Italian health workers’ knowledge, attitudes and behaviours towards COVID-19 vaccination

Background

Vaccine hesitancy is the reluctance or refusal to be vaccinated. While it has been widely studied for various contagious diseases, there is still a lack of knowledge about this phenomenon for COVID-19, especially if health workers' hesitancy is considered.

Methods

An extensive review of the literature was conducted to identify the main determinants of vaccine hesitancy in health workers, as well as to find already validated surveys to evaluate the knowledge, attitudes and behaviors (KAB) of health workers towards vaccination, both in general and with specific regard to COVID-19. Building on the available information, a new survey was developed to assess the KAB of Italian health care workers towards COVID-19 vaccination after validation with a pilot study in a diverse sample of 30 Italian health workers.

Results

A new survey was validated to assess the KAB of health workers towards COVID-19 vaccination in Italian health workers. The survey requires about 6 minutes to complete and is composed of 30 questions, investigating different domains: socio-demographic and professional characteristics (6); health status (2); attitudes (11); behaviors (6); knowledge (4). The survey will be administered to a representative sample of at least 385 Italian health workers through the web platform SurveyMonkey in the period June-September 2021. Preliminary results will be available by the end of October 2021.

Conclusions

By analyzing KAB towards COVID-19 vaccination with a new tool, the magnitude and determinants of health worker's COVID-19 vaccine hesitancy will be evaluated to understand how to improve health workers' perception towards COVID-19 vaccination and, consequently, foster their positive influence on the general population.

Key messages

We explore the knowledge, attitudes and behaviors towards COVID-19 vaccination in all categories of health workers operating on the Italian territory to understand the reasons of vaccine hesitancy.

Understanding the determinants of COVID-19 vaccine hesitancy in Italian health workers is necessary given their influence on the perception of the general population in Italy.

HPV Vaccination in Women Treated for Cervical Intraepithelial Neoplasia: A Budget Impact Analysis

Human Papillomavirus (HPV) is the most common sexually transmitted infection. Its progression is related to the development of malignant lesions, particularly cervical intraepithelial neoplasias (CINs). CINs correlate with a higher risk of premature births, and their excisional and ablative treatment further increases this risk in pregnant women. These complications are also correlated with higher healthcare costs for their management. In Italy, more than 26,000 new cases of CINs are estimated to occur yearly and their economic burden is significant. Therefore, the management of these conditions is a public health priority. Since HPV vaccination is associated with a reduced risk of relapse in women surgically treated for HPV-related injuries, we estimated the economic impact of extending HPV vaccination to this target population. This strategy would result in a significant reduction in the general costs of managing these women, resulting in an overall saving for the Italian Health Service of €155,596.38 in 5 years. This lower cost is due not only to the reduced incidence of CINs following vaccination, but also to the lower occurrence of preterm births. Extending HPV vaccination to this target population as part of a care path to be offered to women treated for HPV injuries is therefore desirable.

A Web Screening on Educational Initiatives to Increase Citizens' Literacy on Genomics and Genetics

Introduction

Population awareness and empowerment in omics sciences represent a fundamental driver to increase the adoption of evidence-based approaches in personalized medicine. In this context, a pivotal role is played by citizens' literacy, and educational initiatives carried out in this context are key assets to drive future effective interventions. With the present study, we summarized the educational initiatives conducted worldwide aimed at increasing citizens' literacy in omics sciences.

Materials and Methods

We conducted a web search of the educational initiatives aimed at improving citizens' literacy in omics sciences undertaken worldwide, by using three search engines (Google, Bing, and Yahoo Search), in English and in Italian languages.

Results

We identified five initiatives in Europe, 22 in non-European countries, and 13 in Italy. Overall, the majority (69%) were web-based initiatives, while 31% required in-person attendance. The online initiatives included web pages for reading, online lessons/courses, web portals, videos/short movies, animations, and apps for mobile devices. The residential initiatives, on the other hand, included exhibitions, seminars, courses, symposia, information stands in public places, guided visits to research laboratories, and interactive laboratories. All the initiatives were highly heterogeneous in terms of methodologies and the topics addressed.

Discussion and Conclusion

Overall, we identified a variety of initiatives aimed at improving citizens' literacy in omics sciences, with the largest majority carried out in the United States and being web-based. Our results showed heterogeneity among the initiatives as to the dealt topics and the adopted methods. Further research is needed, however, to quantitatively assess the effectiveness of educational initiatives to improve citizens' literacy in omics sciences.

Developing an Evidence-Based Tool for Planning and Evaluating Vaccination Strategies Aimed at Improving Coverage in Elderly and At-Risk Adult Population

Background: Vaccination coverages need to be constantly maintained and improved with the implementation of vaccination strategies. This paper describes the development of an evidence-based tool to guide their planning and evaluation.

Methods: A scoping review was performed in MEDLINE and institutional websites to search for similar available tools. A first version of the tool was developed considering review results and a four-step method used for the control and continuous improvement of processes and products, namely the Deming cycle. A panel of eight experts was then involved in a Delphi study for the finalization of the tool that was eventually discussed in a face-to-face meeting.

Results: The scoping review found only one document and the first version of the tool was composed of 30 items. After the Delphi first round, 11 additional items were suggested and 5 original items amended. After the Delphi second round 41 items were eventually included. During the face-to-face meeting, 7 items were recognized as requisites for setting vaccination strategies, whereas 17 as relevant ones.

Conclusions: Current public health challenges impose the need for evidence-based tools to organize effective vaccination strategies. Our tool is a first proposal which aims to reflect this focus.

Capacity Building of Health Professionals on Genetics and Genomics Practice: Evaluation of the Effectiveness of a Distance Learning Training Course for Italian Physicians

BACKGROUND

The rapid spread of personalized medicine requires professionals to manage the "omics revolution." Therefore, the genetics/genomics literacy of healthcare professionals should be in line with the continuous advances in this field, in order to implement its potential implications for diagnosis, control and treatment of diseases. The present study investigates the effectiveness of a distance learning course on genetics and genomics targeted at medical doctors.

METHODS

In the context of a project funded by the Italian Ministry of Health, we developed a distance learning course, entitled Genetics and Genomics practice. The course focused on genetic/genomics testing, pharmacogenetics and oncogenomics and was developed according to andragogical training methods (Problem-based Learning and Case-based Learning). We used a pre-test vs. post-test study design to assess knowledge improvement on a set of 10 Multiple Choice Questions (MCQs). We analyzed the proportion of correct answers for each question pre and post-test and the mean score difference stratified by gender, age, professional status and medical discipline. Moreover, the test was submitted to the participants 8 months after the conclusion of the course (follow-up), in order to assess the retained knowledge.

RESULTS

The course was completed by 1,637 Italian physicians, most of which were primary care physicians (20.8%), public health professionals (11.5%) and specialist pediatricians (10.6%). The proportion of correct answers increased in the post-test for all the MCQs. The overall mean score significantly increased, from 59.46 in the pre-test to 71.42 in the post-test (p < 0.0001). The comparison in test performance between follow-up and pre-test demonstrated an overall knowledge improvement.

CONCLUSION

Genomics literacy among healthcare professionals is essential to ensure optimal translation to healthcare delivery of research. The results of this course suggest that distance-learning training in genetic/genomics practice represents an effective method to improve physicians' knowledge in the immediate and mid-term time scale. A preprint version of this paper is available at: https://www.researchsquare.com/article/rs-10083/v1.

Precision Medicine and Public Health: New Challenges for Effective and Sustainable Health

The development of high-throughput omics technologies represents an unmissable opportunity for evidence-based prevention of adverse effects on human health. However, the applicability and access to multi-omics tests are limited. In Italy, this is due to the rapid increase of knowledge and the high levels of skill and economic investment initially necessary. The fields of human genetics and public health have highlighted the relevance of an implementation strategy at a national level in Italy, including integration in sanitary regulations and governance instruments. In this review, the emerging field of public health genomics is discussed, including the polygenic scores approach, epigenetic modulation, nutrigenomics, and microbiomes implications. Moreover, the Italian state of implementation is presented. The omics sciences have important implications for the prevention of both communicable and noncommunicable diseases, especially because they can be used to assess the health status during the whole course of life. An effective population health gain is possible if omics tools are implemented for each person after a preliminary assessment of effectiveness in the medium to long term.

Increasing HPV Vaccination Uptake among Adolescents: A Systematic Review

Human Papillomavirus (HPV) vaccination is a well-known fundamental strategy in the prevention of cervical cancer, as it is always caused by HPV infection. In fact, primary prevention of the infection corresponds to primary prevention of HPV-related cancers and other diseases. Since an effective prevention at the population level is the final goal, it is mandatory for healthcare systems to achieve a high HPV vaccination coverage among the adolescents to reduce the circulation of the virus and the burden of HPV-related diseases. This research identified, through a systematic literature review, 38 papers on strategies adopted to increase HPV vaccination coverage among adolescents. The evaluated strategies targeted adolescents/parents and/or healthcare providers and could be grouped in three main types: (1) reminder-based, (2) education, information, and communication activities, and (3) multicomponent strategies. Several types of strategy, such as those relied only on reminders and integrating different interventions, showed a positive impact on vaccination coverage. Nonetheless, the heterogeneity of the interventions suggests the importance to adapt such strategies to the specific national/local contexts to maximize vaccination coverage.

Citizens' Attitudes, Knowledge, and Educational Needs in the Field of Omics Sciences: A Systematic Literature Review

Background: The huge development of omics sciences is changing the classical medical approach and making new technologies available. In this context, education of citizens is essential to allow appropriate decisions about their own health. Hence, we aimed to summarize existing literature regarding citizens' knowledge, attitudes, and educational needs on omics sciences. Methods: We performed a systematic literature review (SLR) using Pubmed, ISI Web of Science, and Embase databases. The eligibility criteria for inclusion in this review required that the studies investigated knowledge, attitudes, or educational needs regarding omics sciences among the general population. Results: We included 54 studies, published between 2006 and 2020. Most of the included studies (72%) investigated citizens' knowledge, half of them (56%) attitudes, and 20% educational needs in the field of omics sciences, while 52% investigated attitudes and perceptions about genetic and/or omics tests. Most studies (64%) reported a limited knowledge level among citizens, even though most (59%) reported participants understood the benefits of the use of omics sciences into medicine. As for omics tests, a controversial opinion toward their use into practice was reported among citizens. Most of the studies (82%) investigating citizens' educational needs highlighted a clear gap to be filled. Conclusions: Our SLR summarizes current knowledge on citizens' literacy, attitudes, and educational needs on omics science, underlining the need for strengthening public engagement on this topic. Further research is needed, however, to identify appropriate methods and models to achieve such an improvement.

Systematic review on citizens’ literacy in omic sciences and web search of initiatives to improve it

Introduction

We are assisting to a progressive change in the classical approach to patient care toward so-called personalized medicine, mainly driven by the development of omic sciences. To implement omic sciences into practice it is important to address healthcare professionals', policy makers', leaders', and citizens' literacy

Methods

As part of a project funded by the Italian Centre for Disease Prevention and Control (CCM), we carried out a systematic review (SR) on citizens' attitude, knowledge, and educational needs in omic sciences. The search was carried out on Pubmed, Web of Science, and Embase. We also conducted a separate web search on Google, Yahoo, and Bing on initiatives published in Italian and English aimed at improving citizens' literacy in the same field. Websites of retrieved initiatives were examined to identify additional resources

Results

Forty-nine studies were included in the SR. Most studies (n = 26, 66.7%) reported low levels of knowledge in omic sciences among citizens, and conflicting attitudes related to potential risks and benefits of omic sciences. Eleven studies (22%) evaluated citizens' educational needs, and most (n = 9, 82%) reported a clear knowledge gap. As for the web search, 13 initiatives were identified in Italy, 4 in Europe, and 22 in non-European Countries. Overall, 33% of them required in-person attendance, while 67% were web-based resources. The former included exhibitions, seminars, courses, symposia, information stands in public places, guided visits at research laboratories, and interactive laboratories; the latter included web-pages for reading, online lessons and courses, web portals for information, videos and short movies, animations, apps for mobile devices

Conclusions

Results show a clear need to improve citizens' literacy. To achieve this goal, the implementation of effective strategies and initiatives is crucial, hence this effort to summarize the existing ones will be essential for future plan developments.

Key messages

The current challenge is to identify effective methods of improving citizens' literacy and implementing them. Only through citizens’ empowerment the implementation of omic sciences in the Health System will be possible, since citizens are increasingly active in the health context.

Distance learning training in genetics and genomics practices for Italian healthcare professionals

Background

Genomics and related fields are becoming increasingly relevant in healthcare practice. Italy is the first European country with a structured policy of Public Health Genomics and dedicated guidelines that focus on three pillars: Health Technology Assessment of omic applications, promotion of citizens' literacy, and promotion of extensive training for all healthcare stakeholders. In January 2019 we initiated a project funded by the Italian Ministry of Health and entitled 'Capacity building and Citizens-Omics'.

Objectives

The project is coordinated by the National Institute of Health and is aimed at implementing the “Italian National Plan for innovation of the healthcare system based on omics sciences” published in 2017.

Results

The project had set-up two distance-learning courses on genetic/genomics: an advanced course for physicians and biologists, and a basic one for the remaining healthcare professionals. The courses focused on genetic/genomic testing in clinical practice, pharmacogenomics and oncogenomic and they were developed according to the main models of andragogical training (Problem-based Learning and Case-based Learning). The courses include audio-video lectures and interactive clinical cases and they will be accessible free of charge for a year (from February 17th 2020). In three weeks, we had 2129 participants (1101 physicians, 1028 biologists) for the advanced course and 10.000 for the basic one.

Conclusions

Genomic literacy among healthcare professionals is essential to ensure optimal translation to healthcare delivery of research. The distance-learning training in genetic/genomic practices represents an effective method to improve healthcare professionals' knowledge in the immediate and mid-term time scale. Our courses represent the third Italian experience in distance training in omic field. The educational effects related with online courses could potentially be relevant internationally and across a wider range of potential audiences.

Key messages

In view of the ongoing rapid developments in genetics research it is important that omic literacy among healthcare providers be enhanced to ensure translation to healthcare delivery of research. E-learning training appears to offer a cost-effective and time-efficient method of improving omic knowledge and it could be relevant across a wider range of potential audiences.

BRaVE Project: processing an evidence-based tool to develop and evaluate vaccination strategies

Introduction

Deaths and epidemics due to vaccine-preventable diseases still occur even though there are effective vaccines available. Albeit recommendations released by the Italian Ministry of Health, vaccination coverages remain unsatisfactory. An improvement is therefore needed and new strategies are deserved in order to increase coverage. Nevertheless, neither a validated tool nor an institutional guideline to plan and/or evaluate vaccination strategies are available. The aim of BRaVE project was to build an evidence-based tool to develop and assess them.

Methods

In May 2019, a scoping review in MEDLINE and a search of ECDC and WHO websites were performed to look for validated tools to plan and/or evaluate vaccination strategies. The results of the search and the four phases of the Deming cycle (Plan, Do, Check, Act) were used to develop a grid. A multiprofessional panel of 7 experts validated the items included in the grid through a Delphi process followed by a face-to-face meeting.

Results

The original grid submitted to the panel of experts included 30 items (13 planning, 7 implementation, 4 check, 4 act, 2 other). The first round of Delphi led to the suggestion of 11 additional items and to the amendment of 4 out of 30 original items. During the second round of the Delphi the 41 items proposed were approved. At the end of the face-to-face meeting, 1 item was split. Seven items belonging to “Planning” (Plan) and “Implementation” (Do) were labelled as requisites for launching a vaccination strategy and the remaining 35 as items to be considered in their evaluation (15 planning, 11 implementation, 8 check, 4 act, 4 other).

Conclusions

Despite its importance, vaccination coverage is low. Evidence shows possible improvement in coverage, if innovative vaccination strategies are put in place. The developed grid is proposed as an organizational instrument which could improve and standardize vaccination strategies fostering their success and transferability.

Key messages

Novel organizational strategies could be a useful answer to improve vaccination coverage. The proposed grid could be used for the development and assessment of vaccination strategies.

Strategies to Improve Vaccination among At-Risk Adults and the Elderly in Italy

The World Health Organization (WHO), the United States (US) Centers for Disease Control and Prevention (CDC), the European Center for Disease Control (ECDC), and the immunization guidelines of many countries issue vaccination recommendations for adults and the elderly. However, the uptake of vaccination in these groups is generally low due to several reasons. The present study aimed to identify strategies implemented in Italy in unconventional settings to promote vaccination against influenza, pneumococcal, and herpes zoster virus (HZV) infections among these subjects, i.e., the at-risk adult population and the elderly. We conducted a literature review and a survey of experts. The literature search yielded seven strategies; all of these concerned influenza vaccination, while three also addressed pneumococcal and HZV vaccination. The survey of experts identified 15 strategies; 10 regarded influenza vaccination, while four regarded pneumococcal vaccination and one regarded HZV vaccination. Most of the strategies were implemented in hospital clinics and rest homes. Regarding influenza and pneumococcal vaccinations, the target population mainly comprised at-risk adults, while the elderly represented the main target population for HZV vaccination. Our results show that, in Italy, there are initiatives aimed at promoting vaccination in unconventional settings, but further efforts are required to assess their effectiveness and to further extend them.

Increasing HPV vaccination uptake among adolescents: A Systematic Review

Background

Human Papillomavirus (HPV) is responsible for the development of several pathologies besides the cervical cancer and HPV vaccination is a key strategy for primary prevention. The aim of this research was to identify strategies adopted to increase HPV vaccination coverage among the adolescents.

Methods

A systematic review was carried-out by searching electronic databases (Pubmed, Scopus, and Web of Science) using selected keywords as “papillomavirus vaccine”, “vaccination strategy” and “efficacy”. Articles conducted in high-income countries and evaluating the impact of one or more strategies on vaccination coverage (initiation e/o completion) in adolescents were included.

Results

Out of 3571 single citations screened, 42 papers (2011-2018) were included. Study size ranged from 50 to 325229 individuals. The major part of the studies was from the United States (n = 35; 83,3%) and conducted with an experimental design (n = 17; 40,5%). The evaluated outcomes included first dose uptake, schedule completion, vaccination timeliness and the number of administered doses. Identified strategies included reminds (9), education activities (9), multicomponent strategies (22) and others (2) and were focused on adolescents/parents and/or healthcare providers. Significant positive results were reported in seven studies (77,8%) evaluating the impact of reminds, four studies (44,4%) on education strategies, and in 12 studies (54,5%) on multicomponent strategies. Offering vaccination in “bundle” or during any medical visit was also reported as significantly effective.

Conclusions

Increasing the vaccination coverage is essential to achieve HPV-related diseases control. Several types of strategies are available and showed a positive impact on vaccination uptake, in particular those relied on reminds. Nonetheless, the heterogeneity of interventions suggests the importance to adapt such initiatives to the specific context in order to maximize the improvement in vaccination uptake.

Key messages

Several types of strategies to increase vaccination uptake are available at international level and showed a positive impact among adolescents. These interventions are heterogeneous suggesting the importance of their adaptation to the specific context in order to gain the maximum improvement in vaccination uptake.

Strategies to achieve HPV-related disease control in Italy: results from an integrative approach

Background

Vaccination against Human Papilloma Virus (HPV) might allow controlling HPV-related diseases but coverage in Italy is far from the optimal goal. This project aimed at identifying strategies to promote HPV vaccination in Italy.

Methods

an integrative approach including a systematic review and a two-step panel consultation was used to identify strategies for improving coverage among adolescents who are already target of the national campaign and promote vaccination in further targets. The systematic review followed PRISMA recommendations and the panel consultation relied on the administration of questionnaires in the first step and on a televoting system during a consensus conference in the second one. Ten experts were involved belonging to Gynecology, Public Health, General Practice, Pediatrics and Consumers. Recommendations relied on a set of criteria drawn from the Evidence to Decision framework.

Results

The systematic review led the identification of three main strategies to improve coverage respectively based on reminds, education and multicomponent approaches. Following the evaluation of selected criteria, namely relevance of benefits, evidence strength, feasibility, equity, acceptability and costs, a strong recommendation was formulated on the use of reminds tailored to vaccine recipients or their parents whereas a moderate one was developed on the use of reminds directed to health professionals. A moderate recommendation was released on the implementation of multicomponent interventions. The panel consultation also supported the elaboration of a strong recommendation on the promotion of vaccination among women treated for HPV-related diseases, fertile women not yet vaccinated and 25 years old women. Catch-up initiatives, in particular among women and men 18 years old, were also identified as strongly recommendable.

Conclusions

This project led to identify several valuable strategies to strengthen HPV vaccination at national level.

Key messages

Using reminds tailored to vaccine recipients or their parents is strongly recommended while using reminds directed to health professionals and multicomponent interventions are moderately recommended. It is strongly recommended to promote HPV vaccination among women treated for HPV-related diseases, fertile women not yet vaccinated and 25 years old women.

Disinvestment in cancer care: a survey investigating European countries' opinions and views

Background

The current economic context calls for rationalizing health resources that can be pursued through disinvestment from low value health technologies to invest in the best performing ones, ensuring high healthcare quality. Oncology is a field where, because of high costs of health technologies and rapid innovation, disinvestment is crucial.

Methods

On this basis, the research team investigated through a survey, based on a questionnaire, opinions and views of representatives of European countries about disinvestment, in terms of fields of application, potential advocates and barriers, specifically focusing on cancer care.

Results

A total of 17 questionnaires were filled in (response rate: 32.1%). The survey showed disinvestment is applied in several countries as a tool for containing health care expenditures and identifying obsolete technologies/ineffective interventions. Clinicians' resistance to change and industries' opposition are recognized as the most important barriers to the implementation of disinvestment policies. Potential targets of disinvestment in cancer are seen in diagnostic and therapeutic areas.

Conclusion

Despite the agreement on fields of waste and of disinvestment policies, operational methods to put disinvestment in place are lacking. Since they should rely on an inclusive assessment of the technology, Health Technology Assessment may represent a good approach.

[Omic sciences and capacity building of health professionals: a distance learning training course for Italian physicians, 2017-2018]

BACKGROUND

Nowadays, a strategy to manage the current "omic revolution" is needed in Italy. Actions aimed to improve genetic/omics &quot;literacy&quot; among health professionals and citizens are necessary, based on recommendations outlined in the Italian 2013 Guidelines on genomics in public health, and the 2018 National Plan for the innovation of the health system based on the omic sciences.

MATERIALS AND METHODS

In the context of a project funded by the Italian Ministry of Health, a distance-learning course entitled "Genetic and Genomic practices" was developed, targeted at medical professionals (mainly general practitioners). The main objective of the course was to train physicians in the responsible use of omic technologies. The course was structured according to the main models of adult learning theory (Problem-based-learning and case studies) and delivered on the institutional platform of the Italian National Institute of Health for one year, from February 2017 to February 2018, with the endorsement of the Italian Society of Hygiene and Preventive Medicine and the Italian Society of Human Genetics.

RESULTS

In one year, 3,054 participants registered for the course and 53% completed it. About 21% of participants were primary care physicians, 12% were public health physicians and 11% were hospital paediatricians. The most represented age group of participants was 51-65 years and their geographical distribution was 38.5% southern Italy/islands, 36.3% northern Italy and 25.2% central Italy. Pre-test data showed that training needs of primary care physicians was very high.

CONCLUSIONS

In the current context, characterized by the &quot;omic revolution&quot;, physicians must be able to understand its potential implications for the diagnosis, control and treatment of diseases. It is therefore necessary to work on capacity building of all health professionals involved in various ways in the use of the "omic sciences". Distance-learning training in genetic/genomic practices represents a low-cost, satisfactory and clinically applicable method to improve physicians' knowledge.

Lean thinking in the hospital setting - Results of a systematic review of literature

AIM

The aim of this study was to review experiences of use of the Lean methodology in the hospital setting and assess the impact of the interventions in terms of time of processes, productivity, effects on staff and patientd satisfaction.

METHODS

PubMed, Scopus and CINAHL databases were searched to identify studies evaluating the lean methodology. Two reviewers screened the citations identified and extracted data according to the PRISMA methodology.

RESULTS

In total, 635 citations were identified, of which 27 were included in the present review. Most studies showed a positive outcome related to the implementation of the Lean methodology and tools.

[Improving Hospital efficiency: assessment of performance of a surgical suite through root cause analysis, in a hospital in northern Italy]

A Surgical Suite (SS) is a complex system in which different healthcare professionals work. Inefficient management could lead to waste of money and time and reduce quality of care. The aim of the study was to carry out an organizational assessment of a SS in northern Italy, in order to identify weaknesses and inadequacies related to its performance and promote strategies to increase efficiency. The study was conducted by process mapping of the working context, qualitative and quantitative analysis of patient documents and an evaluation of the critical issues using the root cause analysis (RCA) tool. The Plan Do Check Act (PDCA) method was used to implement the necessary changes. A detailed description of the staff involved, medical devices available, organization and timing of the SS was performed. Inefficiencies in the unit were caused mainly by insufficient medical devices and underusage of the radiological software Picture Archiving and Communication System (PACS). Root causes of inefficiencies were identified and classified into four areas: organization/structure, personnel, technologies and methods. In particular, critical issues were identified in: the planning processes, the heterogeneity of technical and Information technology skills and educational background of nursing staff, the presence of several computerized information systems and lack of a connection interface between the different software, the lack of internal procedures and paths and lack of continuing professional education opportunities. Two multidisciplinary working tables were launched by the hospital management in order to identify improvement strategies. The evaluation allowed us to define the root causes of SS inefficiency in this hospital, leading to a reorganization with a view to continuous improvement. An innovative aspect of the present study was the use of RCA to perform an organizational assessment in healthcare, rather than as a reactive risk management tool.

Disinvestment in healthcare: an overview of HTA agencies and organizations activities at European level

Background

In an era of a growing economic pressure for all health systems, the interest for “disinvestment” in healthcare increased. In this context, evidence based approaches such as Health Technology Assessment (HTA) are needed both to invest and to disinvest in health technologies. In order to investigate the extent of application of HTA in this field, methodological projects/frameworks, case studies, dissemination initiatives on disinvestment released by HTA agencies and organizations located in Europe were searched.

Methods

In July 2015, the websites of HTA agencies and organizations belonging to the European network for HTA (EUnetHTA) and the International Network of Agencies for HTA (INAHTA) were accessed and searched through the use of the term “disinvestment”. Retrieved deliverables were considered eligible if they reported methodological projects/frameworks, case studies and dissemination initiatives focused on disinvestment in healthcare.

Results

62 HTA agencies/organizations were accessed and eight methodological projects/frameworks, one case study and one dissemination initiative were found starting from 2007. With respect to methodological projects/frameworks, two were delivered in Austria, one in Italy, two in Spain and three in U.K. As for the case study and the dissemination initiative, both came from U.K. The majority of deliverables were aimed at making an overview of existing disinvestment approaches and at identifying challenges in their introduction.

Conclusions

Today, in a healthcare context characterized by resource scarcity and increasing service demand, “disinvestment” from low-value services and reinvestment in high-value ones is a key strategy that may be supported by HTA. The lack of evaluation of technologies in use, in particular at the end of their lifecycle, may be due to the scant availability of frameworks and guidelines for identification and assessment of obsolete technologies that was shown by our work. Although several projects were carried out in different countries, most remain constrained to the field of research. Disinvestment is a relatively new concept in HTA that could pose challenges also from a methodological point of view. To tackle these challenges, it is necessary to construct experiences at international level with the aim to develop new methodological approaches to produce and grow evidence on disinvestment policies and practices.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2941-0) contains supplementary material, which is available to authorized users.

Capturing the chance for pneumococcal vaccination in the hospital setting

INTRODUCTION

Because of the relevant burden of pneumococcal diseases, newborns, people at risk and elderly are recommended vaccination but coverage is still low for problems in catching them. This study evaluates the proportion of eligible patients seen at hospital level in the view of assessing its potential role in vaccination campaigns.

METHODS

This is a retrospective analysis of discharge data of all patients over 49 years of age admitted between 2011 and 2013 to "A. Gemelli" teaching hospital. Eligibility for pneumococcal vaccination was evaluated based on ICD-9 codes.

RESULTS

Among 65 047 unique patients, 53.2% were eligible for pneumococcal vaccination. Most common eligibility criteria were chronic heart diseases, cancer and diabetes. Considering also age ≥ 65 as an indication to vaccination, the proportion of eligible patients reached 76.8%. The highest number of eligible patients was seen in medical sciences, general surgery, cardiovascular medicine and neurosciences departments.

CONCLUSIONS

Hospital might play an important role in catching patients eligible for pneumococcal vaccination because their proportion in the hospital setting is high.

[The economic value of vaccinations: a systematic review of Italian economic evaluations and HTA reports]

INTRODUCTION

Decision-making in healthcare should rely on evidence-based approaches able to make possible a transparent and robust assessment of all the aspects related to health technologies. One of the assessment elements is represented by the efficiency that is the specific objective of economic evaluations and also of Health Technology Assessment (HTA). The collection and synthesis of evidence is the first indispensable step in order to foster a proper convey of scientific knowledge to the decision-makers. This work, carried out within a broader project on the transfer of evidence from the scientific to the decision making world, is aimed to release an overview of economic evaluations and HTA on vaccines conducted in Italy. The project was carried out within the activities of the ISPOR Italy-Rome Chapter.

METHODS

A systematic review of Italian economic evaluations and HTA performed on vaccines and published up to May 2015 was carried out. PubMed, Scopus and the NIHR HTA databases were queried and a hand-search was performed on key journals in the field (Global & Regional Health Technology Assessment; PharmacoEconomics Italian Research Articles; Giornale italiano di HTA; Politiche Sanitarie; HTA Focus - Pills of Clinical Governance; Pillole di Farmacoeconomia; Giornale Italiano di Farmacoeconomia e Farmacoutilizzazione; IJPH; Quaderni dell'IJPH). Studies were considered eligible if showing the results of a full economic evaluations and if performed in Italy.

RESULTS

The literature search yielded 10 HTA reports and 33 economic evaluations. Among the latter, 20 (60,6%) were cost-effectiveness analyses. Ten studies (23,3%) assessed the vaccination against S. pneumoniae figuring out that it is cost-effectiveness and even costsaving in cases of newborns and subjects at risk. Nine studies (20,9%) addressed influenza vaccination and demonstrated its dominance on non-vaccination in the elderly. Eight studies (18,6%) evaluated the HPV vaccines concluding that they are cost-effective. Five studies (11,6%) devoted to anti-rotavirus vaccination showing its dominance on non-vaccination, in particular from the society perspective. Vaccination against pertussis, hepatitis B, chicken pox, measles, rubella, mumps were eventually shown cost-saving. The vaccine against Neisseria meningitidis was considered potentially cost-effective.

CONCLUSION

The Italian scientific evidence on efficiency of vaccination is broad and allows concluding that vaccinations are value for money interventions.