Original Article

Journal of General Internal Medicine

, Volume 22, Issue 6, pp 794-798

Factors Affecting Influential Discussions Among Physicians: A Social Network Analysis of a Primary Care Practice

  • Nancy L. KeatingAffiliated withDivision of General Medicine and Primary Care, Brigham and Women’s HospitalDepartment of Health Care Policy, Harvard Medical School Email author 
  • , John Z. AyanianAffiliated withDivision of General Medicine and Primary Care, Brigham and Women’s HospitalDepartment of Health Care Policy, Harvard Medical School
  • , Paul D. ClearyAffiliated withYale School of Public Health
  • , Peter V. MarsdenAffiliated withDepartment of Health Care Policy, Harvard Medical SchoolDepartment of Sociology, Harvard University

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Abstract

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.

KEY WORDS

consultation and referral primary care communication physician behavior