Ligurian general practice is experimenting with a new organizational model that can lead to further developments in initiative medicine. Presented to the Order of Doctors of Genoa, the initiative in fact involved three territorial functional aggregations (Aft) of the ASL3, to which 49 general practitioners and 3,220 diabetic patients, aged between 40 and 65, joined which herpes zoster vaccination has been proposed.
After 5 months of experimentation, the preliminary results were encouraging: as of 4 October, 1,026 first doses had been administered, equal to 32% of those contacted, 533 second doses and 493 planned by 15 December. Numbers that have a positive impact on vaccine prevention medicine in adulthood.
The project, which started on a voluntary basis and made use of the non-conditioning contribution of Medicoop Liguria and GlaxoSmithKline, benefited from the introduction in the region of the new herpes zoster vaccine from the end of 2021, which gives very satisfactory results for different age groups even in the presence of comorbidities. The diabetic patient was therefore chosen because “he is a target that needs to be protected from shingles, which can lead to postherpetic neuralgia” underlined Anna Opisso, medical director of the NO Hygiene and public health operational unit Vaccination strategies during the realization of the project.
“The adult population still considers that the culture of vaccine prevention only concerns the first years of life. Covid has changed perceptions a bit, but it has also focused attention and people tend not to join the active call from the public hygiene services. Instead, general practitioners know their patients well, they have a relationship of dialogue and trust, so they are the privileged actors for a project of this type”, highlighted Opisso.
The vaccination registry has been one of the fundamental tools not only for reaching the patient, but also for reporting the supply chain in terms of safety and expenditure.
“Before the project, the ASL 3 had already activated the active offer for sixty-five-year-olds – underlined Giuseppe Stellini, internist, family doctor in Genoa Asl3 and member of the scientific board that carried out the experimentation -. However, we see that membership is not high, sending a letter is not enough, so it was very useful to experiment with a different method, developed at the level of Aft, territorial aggregations made up of about twenty doctors. The key to success was the organization, thanks to Medicoop who took care of the bureaucratic aspects and assisted the doctor with the vaccinating nurse. The presence of a dedicated secretariat and vaccination staff are fundamental points for obtaining significant results”.
The selection of the target was taken care of by the Medicoop service centre, while the family doctor informed and promoted vaccination among his own diabetic patients. The administration took place in eight vaccination centres. “It wasn’t easy to involve the doctors, because they didn’t believe that such a coordinated system could be built without interfering with the work of the clinic – said Pier Claudio Brasesco, general practitioner at the Asl3 of Genoa and president of Medicoop Liguria – . Actually, the method worked. Now we would like it to be possible to think across the board and in a progressive way, at the level of the Region and of the Local Health Authority, in terms of initiative medicine”.
Positive reception also came from Michele Orlando, medical director of the Ligurian health company of the Liguria Alisa Region, who underlined the centrality of general practitioners in the territorial system, while invoking that this organizational model can be extended to the metropolitan area, where c ‘it is more difficult to integrate hospitals and these into the territory.
Even the Ligurian Medical Association, in the words of the president Alessandro Bonsignore, appreciated the project, emphasizing the role of facilitator of dialogue between institutions “The commitment is to create more sustainable models for the future – added Bonsignore -. We are living in a phase of change in the healthcare system and the decisions of these months will crystallize in the coming years. I believe that prevention is the right investment also for the political interlocutor, especially for the positive repercussions in terms of savings and in this post-pandemic phase”.
“Initiative medicine is at the heart of the Pnrr and prevention is a fundamental key – said Lorenzo Sampietro, social and health director of the ASL 3 of Genoa -. The crisis in the health system, from the hospital to the emergency room, is also due to the fact that we are waiting for the acute phase of the disease to manifest itself. This project aligns with the concept of the chronic care model: we have been talking about it for twenty years and now the question of cost-benefit is increasingly pressing, to give the national health system a future”.
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