Elderly, so we can increase vaccination coverage

Elderly, so we can increase vaccination coverage

A letter home, a phone call, perhaps a text message or a WhatsApp message, or even an invitation to open your health file. It can take different forms: the important thing is that the active call arrives and that the invitation not to miss the appointment with the recommended vaccinations is personalized, clear and simple. But also that the places where you can receive the vaccines are easy to reach. These are the cornerstones of a new active call model aimed at the regions to improve coverage for the vaccines recommended for those over 65, those who still struggle to achieve the desired vaccination coverage. Regions that will be able to choose the most congenial formula. It was developed by HappyAgeing – Italian Alliance for Active Aging, which created a position paper taking inspiration from good practices already successfully tested.

Vaccination plan: we must make it implementable

The premise in fact, he explained Michele Conversano, President of the Technical Scientific Committee of HappyAgeing, it is not that there is a lack of indications: the problem, rather, is implementing the new vaccination plan, approved with difficulty at the end of last summer. The 2023-2025 plan, in fact, at least scientifically, has been welcomed with enthusiasm by professionals. The choice of a calendar separate from the plan was appreciable, as was the objective of strengthening the vaccination offer, increasing both the points for the administration of vaccines and the promotional activities. The problem, as often happens, is to move from theory to practice, and find a way to act on the most painful part of vaccination coverage, those in the elderly, which are too far from the objectives.

“If we are good enough when it comes to vaccinations for children, we are less so, much less so, for frail and elderly people”, recalled Conversano. Here the coverage for the recommended vaccines – we are talking above all about vaccinations against pneumococcus and herpes zoster, but we should now also add Covid – are far from the recommended objectives, he says Alessandro Rossi, National President of SIMG. Yet, the experts recalled, we already have tools that could help us tackle the problem: the active call on the one hand (provided for in the LEAs and in the vaccination plan itself, but still little applied) and digital tools on the other: from the health file to the apps with which general practitioners are increasingly in contact with their patients. By combining these two tools – also taking inspiration from the Covid experience – it is possible to imagine a new active calling model. And this is what the experts brought together by HappyAgeing did.

Active calling: successful models

The examples served as inspiration come from Calabria, Emilia Romagna, Veneto and Friuli Venezia Giulia, where the different active call models have shown that they can work, increasing adherence to the recommended vaccines, in some cases reaching coverage of 60% for pneumococcal vaccines. But experiences have also shown that, for it to work, vaccination services and centers must be present and easily accessible – perhaps with general practitioners themselves as providers. Integrated digital systems, as well as communication and word-of-mouth activities, also contribute to increasing coverage. This is net of some difficulties that still exist, such as the limits of privacy that prevent active calls to subjects who are fragile due to pathology, and for whose vaccinations we rely on referral by specialists, the specialists recalled during the conference.

Active call: who and how to do it

“Each territory is different, and therefore there cannot be a universal active call model that works for every region – he explained Carmela Russo, Medical Director, Prevention Department, ASL Taranto illustrating the position paper – therefore what we propose is a flexible model, adaptable according to your needs”. The proposed system shows who should be the main contact person for vaccinations in the elderly, how to make the active call, when and where to carry out vaccinations.

The general practitioner appears to be the most suitable figure to identify the population to be vaccinated, in collaboration with the prevention departments and the social and health districts. On the as make the active call, the proposal is to go beyond the classic letters and calls to users, imagining also exploiting (where active) the electronic health record. But also make room for emails, text messages, WhatsApp with invitations that refer to information on vaccinations. “It is important to personalize the active call, with clear and simple content that already indicates the day and place of the vaccination, as well as a system for canceling the appointment and a reminder a couple of days before,” underlined Russo.

Where and when to vaccinate

It is also important to overcome the concept of seasonality of vaccinations, i.e. to promote vaccines only in conjunction with the anti-flu one: “The active call must always be made, with a planning by birth cohort, at the age of 65, ideally at the doctors’ office of general medicine, or vaccination clinics – continued Russo – But it is also important to find new places to vaccinate in a widespread manner, perhaps with the collaboration of pharmacies”. Which are essential, Russo concludes: “Communication must involve all the actors: not only doctors, pharmacies or scientific societies, but it is also necessary to involve pensioners’ unions and patient associations”.

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