Local opinion leaders: effects on professional practice and healthcare outcomes

Flodgren, Gerd; O’Brien, Mary Ann; Parmelli, Elena; Grimshaw, Jeremy

doi:10.1002/14651858.cd000125.pub5

Cited by 164 publications

(181 citation statements)

References 129 publications

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“…A Cochrane review confirmed that opinion leaders can promote evidence-based practice and reported a 10.5% increase in compliance when used as a strategy [29]. However, several studies failed to identify and clearly describe the role of clinical opinion leaders, particularly in ambulatory care settings [29,30]. Physicians participating in this study only mentioned opinion leaders in their PCNs when asked general questions about PCNs management and scarcely regarding a rational use of antibiotics.…”

Section: Discussionmentioning

confidence: 71%

“…This is particularly notable as opinion leaders are a frequently examined aspect of social networks and considered to be a strong influence on other network members as they seem to amplify dissemination of ideas and information [28]. A Cochrane review confirmed that opinion leaders can promote evidence-based practice and reported a 10.5% increase in compliance when used as a strategy [29]. However, several studies failed to identify and clearly describe the role of clinical opinion leaders, particularly in ambulatory care settings [29,30].…”

Section: Discussionmentioning

confidence: 99%

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Promoting rational antibiotic prescribing for non-complicated infections: understanding social influence in primary care networks in Germany

et al. 2020

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Background: Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified. Methods: For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories 'social support', 'social learning', 'social normative pressures' and 'social contagion' to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks' potential impact on antibiotic prescribing. Results: Social influence processes proved to be relevant regarding knowledge transfer, manifestation of bestpractice care and self-reflection. Peer communication was seen as a great asset, the main reason for membership and affirmative for own perspectives. All interviewed physicians (n = 27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflective management of antibiotic prescribing. Non-physician health professionals (n = 11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n = 7) expected networks and their members to be drivers for care optimization.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Promoting rational antibiotic prescribing for non-complicated infections: understanding social influence in primary care networks in Germany

et al. 2020

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“…For example, academic detailing has potential to influence clinician behavior, especially if targeted to key opinion leaders who are perceived as influential experts by their peers. 21,27 Other evidence suggests that in decentralized networks, social influence can generate learning dynamics that improve the performance of the group, 28 which could potentially slow adoption of low-value therapies or those lacking sufficient evidence.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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IMPORTANCE Understanding adoption of new cancer therapies may help identify opportunities to increase use for high-value indications. OBJECTIVE To determine whether use of bevacizumab in 2005 to 2006 by oncologists' peers was associated with greater bevacizumab use among oncologists in 2007 to 2010. DESIGN, SETTING, AND PARTICIPANTS This cohort study of physicians and their patients took place in 51 randomly selected hospital referral regions in the United States. Participants were 44 012 fee-for-service Medicare beneficiaries aged 65 years or older with cancers of the colorectum, lung, breast, kidney, brain, or ovary treated by 3261 oncologists in 2005 to 2010 and assigned to one of 252 communities. Data were analyzed in 2017 to 2018. EXPOSURES Among patients treated with chemotherapy during 2007 to 2010 by an oncologist who had not treated patients with bevacizumab in 2005 to 2006, models assessed the association of bevacizumab use with rates of bevacizumab use in their physician's community of connected physicians in 2005 to 2006. Models adjusted for patient and physician characteristics and physician, practice, and community random effects. MAIN OUTCOMES AND MEASURES Receipt of bevacizumab. RESULTS A total of 34 750 patients (14 126 [40.6%] aged Ն75 years; 21 321 [61.4%] female) with cancers of the colorectum, lung, breast, kidney, brain, and ovary were treated with chemotherapy in 2005 to 2006 in the 51 hospital referral regions. Among 9262 patients treated in 2007 to 2010 by 829 physicians whose patients did not use bevacizumab in 2005 to 2006, 3654 (39.5%) were aged 75 years or older and 6227 (67.2%) were female. The rate of bevacizumab use relative to other chemotherapy in 2007 to 2010 by tertile of use (bevacizumab for <4.4%, 4.4%-6.2%, and >6.2% of all patients receiving chemotherapy) among their physician's peers in 2005 to 2006 was 10.0%, 9.5%, and 13.6%, respectively. After adjustment, use of bevacizumab in 2007 to 2010 was greater among physicians in communities with the highest rates of bevacizumab use in 2005 to 2006 compared with those whose peers were in the lowest tertile of bevacizumab use in 2005 to 2006 (adjusted odds ratio, 1.64; 95% CI, 1.20-2.25). CONCLUSIONS AND RELEVANCEThis study found that an increase in oncologists' adoption and use of bevacizumab in the years after its approval was associated with their peer physicians being earlier adopters. As organizations seek to provide better care at lower costs, interventions that leverage physician ties may help to promote adoption of high-value use of new cancer treatments and deimplementation of low-value therapies. Question Is peer influence associated with physician adoption of new cancer therapies? Findings In this cohort study of 44 012 Medicare beneficiaries with cancer treated by 3261 oncologists, use of bevacizumab in 2007 to 2010 was greater among physicians whose peers had the highest rates of bevacizumab use in 2005 to 2006 compared with those whose peers were in the lowest tertile of bevacizumab use. Meaning These findings sugge...

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“…A Cochrane review confirmed that opinion leaders can promote evidence-based practice and reported a 10.5% increase in compliance when used as a strategy [29]. However, several studies failed to identify and clearly describe the role of clinical opinion leaders, particularly in ambulatory care settings [29,30]. Physicians participating in this study only mentioned opinion leaders in their PCN when asked general questions about PCN management and scarcely regarding a rational use of antibiotics.…”

Section: Discussionmentioning

confidence: 72%

Promoting rational antibiotics prescribing for non-complicated infections: Understanding social influence in primary care networks in Germany

Poß-Doering

Kamradt

Glassen

et al. 2019

Preprint

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Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified. Methods For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories ‘social support’, ‘social learning’, ‘social normative pressures’ and ‘social contagion’ to reflect social influence processes. To foster understanding of the networks’ potential impact on antibiotics prescribing, data generated through surveys with physicians and non-physician health professionals were analyzed descriptively. Results : Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as great asset, main reason for membership and affirmative for own perspectives. All interviewed physicians (n=27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflected management of antibiotics prescribing. Non-physician health professionals (n=11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n=7) expected networks and their members to be drivers for care optimization. Conclusion: Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotics prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics. .

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Local opinion leaders: effects on professional practice and healthcare outcomes

Cited by 164 publications

References 129 publications

Promoting rational antibiotic prescribing for non-complicated infections: understanding social influence in primary care networks in Germany

Promoting rational antibiotic prescribing for non-complicated infections: understanding social influence in primary care networks in Germany

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

Promoting rational antibiotics prescribing for non-complicated infections: Understanding social influence in primary care networks in Germany

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