Public subsidies and the recommendation of child vaccines among primary care physicians: a nationwide cross-sectional study in Japan

Abstract

ObjectiveAlthough public subsidies and physician recommendations for vaccination play key roles in increasing childhood vaccination coverage, the association between them remains uncertain. This study aimed to identify the association between awareness of public subsidies and recommendations for Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (pneumococcal conjugate vaccine (PCV)) and human papillomavirus (HPV) vaccinations among primary care physicians in Japan.DesignThis is a cross-sectional study.SettingIn 2012, a questionnaire was distributed among 3000 randomly selected physicians who were members of the Japan Primary Care Association.ParticipantsFrom the questionnaire, participants were limited to physicians who administered childhood vaccinations.Primary and secondary outcome measuresThe primary measures were participants’ awareness of public subsidies and their recommendation levels for Hib, PCV and HPV vaccines. Multiple logistic regression analysis was performed to investigate the association between awareness and recommendation, with adjustment for possible confounders.ResultsThe response rate was 25.8% (743/2880). Of 743 physician respondents, 434 were included as analysis subjects. The proportions of those who recommended vaccinations were 57.1% for Hib, 54.1% for PCV and 58.1% for HPV. For each vaccine, multivariable analyses showed physicians who were aware of the subsidy were more likely to recommend vaccination than those who were not aware: the adjusted ORs were 4.21 (95% CI 2.47 to 7.15) for Hib, 4.96 (95% CI 2.89 to 8.53) for PCV and 4.17 (95% CI 2.00 to 8.70) for HPV.ConclusionsPrimary care physicians’ awareness of public subsidies was found to be associated with their recommendations for the Hib, PCV and HPV vaccines. Provision of information about public subsidies to these physicians may increase their likelihood to recommend vaccination.

Factors associated between behavior of administrating or recommending mumps vaccine and primary care physicians’ knowledge about vaccination: A nationwide cross‐sectional study in Japan

“…However, a paradox existed in our results, that is, the range of the working years after graduation was positively associated with the administration of voluntary mumps vaccine for adults but negatively associated with the recommendation of voluntary mumps vaccine for children. Sakanishi et al reported generation‐specific gaps regarding vaccination recommendation in 2012, which described PCPs working 3–10 years after graduation as more disposed to recommended Haemophilus influenza type b vaccine, seven‐valent pneumococcal conjugate vaccine, and human papillomavirus vaccine than PCPs working 11–40 years after graduation 14 . On the other hand, PCPs with a higher postgraduate year may generally have a greater interest in mumps vaccines at the present study.…”

“…If local governments subsidize voluntary mumps vaccination for children, the economic burden will be lower for vaccine recipients, making it easier for PCPs to recommend the vaccine. Subsidies also have the potential to improve vaccination rates 14,23 . The Japanese government subsidized the measles–rubella vaccine for a catch‐up campaign during a measles outbreak from 2008 to 2013 24 .…”

“…Several researchers reported that recommendation by physicians affects recipients’ vaccine decisions 9–12 . Physicians’ appropriate knowledge about the vaccine is important for increasing vaccine administration 13,14 . Since there is no cost exemption or guidance from the government for voluntary vaccination, it is critical that it is recommended by a medical provider with appropriate knowledge.…”

Knowledge, attitudes and behaviors of family physicians about childhood vaccinations that are not in the routine vaccination schedule: a cross-sectional study

“…In the study of Tolunay et al (2014), it was determined that the physicians who did not recommend the vaccine indicated the cost as the primary reason. In addition, in the study conducted by Sakanishi et al (2018) in 2012 in Japan, it was determined that primary care physicians recommended the HPV vaccine at a frequency of 58.1%. In a study conducted with tertiary healthcare professionals, 80.2% of the participants were aware of the existence of the HPV vaccine, but only 30.5% stated that they or a relative had the HPV vaccine.…”

Association between administration or recommendation of the human papillomavirus vaccine and primary care physicians’ knowledge about vaccination during proactive recommendation suspension: a nationwide cross-sectional study in Japan

“…Thus, it is important for physicians to have accurate knowledge regarding vaccination to increase vaccine administration or recommendation rates 20–22. In Japan, the HPVv is administered not only by paediatricians, obstetricians and gynaecologists (OBGYNs), but also by primary care physicians (PCPs) 23 24. A 2012 nationwide survey on practices and attitudes towards vaccination among PCPs in Japan23 24 showed that the proportion of PCPs administering and actively recommending HPVv was 58.3% and 46.5%, respectively 23.…”