal Impact Factor were extracted.Results:Fifty-two AHP workers were identified as authors, having published 105 articles between 1993 and 2019. The number of papers increased over the years (p < .001). Published papers in journals with Impact Factor were 67.6% (n = 71) of the total, with a median Impact Factor = 2.676 (range = 0.583 – 59.102). The median number of citations was 4 (range = 0 – 99). The prevalence among units ranged from 0.8% to 5.0%, 2.9% in the whole department. There were not significant differences in number of articles (p = .138), citations received (p = .337), and H-Index (p = .661) among units.Conclusions:In the Local Health Authority under investigation, publication productivity of AHPs workers was found to be low, although it is increasing over time, with no significant differences among units. Further investigations should be carried out to link these results with authors’ information and organizational characteristics to study the relationship between authors’ profiles and publication productivity. (www.actabiomedica)

BackgroundOver the past few decades, in OECD countries there has been a general growing trend in the prevalence of out-of-hospital healthcare services, but there is a general lack of data on the use of these services.MethodsWe defined a list of 303 indicators related to primary and community healthcare services in collaboration with 13 Italian Local Health Authorities (LHAs). Then, for each LHA, we collected and analyzed these indicators for two different years (2003 and 2007).ResultsOut-of-hospital care absorbs 56% of all costs in our sample of LHAs. Expenditure on outpatients’ visits to specialists and on diagnostic examinations accounts for 13% of the costs, while spending on primary care (including prevention and public health) accounts for 9%, and for intermediate structures (including those related to rehabilitation, elderly people, disabled people, and mental health) the figure is 11%. Different Italian LHAs have made different strategic choices with respect to primary and community-based care (PCC).ConclusionsTwo distinct strategic orientations in the adoption of PCC services by LHAs has emerged from our study. The first has been an investment mainly in ambulatory and home-based primary care services in order to increase the number of low-complexity settings. A second strategy has prioritized the allocation of resources to intermediate inpatient structures for specific types of patients, namely elderly and disabled people, post-acute patients in need of rehabilitation and long-term care, and patients in hospices.

Pertussis is quite common in adolescents and adults, but it is especially dangerous in new-borns. The national immunization plan (NIP) 2017-2019 recommended a Tdap booster for every pregnancy at 28-36 weeks, but adherence is still far from the optimal level. This work aims to evaluate the effectiveness of a dedicated pathway organized by the department of prevention to improve the Tdap coverage among pregnant woman attending antenatal class. The women attending from November 2019 to October 2019 the public antenatal class organized by the local health authority have been evaluated for their Tdap coverage in pregnancy. From May 2019, public health experts have been involved for 30 minutes during the first lesson to explain the NIP with a focus on vaccination in pregnancy. Then the eligible women (28-36 weeks not yet vaccinated) who voluntarily agree were accompanied to the ambulatory to be vaccinated. Pre-post Tdap vaccination coverage and pregnancy weeks at vaccination have been evaluated respectively by chi2 and t-test. 90 pregnant women have been included in the study. Their mean age was 32.3 (SD 5.2) and the overall Tdap coverage was 44.4%. The Pre-post Tdap coverage was 26.7%(12/45) before May 2019 and 62.2% (28/45) after the introduction of the new pathway (p = 0.001). 50% of the vaccinated women decided to receive the booster the same day of the antenatal lesson, while the remaining 50% delayed the vaccination till a maximum of 30 days. We observed a clinical, but not statistically, significant anticipation in the pregnancy week in which they received Tdap booster (32.4 weeks before and 31.3 after May 2019; p = 0.150). The introduction of a short intervention on vaccination in the antenatal class followed by the opportunity to receive the booster in a dedicated time and without waiting list significantly improved the Tdap coverage in pregnancy. This study encourages the cooperation among the different public health actors involved in the field of antenatal care. Key messages Antenatal class represents a great opportunity to improve vaccine confidence in pregnant women. Intervention aimed to ameliorate vaccine convenience could improve Tdap coverage in pregnancy.

Globally, age and some comorbidities have been associ-ated with the risk of more severe outcomes of COVID-19. The purpose of this research is to calculate the hospitalization rate of SARS-CoV-2 positive patients in an Italian Local health Authority (LHA) and to examine whether medical comorbidities encoded through pharmaceutical administrative data are predictors of hospital admission in patients with a positive SARS-CoV-2 naso-pharyngeal swab. This retrospective observational study was conducted in a LHA of Pescara. Comorbidities were coded through the consumption of drugs, using the WHO's Anatomical Therapeutic Chemical (ATC) classification System. The admission was ascertained by checking the hospital discharge records where generated. During the study period, 1571 patients were tested positive for SARS-CoV-2 oro-and-nasopharyngeal swab. Multivariable logistic analisys showed as predictors of admission an age ≥65 in the total sample (aOR 10.91; 95%CI 6.86-17.36) as well as in the male (aOR 12.64;95%CI 6.42-24.87) and female. (aOR 9.27; 95%CI 4.87-17.66) in SARS-CoV-2 positive patients. Comorbidities assiociated with admission were (GERD) in overall (AdjOR 1.58; 95% CI 1.06-2.34) and male (AdjOR 2.30; 95%CI 1.12-4.72) samples and anticoagulants drugs use in male (AdjOR 3.90; 95% 1.11-13.65) sample, the presence of congestive heart failure (CHF) in female (AdjOR 0.47;95%CI 0.27-0.83) sample results as protective factor. In conclusion, increasing age, male gender and PPI use are positively associated while female gender and CHF-related drug use are negatively associated with hospitalization in SARS-CoV-2 positive patients.

Measuring costs of community mental health care in Italy: A prevalence-based study

BackgroundIn several health systems of advanced countries, reforms have changed primary care in the last two decades. The literature has assessed the effects of a variety of interventions and individual factors on the behavior of general practitioners (GPs). However, there has been a lack of investigation concerning the influence of the resources embedded in the GPs’ personal advice networks (i.e., social capital) on GPs’ capacity to meet defined objectives.The present study has two goals: (a) to assess the GPs’ personal advice networks according to the social capital framework and (b) to test the influence of such relationships on GPs’ capacity to accomplish organizational goals.MethodsThe data collection relied on administrative data provided by an Italian local health authority (LHA) and a survey administered to the GPs of the selected LHA. The GPs’ personal advice networks were assessed through an ad-hoc instrument and interpreted as egocentric networks. Multivariate regression analyses assessed two different performance measures.ResultsSocial capital may influence the GPs’ capacity to meet targets, though the influence differs according to the objective considered. In particular, the higher the professional heterogeneity of a GP personal advice network, the lower her/his capacity is to meet targets of prescriptive appropriateness.ConclusionsOur findings might help to design more effective primary care reforms depending on the pursued goals. However, further research is needed.

This qualitative study examines the potential role of Family and Community Nurses (FCNs) in an Italian Local Health Authority (LHA) context, aiming to identify unmet healthcare needs and facilitate the integration of FCNs into the healthcare system. Focus Group (FG) sessions involving healthcare professionals from three centers in the Emiliano–Romagnolo Apennines region revealed shared concerns about unaddressed healthcare needs, caregiver support inadequacies, service accessibility barriers, and the importance of enhanced interprofessional collaboration. Participants highlighted vulnerable populations, such as the frail and chronically ill, as those requiring more comprehensive care. The study identified key areas where FCNs could be instrumental, including monitoring complex medication regimens for elderly individuals, supporting caregivers, empowering vulnerable individuals, providing education, facilitating service access, and fostering collaboration among healthcare professionals. It emphasized the significance of multidisciplinary teamwork while maintaining clear role distinctions for FCNs. Further research is needed to assess the effectiveness and economic implications of FCN integration. These findings offer valuable insights for policymakers and organizations to promote FCN utilization, aligning with the World Health Organization's emphasis on primary healthcare and catering to the needs of individuals, families, and communities.

Atrial fibrillation (AF) increases significantly the risk of comorbidities and premature death. This paper aims to estimate: 1) the current prevalence of AF in Italy as a whole and within individual local health authorities (LHA); 2) the proportion of strongly eligible patients receiving oral anticoagulants; 3) the impact of non-vitamin K antagonist oral anticoagulants (NOACs). The prevalence of AF and the proportion of patients strongly eligible for anticoagulant treatment (defined by a CHADS2 score ≥2) were obtained by applying the results of a systematic literature search to the Italian population stratified by gender, age and LHA. The consumption of oral anticoagulants in eligible patients within each LHA was derived from Intercontinental Marketing Services data. Altogether, the detected prevalence of AF in Italy is 1.7%, i.e. 1 036 448 cases. Of these, 62.6%, i.e. 648 832 subjects, are estimated to have a CHADS2 ≥2 and therefore strongly eligible for anticoagulant treatment. The estimated percentage of eligible treated patients in 2015 was 43.7%, significantly greater compared to 2014 (31.3%), with local and regional variabilities. In 2015 the estimated use of NOACs for AF was 36.4% of all oral anticoagulants, with marked local and regional variabilities. NOAC prescription appears influenced by financial limitations and by factors related to the network of anticoagulation services. The present analysis shows a prevalence of AF in Italy of 1.7%. The overall rate of anticoagulant use is increasing, but is still insufficient, with marked regional and local variations. In 2015, approximately one third of oral anticoagulation in eligible patients was based on NOACs.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Background: Outside the USA, Agency for Healthcare Research and Quality (AHRQ) prevention quality indicators (PQIs) have been used to compare the quality of primary care services only at a national or regional level. However, in several national health systems, primary care is not directly managed by the regions but is in charge of smaller territorial entities. We evaluated whether PQIs might be used to compare the performance of local providers such as Italian local health authorities (LHAs) and health districts. Methods: We analysed the hospital discharge abstracts of 44 LHAs (and 11 health districts) of five Italian regions (including ≈18 million residents) in 2008–10. Age-standardized PQI rates were computed following AHRQ specifications. Potential predictors were investigated using multilevel modelling. Results: We analysed 11 470 722 hospitalizations. The overall rates of preventable hospitalizations (composite PQI 90) were 1012, 889 and 988 (×100 000 inhabitants) in 2008, 2009 and 2010, respectively. Composite PQIs were able to differentiate LHAs and health districts and showed small variation in the performance ranking over years. Conclusion: Although further research is required, our findings support the use of composite PQIs to evaluate the performance of relatively small primary health care providers (50 000–60 000 enrollees) in countries with universal health care coverage. Achieving high precision may be crucial for a structured quality assessment system to align hospitalization rate indicators with measures of other contexts of care (cost, clinical management, satisfaction/experience) that are typically computed at a local level.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. However, COPD is still underdiagnosed, undertreated, and not sufficiently prevented. Health administrative databases provide a powerful way of studying COPD in the population. This retrospective study used administrative data, collected during 2011 and 2012, retrieved from 3 Italian local health authorities (LHAs). The analysis through administrative databases allowed firstly to identify patients with COPD receiving services by the 3 LHAs: The estimated average is ~3% of the population aged ≥40years. Furthermore, it was also possible to stratify patients by investigating the health consumption in hospitalization for COPD and use of respiratory drugs. In all 3 LHA patients with moderate COPD were the majority of the population with COPD. Finally, it was possible to distinguish patients who made an appropriate use of SABA (76% of the total), patients who had a potentially inappropriate use (20%), and those with an overuse of SABA (4%). The use of SABA consumption patterns can be a reliable proxy variable to detect subgroups who may necessitate therapy revision. Health administrative databases seem beneficial for planning health care interventions, including the COPD field. They are robust information systems subjected to regular data quality controls remaining the prevalent data source, reliable because of the amount of data and the population coverage, especially in countries with a National Health Service System.

From clicks to care: Exploring the digital strategies of Italian health authorities in communicating 'General Practitioner Selection' service.