Factors affecting influential discussions among physicians: A social network analysis of a primary care practice
Factors affecting influential discussions among physicians: A social network analysis of a primary care practice
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DOI：
10.1007/s11606-007-0190-8
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发表时间：
2007-06-01
影响因子：
5.7
通讯作者：
Marsden, Peter V.
中科院分区：
文献类型：
--
作者：
Keating, Nancy L.;Ayanian, John Z.;Marsden, Peter V.
背景：医生经常依靠同事提供有关病人护理的新信息和建议。目的：评估以医院为基础的学术实践中初级保健医生之间有影响力的讨论网络。设计：调查医生与同事就妇女健康问题进行的有影响力的讨论。我们使用社会网络分析来描述讨论网络，并检验预测医生在网络中的位置的因素。目的：在医院为基础的学术实践中的所有38名初级保健医生。测量：医生在有影响力的讨论网络中的位置以及与网络中其他医生的关系。结果：在33名回答的医生中(响应率=87%)，5名报告妇女健康的专业知识比其他专家更有可能被引用为有影响力的信息来源(优势比[OR]6.81，95%贝叶斯可信区间[CI]2.25-23.81)。照顾更多女性的医生也被更多地引用(OR 1.03，95%CI 1.01-1.05，女性患者比例增加1个百分点)。在同一诊所执业的医生比在不同诊所执业的医生更频繁地进行有影响力的讨论(OR 5.03，95%CI 3.10-8.33)，每周临床会议次数更多(OR 1.33，95%CI 1.15至1.54)。结论：在所研究的初级保健实践中，医生从具有更多专业知识和经验的同事以及根据地点和时间表可以联系到的同事那里获得信息。有可能组织实践，以促进更快地传播高质量的循证医学。
BACKGROUND: Physicians often rely on colleagues for new information and advice about the care of their patients.OBJECTIVE: Evaluate the network of influential discussions among primary care physicians in a hospital-based academic practice.DESIGN: Survey of physicians about influential discussions with their colleagues regarding women's health issues. We used social network analysis to describe the network of discussions and examined factors predictive of a physician's location in the network.SUBJECTS: All 38 primary care physicians in a hospital-based academic practice.MEASUREMENTS: Location of physician within the influential discussion network and relationship with other physicians in the network.RESULTS: Of 33 responding physicians (response rate= 87%), the 5 reporting expertise in women's health were more likely than others to be cited as sources of influential information (odds ratio [OR] 6.81, 95% Bayesian confidence interval [CI] 2.25-23.81). Physicians caring for more women were also more often cited (OR 1.03, 95% CI 1.01-1.05 for a 1 percentage-point increase in the proportion of women patients). Influential discussions were more frequent among physicians practicing in the same clinic within the practice than among those in different clinics (OR 5.03, 95% CI 3.10-8.33) and with physicians having more weekly clinical sessions (OR 1.33, 95% CI 1.15 to 1.54 for each additional session).CONCLUSIONS: In the primary care practice studied, physicians obtained information from colleagues with greater expertise and experience as well as colleagues who were accessible based on location and schedule. It may be possible to organize practices to promote more rapid dissemination of high-quality evidence-based medicine.