The winners for the ASSET best practice award

The second edition of the ASSET best practice award for general practitioners has come to an end, with the assignment of the four grants to health professionals or groups of health professionals working in the primary health sector. The four winners are the Health Centre of Nea Michaniona from Central Macedonia; the Immunization Working Group of the National Society of General Practitioners, Romania; Dr Theodora Nakouti from Karditsa, Greece; and the National School of Public Health of Athens.

The Health Centre of Nea Michaniona

The Health Centre of Nea Michaniona organized a multidisciplinary intervention with a three-years perspective, aimed to enhance vaccination coverage in its catchment area. The intervention involved two general practitioners, a health visitor and a member of the administrative stuff alongside their routine schedule. The first phase of the  intervention intended to acquaint the local population with and establish the vaccination services of the Health Centre. Up to now, the intervention was targeted mainly at the health care personnel and the patients of the Health Centre, using personnel meetings, posters, leaflets and opportunistic pro vaccination advice during consultations. Through a collaboration with the local municipality, the cleaning services workers were targeted as well. Moreover, while conducting health promotion interventions at local schools, students and teachers were informed about the opportunity to get vaccinated without cost in the Health Centre. During the second phase of the intervention, meetings and promotional events were scheduled with the local parents’ associations and the open care centres for the elderly in order to inform them about the need to vaccinate and resolve any anti-vaccination issues. At the same time, the vaccination services were scheduled to be upgraded with the additional help of the nursing staff.

The small proportion of children attending public vaccination services in the area reflects the lack of paediatricians in the Health Centre and therefore lack of trust in paediatric services. It also suggests that the population is oriented to the private health sector for this kind of services. On the other hand, the high coverage ascertained with influenza immunization of health personnel and hepatitis A vaccination of cleaning services staff demonstrates that targeted interventions proved to be successful. Focused interventions promoting immunizations are crucial for establishing and maintaining adequate vaccination status, while public health services have to take up these interventions in an organized manner, considering them an integral part of their routine.

The Immunization Working Group

The Immunization Working Group (IWG) of the Romanian National Society of General Practitioners consists in eleven general practitioners. Its main focus is to promote up to date information regarding vaccination, delivered to fellow GPs in national and local conferences; to organize workshops and debates at international conferences on topics like migrant children immunization, pregnant women vaccines, or vaccine’s electronic records; and to raise awareness about benefit of vaccines, providing information on real adverse reactions, and organizing interactive seminaries with patients, on a national scale.

In the current context, as WHO declared Romania at high risk for measles and polio, IWG actions must continue and its efforts must double. The members of the group are planning to organize seminars and workshops dedicated to fellow GPs, the only vaccine providers in Romania, in order to update the information regarding National Immunization Program, vaccine coverage level, vaccine recovery principles, etc. Such events will be held in different parts of the country. As in the previous years, IWG will continue to meet parents and patients of all ages, to provide information regarding the importance of being vaccinated, to prevent the spread of diseases. On a separate note, the group dedicates its attention to those people who refuse or directly oppose vaccines by organizing special meetings with them, inviting not only GPs but also epidemiologists, immunologists and other medical professionals. Members of the IWG strongly believe that the results of these actions will rise the immunization acceptance and vaccine coverage.

Dr Theodora Nakouti

Theodora Nakouti is a specialist in Internal Medicine with a sub specialization in Infectious Diseases. She worked in the private sector since 2013 and, in the summer of 2016, she started to work in Karditsa, a town in Central Greece, where the increased frequency of brucellosis as well as the appearance of some spontaneous cases of malaria are an important issue, together with the only partial immunization of adult population.

Thus, she carried out a series of actions to inform her patients and the general population about the importance of immunization and the appropriate vaccinations each of them needs to do. She delivered leaflets and speeches to many age groups, with a main focus on pregnant women through the most popular local newspapers about the importance of immunization against seasonal flu, tetanus and whooping cough.

As a consequence, almost all her patients, including the majority of pregnant women, have already been informed and vaccinated against the seasonal flu and pneumococcus. Additionally, many local organizations shown enthusiasm and are interested in informing people in order to protect public health. It seems that both people and authorities are willing to participate in these actions. My goal is to keep on informing the population through media. Moreover, she would like to raise other doctors’ interest in her area, in order to develop a more comprehensive intervention.

National School of Public Health of Athens

Dimitrios Papamichail, from the National School of Public Health of Athens, coordinated a national vaccination coverage survey of Roma children. Research on Roma health is fragmentary as major methodological obstacles often exist. Reliable estimates on vaccination coverage of Roma children at a national level and identification of risk factors for low coverage could play an instrumental role in developing evidence-based policies to promote vaccination in this marginalized population group.

Thirty Roma settlements, stratified by geographical region and settlement type, were included; 7–10 children aged 24–77 months were selected from each settlement using systematic sampling. Information on children’s vaccination coverage was collected from multiple sources. In the analysis, we applied weights for each stratum, identified through a consensus process.

The majority (86%) of the 251 Roma children who participated in the study had a vaccination document but vaccine coverage was very low. Minimum vaccinations – such as DTP3 and IPV2 and MMR1 – were administered only in 35–39% of children, while 34–38% had received the HepB3 shot and 31–35% the Hib3 one. No child was vaccinated against tuberculosis in the first year of life. Better living conditions and primary care services close to Roma settlements were associated with higher vaccination indices.

This study showed inadequate vaccination coverage of Roma children in Greece, much lower than that of the non-minority child population. This serious public health challenge should be systematically addressed, or, amid continuing economic recession, the gap may widen. Valid national estimates on important characteristics of the Roma population can contribute to planning inclusion policies.