Higuchi Mariko, Narumoto Keiichiro, Goto Takahiro, Inoue Machiko
The Department of Internal Medicine, Tsukuba Central Hospital, 1589-3 Kashiwadachou, Ushiku, Ibaraki, 300-1211, Japan.
The Department of Obstetrics and Gynecology, Kikugawa Municipal General Hospital, 1632 Higashiyokoji, Kikugawa, Shizuoka, 439-0022, Japan.
BMC Fam Pract. 2018 Sep 5;19(1):153. doi: 10.1186/s12875-018-0841-3.
Vaccination 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.
We 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's 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.
We 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.
Family 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.
疫苗接种是家庭医学中维持健康的重要组成部分。23价肺炎球菌多糖疫苗（PPSV23）强烈推荐给老年人，但在日本其接种率较低。日本的基层医疗系统仍在发展中，预防性服务在日本医疗实践中往往被忽视。本研究旨在调查门诊护理期间家庭医生对PPSV23的推荐与老年人PPSV23接种意愿和行为之间的关联。
我们在日本农村地区的一家家庭医学诊所通过问卷调查进行了一项横断面研究。参与者为65岁以上无痴呆且与该诊所保持连续性的患者。问卷询问了PPSV23接种状况、家庭医生对PPSV23的建议、社会人口统计学信息以及健康信念模型中的相关因素。我们将有接种意愿和行为的人定义为“PPSV23接种组”，将未接种且对未来是否接种不确定或无接种意愿的人定义为“PPSV23未接种组”。我们使用卡方检验来分析医生建议与PPSV23接种/意愿之间的相关性，使用单因素和多因素逻辑回归分析与接种/意愿相关的因素，并对不愿接种的原因进行描述性分析。
我们分析了209份有效回复。PPSV23接种组有142名参与者，PPSV23未接种组有67名参与者。PPSV23接种组更有可能得到医生建议（80.2%对21.3%，p<0.001）。多因素逻辑回归分析显示，PPSV23接种与医生建议（比值比8.50，95%置信区间2.8 - 26.0）、对PPSV23的知晓度（比值比8.52，95%置信区间2.1 - 35.0）以及对PPSV23有效性的认知（比值比4.10，95%置信区间1.2 - 13.9）之间存在显著关联。不愿接种的原因包括对PPSV23缺乏了解、缺乏医生建议以及对PPSV23副作用的担忧。
家庭医生的建议与老年人PPSV23接种意愿和行为呈正相关。这强化了在时间有限的门诊护理期间提供预防性服务的重要性，即使在该服务被低估的医疗系统中也是如此。
