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    • br Methods br Results Of the randomly

    2018-10-25


    Methods
    Results Of the 5151 randomly selected GPs invited to participate in the panel, 695 could not be contacted, and 732 were not eligible; 1712/3724 eligible GPs (46.0%) agreed to participate. GPs who refused were more often men (P<10), older (P<10), and had more consultations in 2012 (P<0.05, Table 1). They reported two main reasons for refusing: lack of time (55%) and lack of interest in participating in a panel (31%). In all, 1582/1712 GPs (92.4%) participated in the cross-sectional survey: their characteristics did not differ significantly from those of the GPs who joined the panel but did not participate in the procollagen c proteinase survey (Table 1). The frequency of GPs\' vaccine recommendations to their patients varied according to the vaccine situation (Table 2): 83% of the participants reported that they would often or always recommend vaccination against measles, mumps and rubella (MMR) for non-immune adolescents and young adults, 68% would recommend vaccination against meningococcal meningitis C for infants aged 12months, but only 57% for the group aged 2–24years (Table 2). Over 80% of the participants trusted official sources (Ministry of Health, health agencies, scientists, or specialist colleagues) to provide reliable information about vaccine benefits and risks (Table 2). GPs\' opinions of the likelihood of severe adverse effects of vaccines also varied according to vaccine: 6% of the participants considered a link between HPV vaccines and multiple sclerosis likely or very likely, while 33% responded positively to the question about a link between adjuvanted vaccines and long-term complications. More than a quarter (26%) agreed somewhat or strongly that some vaccines recommended by the authorities are not useful and 20% that children are vaccinated against too many diseases. Only 43% of the participants felt confident explaining the role of adjuvants to their patients (Table 2). Overall, 89% of the participants reported that at least one of their patients had had at least one of the vaccine-preventable diseases mentioned in the questionnaire in the past 5years. Multivariable logistic regressions of the dichotomized global score of vaccine recommendations (Table 3) showed that GPs\' vaccine recommendations to patients were more frequent when they were comfortable explaining benefits and risks to patients, or trusted official sources of information highly than when they did not. Their recommendations were less frequent when they believed serious adverse effects to be likely, or doubted the vaccine\'s utility than when they did not. We found no issue of multicollinearity in the linear models and, as multicollinearity is a property of the explanatory variables, not the dependent variable (Allison, 2012), we can conclude that there was no issue of multicollinearity in the logistic models either. The results of the LR tests for the bivariate probit model with sample selection showed no significant correlation for either recommendation score (global score: rho=0.05, P=0.97; score for uncontroversial vaccines: rho=0.18; P=0.89). Dichotomization of the scores with a threshold at mean+1 standard deviation rather than the median produced similar estimates of the odds ratios for the variables of interest. The multivariable logistic regression of the dichotomized global score of vaccine recommendations, adjusted for the four stratification variables, showed that GPs\' recommendations to patients were significantly associated with their own vaccination behavior (2013–2014 seasonal influenza: ORa=2.95, 95% CI=[2.31;3.77]; 3 doses or more of hepatitis B vaccine: 1.90 [1.27;2.84]).
    Discussion Given that by joining the panel, GPs agreed to take part in five different surveys during a 30-month period, the commitment rate (46%) was high, higher than in other primary physician panels (Joyce et al., 2010). To limit potential selection bias that could have resulted from particular opinions or attitudes about vaccination, this topic was not mentioned to GPs before they were asked to consent to participate in the panel. Panel participants differed from non-participants for several characteristics (sex, age and workload), and these characteristics were associated with the vaccine recommendation scores (Table 3). But weighting the sample according to sex, age and workload should have corrected this selection bias and prevented any impact on the recommendation scores. Moreover, the lack of significance of the LR tests for the bivariate probit models with sample selection gives us confidence that the estimates of the logistic regression models were not biased.