Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.
Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
BMC Health Serv Res. 2024 Aug 20;24(1):950. doi: 10.1186/s12913-024-11443-9.
Seasonal influenza vaccination coverage in Italian older adults is insufficient and well below the minimum target of 75%. In Italy, most influenza vaccine doses are administered by general practitioners (GPs), whose number has been declining. In parallel, the number of patients per GP and GP workload increased dramatically, which theoretically may impair vaccination counselling. In this ecological study, we aimed to assess whether influenza vaccination coverage in older adults is associated with the density of GPs having high number of patients.
The study outcome was the influenza vaccination coverage rate in adults aged ≥ 65 years and registered in 20 Italian regions over the last 23 years. The independent variable of interest was the proportion of GPs with more than 1,500 adult patients, which is an imposed normative ceiling. This latter variable was considered as a proxy of GP overload. By adopting a panel regression approach, different specifications of fixed- and random-effects models were run to assess the association of interest, when adjusted for several social structural, economic and healthcare-related variables.
Over the last two decades, most regions showed a negative association between influenza vaccination coverage rates and the density of GPs with a high number of patients. This latter negative association was confirmed (P < 0.05) in different panel model specifications. In particular, in the fully adjusted two-way fixed-effects model, each 10% increase in the number of GPs with more than 1,500 patients was associated with a 1.7% decrease in influenza vaccination coverage. However, this association was present only in region-years where at least 18% of GPs were deemed overloaded.
In the upcoming years, the number of Italian GPs is projected to decline further. At the same time, the aging Italian population will determine an even greater workload for GPs. This study demonstrated that increased GP workload may partially explain the spatiotemporal variation in influenza vaccination uptake in the Italian elderly. With the imperative of increasing or at least maintaining influenza vaccination coverage rates, several short- and mid-term initiatives should be implemented in order to optimize GP workload during seasonal immunization campaigns.
意大利老年人的季节性流感疫苗接种覆盖率不足，远低于 75%的最低目标。在意大利，大多数流感疫苗剂量由全科医生（GP）接种，而 GP 的数量一直在减少。与此同时，每位 GP 管理的患者数量和 GP 的工作量大幅增加，这在理论上可能会影响疫苗接种咨询。在这项生态学研究中，我们旨在评估老年人的流感疫苗接种覆盖率是否与高患者人数的 GP 密度有关。
本研究的结果是 23 年来意大利 20 个地区≥65 岁成年人的流感疫苗接种覆盖率。感兴趣的自变量是超过 1500 名成年患者的 GP 比例，这是一个强制性的规范上限。该变量被视为 GP 过载的代理变量。通过采用面板回归方法，运行固定效应和随机效应模型的不同规格，以调整几个社会结构、经济和医疗保健相关变量后，评估相关性。
在过去的二十年中，大多数地区的流感疫苗接种覆盖率与高患者人数的 GP 密度之间呈负相关。在不同的面板模型规格中，这种负相关关系得到了证实（P<0.05）。特别是，在完全调整的双向固定效应模型中，每增加 10%超过 1500 名患者的 GP 数量，流感疫苗接种覆盖率就会下降 1.7%。然而，这种关联仅存在于至少 18%的 GP 被认为过载的地区-年份。
未来几年，意大利 GP 的数量预计将进一步下降。与此同时，意大利人口老龄化将给 GP 带来更大的工作量。本研究表明，GP 工作量的增加可能部分解释了意大利老年人季节性流感疫苗接种率的时空变化。为了提高或至少维持流感疫苗接种覆盖率，在季节性免疫接种活动期间，需要实施一些短期和中期措施，以优化 GP 的工作量。
