Association of Physician Peer Influence With Subsequent Physician Adoption and Use of Bevacizumab

Keating, Nancy L.; O’Malley, A. James; Onnela, Jukka‐Pekka; Gray, Stacy W.; Landon, Bruce E.

doi:10.1001/jamanetworkopen.2019.18586

Cited by 25 publications

(30 citation statements)

References 21 publications

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“…Patient‐sharing networks are a promising approach for exploring how the relationships between physicians impacts health care utilization, costs, and quality 29,42,43 . Strengths of our study design include our use of a national breast cancer physician network based on patient‐sharing and co‐location.…”

Section: Discussionmentioning

confidence: 99%

“…We calculated medical oncologist patient volume as the sum of unique cohort patients attributed to each medical oncologist within each time period. Primary medical oncologists were assigned to patients by a modification of the method of Keating et al hierarchically, based on whether they (a) prescribed ODX to the patient or (b) were the medical oncologist with whom the patient had the most visits 29 . In the event of a tie for (2), the medical oncologist who saw the patient closest to the date of diagnosis was assigned to the patient.…”

Section: Methodsmentioning

confidence: 99%

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Surgeon and medical oncologist peer network effects on the uptake of the 21‐gene breast cancer recurrence score assay

et al. 2021

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Background Drivers behind the adoption of gene expression profiling in breast cancer oncology have been shown to include exposure to physician colleagues’ use of a given genomic test. We examined adoption of the Oncotype DX 21‐gene breast cancer recurrence score assay (ODX) in the United States after its incorporation into clinical guidelines. The influence of patient‐sharing ties and co‐location with prior adopters and the role of these potential exposures across medical specialties on peers’ adoption of the test were examined. Methods We conducted a retrospective cohort study of women with incident breast cancer using a 100% sample of fee‐for‐service Medicare enrollee claims over 2008–2011. Peer networks connecting medical oncologists and surgeons treating these patients were constructed using patient‐sharing and geographic co‐location. The impact of peer connections on the adoption of ODX by physicians and testing of patients was modeled with multivariable hierarchical regression. Results Altogether, 156,229 women identified with incident breast cancer met criteria for cohort inclusion. A total of 7689 ODX prescribing physicians were identified. Co‐location with medical oncologists who adopted the test in the early period (2008–2009) was associated with a 1.38‐fold increase in the odds of a medical oncologist adopting ODX in 2010–2011 (95% CI = 1.04–1.83), as was co‐location with early‐adopting surgeons (odds ratio [OR] = 1.25, 95% CI = 1.00–1.58). Patients whose primary medical oncologist was linked to an early‐adopting surgeon through co‐location (OR = 1.17, 95% CI = 1.04–1.32) or both patient‐sharing and co‐location (OR = 1.17, 95% CI = 1.03–1.34) were more likely to receive ODX. Conclusions Exposure to surgeon early adopters through peer networks and co‐location was predictive of ODX uptake by medical oncologists and testing of patients. Interventions focused on the role of surgeons in molecular testing may improve the implementation of best practices in breast cancer care.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Surgeon and medical oncologist peer network effects on the uptake of the 21‐gene breast cancer recurrence score assay

et al. 2021

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“…[ 8 ] Rather than rely on communication of a medical innovation, most physicians adopted the innovation after watching their colleagues use them. [ 44 ] This is especially true when contemplating use in populations excluded in the RCTs, [ 44 ] such as older patients with multimorbidity. Although the use of ICI as first-line treatment in late-stage melanoma was added in NCCN guideline in 2012, studies on the use of ICI in real-world settings remain limited.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with immune checkpoint inhibitor use among older adults with late-stage melanoma

et al. 2021

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Improvement in overall survival by immune checkpoint inhibitors (ICI) treatment in clinical trials encourages their use for late-stage melanoma. However, in the real-world, heterogeneity of population, such as older patients with multimorbidity, may lead to a slower diffusion of ICIs. The objective of this study was to examine the association of multimorbidity and other factors to ICI use among older patients with late-stage melanoma using real world data. A retrospective cohort study design with a 12-month baseline and follow-up period was adopted with data from the linked Surveillance, Epidemiology, and End Results cancer registry/Medicare database. Older patients (>65 years) with late-stage (stage III/IV) melanoma diagnosed between 2012 and 2015 were categorized as with or without multimorbidity (presence of 2 or more chronic conditions) and ICI use was identified in the post-index period. Chi-square tests and logistic regression were used to evaluate factors associated with ICI use. In the study cohort, 85% had multimorbidity, 18% received any treatment (chemotherapy, radiation, and/or ICI), and 6% received ICI. Only 5.5% of older patients with multimorbidity and 6% without multimorbidity received ICIs. Younger age, presence of social support, lower economic status, residence in northeastern regions, and recent year of diagnosis were significantly associated with ICI use; however, multimorbidity, sex, and race were not associated with ICI use. In the real-world clinical practice, only 1 in 18 older adults with late stage melanoma received ICI, suggesting slow pace of diffusion of innovation. However, multimorbidity was not a barrier to ICI use.

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“…Studies reported mixed results of patients' age, gender, and ethnicity impact on the uptake of new medicines. Some prescribers tended to prescribe new medicines to younger [32,[39][40][41][42][43][44][45][46][47][48], male [39,46,47,49], female [50], or white ethnicity [30] patients. Others observed use of new medicine in older patients [50][51][52][53][54], mixed impact of ethnicity [41,42,[46][47][48]51], or suggested that patients' age [29,49,55], gender [29,32,40,44,48,55,56], ethnicity [44,50,53] had no impact on prescribing decisions.…”

Section: Reported Factors Affecting the Uptake Of New Medicinesmentioning

confidence: 99%

Barriers and Facilitators to the Uptake of New Medicines into Clinical Practice: A Systematic Review

Medlinskiene

Tomlinson

Marques

et al. 2021

Preprint

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Background: Implementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. However, the uptake of new medicines into practice faces a wide range of obstacles Earlier reviews provided insight into determinants for new medicine uptake (such as medicine, prescriber, patient, organization, and external environment factors), but the methodological approaches used had limitations (e.g., single author, narrative review, narrow search, no quality assessment of reviewed evidence).This systematic review aims to identify barriers and facilitators affecting the uptake of new medicines into clinical practice and identify areas for future research. Method: A systematic search was undertaken within seven databases. Eligible qualitative, quantitative, and mixed-methods studies focused on adult participants (18 years and older) requiring or taking new medicine(s) for any condition, in the context of healthcare organizations and identified factors affecting the uptake of new medicines. The methodological quality was assessed using QASTDD tool. A narrative synthesis of reported factors was conducted using framework analysis and conceptual framework was utilised to group them. Results: A total of 66 studies were included. Most studies (n=62) were quantitative and used secondary data (n=46) from various databases, e.g., insurance databases. The identified factors had a varied impact on the uptake of the different studied new medicines. Differently from earlier reviews, patient factors (patient education, engagement with treatment, therapy preferences), cost of new medicine, reimbursement and formulary conditions, and guidelines were suggested to influence the uptake. Also, the review highlighted that health economics, wider organizational factors, and underlying behaviours of adopters were not or under explored. Conclusion: This systematic review identifies additional factors affecting new medicine use not reported in earlier reviews, which included patient influence and education level, cost of new medicines, formulary and reimbursement restrictions, and guidelines. Further research employing determinant frameworks or implementation theories is needed to gain a better understanding of factors, especially patient, prescriber, and organizational, affecting the uptake of new medicines into clinical practice.Registration: PROSPERO database (CRD42018108536)

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Association of Physician Peer Influence With Subsequent Physician Adoption and Use of Bevacizumab

Cited by 25 publications

References 21 publications

Surgeon and medical oncologist peer network effects on the uptake of the 21‐gene breast cancer recurrence score assay

Surgeon and medical oncologist peer network effects on the uptake of the 21‐gene breast cancer recurrence score assay

Factors associated with immune checkpoint inhibitor use among older adults with late-stage melanoma

Barriers and Facilitators to the Uptake of New Medicines into Clinical Practice: A Systematic Review

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