Clinical, demographical characteristics and hospitalisation of 3,010 patients with Covid-19 in Friuli Venezia Giulia Region (Northern Italy). A multivariate, population-based, statistical analysis

OBJECTIVES

to describe the clinical and demographical characteristics of COVID-19 infected people in the Friuli Venezia Giulia Region (FVG, Northern Italy).

DESIGN

retrospective cohort study with an individual level record linkage procedure of different administrative databases.

SETTING AND PARTICIPANTS

the cohort included 3,010 patients residing in FVG who tested positive for COVID-19 between 1 March and 15 May 2020, 2020. Regional hospital admissions and deaths without hospital admissions up to June 1st, 2020 were analysed. Determinants of the probability of a highly severe illness were investigated in terms of hospitalisations or death without hospital admission.

MAIN OUTCOME MEASURES

COVID-19 patients were identified from regional epidemiological data warehouse. Demographical and clinical variables such as gender, age, patient's comorbidities, vaccinations, ARBs/sartans prescriptions, and geographical residence variables were collected by linking different databases. Descriptive analyses were performed. Logistic multivariate regressions were used to estimate the probability of hospitalisation or death, whichever came first. Model coefficients and odds ratios (OR) were reported.

RESULTS

COVID-19 population in FVG had a mean age of 60 years and 59% were females. The study found that 37% had hypertension while patients with cardiologic diseases, diabetes, and cancer were around 15%; 22% of the cases were residing in retirement homes. Approximately 30% received flu or pneumococcal vaccination and a similar proportion of patients had at least one prescription of ARBs /sartans in the previous 6 months. Statistical models showed a higher probability of a worst course of disease for males, elderly, highly complicated (in terms of resource use) subjects, in the presence of cardiologic diseases, diabetes, and pneumococcal vaccination. People living in retirement homes had a lower probability of hospitalisation/death without hospital admission. The cohort was divided into two groups: COVID-19 patients infected in the territory and infected in retirement homes. Among COVID-19 patients infected in the territory, the probability of hospitalisation/death was higher for males, for older individuals, and for those with comorbidities. Diabetes resulted to be a risk factor (OR 1.79; 95%CI 1.23-2.62), as well as pneumococcal vaccination (OR 1.64; 95%CI: 1.18-2.29), which is a likely proxy of fragile patients with pulmonary disease. The flu vaccination showed a potential protective effect with a 40% lower probability of hospitalisation or death (OR 0.62; 95%CI 0.44-0.85). Among the retirement homes cohort group, a higher probability of a bad course of disease emerged for males and for more complex patients.

CONCLUSIONS

the greatest risk of hospitalisation/death as a measure of more severe illness was confirmed for males, elderly, and for individuals with comorbidities. Flu vaccination seemed to have had a protective effect while pneumococcal vaccination likely identified a group of high-risk patients to be actively monitored. For patients infected in the territory, different hospitalisation strategies were implemented by the regional health districts.

Health promoting pharmacies in Northern-Italy: more than drugstores

Issue

In Friuli Venezia-Giulia Region (Italy), accessibility to health services can be substantially influenced by the geographical context. In fact, during recent years, at-risk inhabitants of mountain villages were less likely to be vaccinated against flu in comparison with other areas. To tackle inequalities, local pharmacies were identified as a proximity health promotion network to be engaged in the 2019/2020 flu vaccination campaign.

Description

Within the mountainous Carnia District, 43 pharmacists from 25 pharmacies were trained before the campaign to promote flu shot uptake through counseling in over 65 and high-risk subjects. After counseling, subjects were directed to General Practitioners who performed vaccine administration and registration. Anti-flu counseling offered by pharmacists was traced and vaccine coverage against influenza among target categories was considered as the principal outcome. A reward was granted to pharmacies in relation to flu vaccine conversions among counseled subjects.

Results

Between October 2019 and January 2020, a total of 2,748 counseling sessions with people accessing pharmacies for any reason were conducted. Within Carnia District, flu vaccine was administered to 6,484 out of 10,895 (59.5%) over 65 subjects in comparison with 5,569/10,251 (54.3%) who got their flu shot during the 2018/19 flu season, achieving an improvement of + 5.2%. This result exceeded the regional global outcome reaching +2.2%, being the best among all districts. In particular, in comparison with the previous year, +10.2% over 65 and +37.8% at-risk subjects were vaccinated against flu in Carnia District.

Lessons

Pharmacies played an important role in promoting flu vaccination locally, and proved their potential contribution in tackling inequalities related to difficult contexts. The collaboration of health professionals, including pharmacists, should be taken into consideration to improve health promotion and health services access.

Key messages

Pharmacies are trustworthy healthcare system access points for people, therefore their role in health promotion should be fostered. Pharmacists can help in improving flu shot uptake in contexts where health service access is hindered.

Pharmacists’ one-to-one counseling succeeds in promoting flu shots among target population

Background

Vaccine hesitancy among general population can be even greater regarding flu than other vaccine preventable diseases, as complacency towards influenza is quite high and confidence can be reduced by the confounding effect of influenza-like-illnesses. Health professionals face hesitant people alleging many different motivations against flu vaccination, some of them being susceptible to tailored one-to-one health promotion.

Methods

During 2019/20 flu vaccination campaign, 44 trained pharmacists of Carnia District in Friuli Venezia Giulia Region (Italy) surveyed at-risk people accessing 25 pharmacies regarding beliefs on flu vaccination and offered one-to-one advice. As stated in the Italian national vaccination plan, subjects with comorbidities or older than 65 were considered at risk. Adherence to influenza vaccination during past flu season and reasons for that choice, as well as intention to be administered flu shots after counseling were registered.

Results

A total of 2,748 at-risk subjects adhered to the project with a mean age of 70±12 years, 57% of them being females; 1,702 (38%) did not adhere to flu vaccination campaign last year. Most of them confirmed a low complacency level, reporting to have refused flu vaccination because of “not getting ill” (43%) believing that vaccines are dangerous (12%) or not effective (5%); some did not know they could access flu vaccination (8%). After counseling, 2196 (80%) decided to adhere to flu vaccination, in particular 83% (1284/1555) of over 65 and 84% (684/816) of at-risk subjects.

Conclusions

More than one third of over 65 or at-risk surveyed subjects did not receive influenza vaccination during 2018/19 flu season. One-to-one tailored counseling conducted by pharmacists resulted to be effective in tackling vaccine hesitancy among 2019/20 flu shot target population.

Key messages

Motivations underlying vaccine hesitancy toward flu vaccination continue to impair health outcomes of target population. A one-to-one counseling intervention conducted by pharmacists with specific targets should be useful to improve seasonal flu vaccine coverage.

COVID-19 infections in the Friuli Venezia Giulia Region (Northern Italy): a population-based retrospective analysis

OBJECTIVES

to study the cumulative incidence, the demographics and health conditions of the population tested for COVID-19, and to map the evolving distribution of individual cases in the population of the Friuli Venezia Giulia Region (North-Eastern Italy).

DESIGN

population-based observational study based on a record linkage procedure of databases included in the electronic health information system of the Friuli Venezia Giulia Region.

SETTING AND PARTICIPANTS

the study group consisted of individuals who resided in the Friuli Venezia Giulia Region and who underwent COVID-19 testing from 01.03 to 24.04.2020. The study group was identified from the laboratory database, which contains all the microbiological testing performed in regional facilities. Tested people were categorized into positive or negative cases, based on test results.

MAIN OUTCOME MEASURES

probability of being tested for and cumulative incidence of COVID-19.

RESULTS

the cumulative probability of being tested for COVID-19 was 278/10,000 inhabitants, while the cumulative incidence was 22 cases/10,000. Out of 33,853 tested people, 2,744 (8.1%) turned out to be positive for COVID-19. Women were tested more often than men (337 vs 216/10,000), and they showed a higher incidence of infection than men (25 and 19 infected cases/10,000 residents, respectively). Both cumulative incidence and cumulative probability of being tested were higher in the elderly population. About 25% of infected people was hosted in retirement homes and 9% was represented by healthcare workers. Thirty seven percent of positive cases had hypertension, 15% cardiologic diseases, while diabetes and cancer characterized 11.7% and 10% of the infected population, respectively. The geographic distribution of positive cases showed a faster spread of the infection in the city of Trieste, an urban area with the highest regional population density.

CONCLUSIONS

the COVID-19 pandemic did not hit the Friuli Venezia Giulia Region as hard as other Northern Italian Regions. In the early phase, as documented in this study, the COVID-19 pandemic particularly affected women and elderly people, especially those living in retirement homes in Trieste.