The Role of Physician Networks in the Adoption of New Prescription Drugs.

描述（由申请人提供）：治疗和预防心血管疾病（CVD）的药物大大降低了心血管疾病相关的发病率和死亡率；然而，它们的扩散并不均衡。医生们在采用一些循证治疗方面进展缓慢，而迅速采用了其他低价值的治疗方法。在美国的一些地区，更新的品牌药的使用率要高得多，这表明这些地区的医生是新药的快速采用者。然而，医生采用新药物的决定因素却知之甚少。医生可能会向他们的同行寻求有关药物用途、益处和风险的信息。网络分析提供了一个分析框架和测量技术，以了解医生如何相互学习新的治疗方法。我们的长期目标是了解医生网络在技术传播中的作用。为实现这一目标，我们提出两个具体目标。首先，我们将检验在地方一级医生采用新药与处方药支出和非药物总医疗支出之间的关系。我们将测量宾夕法尼亚州几乎所有医生对近年来引进的5种用于心血管疾病或糖尿病的新药的采用率和速度。我们将获得宾夕法尼亚州几乎所有5万名医生的处方数据。我们还将获得该州200多万成年人的医疗保险和医疗补助申请数据，这些人都在这些项目的覆盖范围内。其次，我们将研究多种类型的专业网络、医生特征、患者特征和机构对医生采用新药的影响。特别是，我们将评估在培训（例如，住院医师计划）、组织（例如，医疗团体、医院）和通过患者共享（转诊）形成的医生网络对医生采用新药的影响。了解这些网络的作用将指导干预措施的传播，如学术细节，以提高药物治疗的质量和效率。医疗保险和医疗补助是研究网络效应的关键设置，因为它们为最脆弱的人群提供了覆盖，因为这些项目的成本对公共预算施加了巨大压力。

DESCRIPTION (provided by applicant): Medications to treat and prevent cardiovascular disease (CVD) have substantially reduced CVD-related morbidity and mortality; however, their diffusion has been uneven. Physicians have been slow to adopt some evidence-based treatments and have rapidly adopted others of low value. Use of newer, brand name drugs is much higher in some regions in the US and suggests that physicians in those regions are rapid adopters of new drugs. Yet the determinants of physician adoption of new medications are poorly understood. Physicians are likely to turn to their peers for information on drugs' uses, benefits and risks. Network analysis offers an analytic framework and measurement techniques for understanding how physicians learn from each other about new treatments. Our long-term objective is to understand the role of physician networks in technology diffusion. To accomplish this objective, we propose two specific aims. First, we will examine the association at the local-level between physician adoption of new medications and prescription drug spending and total non-drug medical spending. We will measure the rate and speed of adoption among nearly all physicians in Pennsylvania of 5 new drugs used for CVD or diabetes introduced in recent years. We will obtain data on prescribing for nearly all of Pennsylvania's 50,000 physicians. We will also obtain Medicare and Medicaid claims data for the more than 2 million adults in the state who are covered by these programs. Second, we will examine the influence of multiple types of professional networks, physician characteristics, patient characteristics, and institutions on physician adoption of new medications. In particular, we will assess the influence on physician adoption of new drugs of physician networks formed during training (e.g., residency program), in organizations (e.g., medical groups, hospitals), and through the sharing (referral) of patients. Understanding the role of these networks will guide dissemination of interventions such as academic detailing to improve the quality and efficiency of pharmacotherapy. Medicare and Medicaid are key settings for studying network effects because they provide coverage to the most vulnerable and because the costs of these programs exert substantial pressure on public budgets.