Higuchi M, et al. - This cross-sectional study with a questionnaire at a family medicine clinic in a rural area in Japan examined the relation between family physician’s recommendation for 23-valent pneumococcal polysaccharide vaccine (PPSV23) during outpatient care and PPSV23 vaccination intention and behavior in the elderly (aged >65 years). This is the first study in Japan to examine the value of preventive service provided by family physicians during the busy outpatient continuity care. Results showed that the family physician’s direct advice was significantly and positively correlated with PPSV23 vaccination intention and behavior in the elderly in the Japanese primary care setting. This finding supports the value of providing preventive services during time-constrained outpatient care, even in medical systems where it is undervalued. Reasons for not getting vaccinated with PPSV23 included lack of understanding of PPSV23, lack of physician’s recommendations, and concerns about side effects of PPSV23.