Correlation between family physician’s direct advice and pneumococcal vaccination intention and behavior among the elderly in Japan: a cross-sectional study

Abstract

BackgroundVaccination is an important element of health maintenance in family medicine. The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is highly recommended for the elderly, but its uptake is low in Japan. Primary care system remains under development and preventive services tend to be neglected in the Japanese medical practice. The study aims to investigate the association between family physician’s recommendations for PPSV23 during outpatient care and PPSV23 vaccination intention and behavior in the elderly.MethodWe conducted a cross-sectional study with a questionnaire at a family medicine clinic in a rural area in Japan. The participants were over the age of 65 without dementia who had maintained a continuity with the clinic. The questionnaire inquired PPSV23 vaccination status, family physician’s advice for PPSV23, socio-demographics, and the constructs in the Health Belief Model. We defined those who had had vaccination intention and behavior as “PPSV23 vaccinated group” and those who had no vaccination and uncertainty about being or no intention to be vaccinated in the future as “PPSV23 unvaccinated group.” We used chi-square test for correlation between physician advice and PPSV23 vaccination/intention, univariate and multivariate logistic regression analysis for factors related to the vaccination/intention, and descriptive analysis for reasons for reluctance to the vaccination.ResultsWe analyzed 209 valid responses. There were 142 participants in the PPSV23 vaccinated group and 67 in the PPSV23 unvaccinated group. The PPSV23 vaccination group was more likely to have had their physician’s advice (80.2% vs 21.3%, p < 0.001). Multivariate logistic regression analysis showed a significant association between PPSV23 vaccination and their physician’s recommendation (OR 8.50, 95%CI 2.8–26.0), awareness of PPSV23 (OR 8.52, 95%CI 2.1–35.0), and the perceived effectiveness of PPSV23 (OR 4.10, 95%CI 1.2–13.9). The reasons for reluctance to get vaccinated included lack of understanding of PPSV23, lack of physician’s recommendations, and concerns about side effects of PPSV23.ConclusionFamily physician’s recommendation was positively correlated with PPSV23 vaccination intention and behavior in the elderly. This reinforces the importance of providing preventive services during time-constrained outpatient care, even in medical systems where it is undervalued.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0841-3) contains supplementary material, which is available to authorized users.

A Japanese nationwide survey of 23-valent pneumococcal capsular polysaccharide vaccine (PPSV23) coverage among patients with chronic medical condition aged 50 and older

“… 18 In another questionnaire-based study, Higuchi et al looked at PPSV23 rates and motivations among elderly adults receiving regular outpatient care, and found doctors’ advice to positively correlate with vaccinated status. 19 We observed doctors’ recommendations to significantly and strongly predict PPSV23-vaccinated status in all three age groups in the present study. In addition, PPSV23’s inclusion in Japan’s routine immunization schedule for elderly adults appears to have been the major reason for coverage observed in the 65+ age group.…”

Health-care professional’s attitude, beliefs and perceived potential barriers for recommended adult immunization practices in patients with type-2 diabetes mellitus

“…HCPs are the forefront for improving immunization rates as their recommendation is the greatest motivation. 11,16 It works equally effective as compared to the time and efforts spent on counselling and other preventive services.…”

“…The survey questionnaire comprised of questions for HCPs which embraced the knowledge, practices and barriers for pneumococcal, influenza and hepatitis-B vaccination in adults with type-2 DM based on previous studies. 11,12 The questions were designed based on logic framework for vaccine preventable diseases, provided by Centres for Disease Control and Prevention (CDC)based "The Guide to Community Preventive Services", developed under the leadership of Task Force on Community Preventive Services. 14,15 The design had taken into consideration the following aspects: (a) provider-based Perception (e.g.…”

“…Rapidly changing epidemiology of DM and present constellation of potential VPD-associated morbidity and mortality necessitate effective education, communication and surveillance regarding vaccine uptake and its determinants in both patients and HCPs. 11,12 Adult immunization in immunologically vulnerable diabetics still remains a need to be addressed. 13 As HCPs play a key role in ensuring continuity of care, the study aimed to analyse the knowledge and practices of adult immunization practices in diabetics by HCPs and the potential barriers faced by them.…”

Contributions of physicians to government-subsidised disease prevention programmes: an appeal for active participation

“…26 A study among Japanese primary care physicians found that patients who had pneumococcal vaccination were more likely to have received advice from physicians than those who did not receive such advice (80% vs 21%), and a strong association was shown between physician recommendation and patient participation in vaccination with an adjusted odds ratio of 8.50. 27 A study in France demonstrated that patients who received recommendations from trusted family physicians were more likely to participate in HPV vaccination programme. 28 In Hungary, physicians effectively motivated approximately 27% of women who initially refused to join cervical cancer screening programmes.…”