Vaccine Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 377

situations and vaccines. Ninety-fi ve percent of US physicians reported that they
review the immunization status of adolescent patients at health maintenance visits,
whereas only 43 % reported routinely doing so at illness-related visits (Schaffer
et al. 2001 ). Physicians in Asia initiated 56 % of conversations about HPV vaccina-
tion, but only 32 % of them were proactive initiators, defi ned as initiating more than
75 % of the conversations (Chow et al. 2010 ). Humiston et al. ( 2009 ) segmented
physicians by their recommendation behavior into three groups: (1) vaccine advo-
cates, who proactively encourage patients to receive recommended immunizations;
(2) vaccine doers, who immunize as a part of their routine or do the service at the
request of the patient; and (3) vaccine cautious, who may not offer immunization
services or dissuade patients from receiving all recommended immunizations. Only
41 % of US primary care physicians strongly recommended a new herpes zoster
vaccine, whereas almost all strongly recommended established vaccines, such as
pneumococcal, tetanus, and infl uenza vaccines (Hurley et al. 2010 ). While 96 % of
primary care physicians providing primary care to adults aged 19-64 years stocked
at least one vaccine recommended for adults, only 27 % stocked all adult vaccines
( Freed et al. 2011b ).

13.3.3.1 Determinants of Physicians' Vaccination Behavior

Differences in physicians' vaccination behavior have been related to socio-
demographic and social psychological variables.
Physician specialty is the socio-demographic variable most often studied. For
example, physician specialty (pediatricians vs. family physicians) makes a differ-
ence for adolescent vaccination practices (Schaffer et al. 2001 ) and for HPV vacci-
nation (Daley et al. 2010 ). Physicians who would not recommend HPV vaccination
to all eligible patients were more likely to be generalists (Ishibashi et al. 2008 ).
Internal medicine physicians were more likely to stock vaccines for adults aged
19-64 years than family physicians (Freed et al. 2011b ). Other relevant socio-
demographic variables include physician gender and practice characteristics.
Female gender of provider was associated with a higher intention to recommend a
cervical cancer vaccine (Riedesel et al. 2005 ). Infant combination vaccines were
less likely to be used by smaller pediatric practices, by those with a lower propor-
tion of publicly insured patients, and those with less inclusive state vaccine fi nanc-
ing policies (Gidengil et al. 2010 ).
One study reported a relationship between general social psychological vari-
ables and recommendation behavior (Ishibashi et al. 2008 ). Physicians who
would not recommend HPV vaccination to all eligible patients were more likely
to have higher intrinsic religiosity and self-described themselves as being con-
servative. The study also found that pediatricians who recommended the recently
launched HPV vaccine to all eligible patients reported earlier adoption of new
drugs/vaccines.
The many other social psychological variables that have been used in studies of
health care professionals' vaccination behavior can be grouped into three categories.