Abstract
Although physicians learn about new medical technologies from their peers, the magnitude and source of peer influence is unknown. We estimate the effect of peer adoption of three first-in-class medications (dabigatran, sitigliptin, and aliskiren) on physicians’ own adoption of those medications. We included 11,958 physicians in Pennsylvania prescribing anticoagulant, antidiabetic, and antihypertensive medications. We constructed 4 types of peer networks based on shared Medicare and Medicaid patients, medical group affiliation, hospital affiliation, and medical school/residency training. Instrumental variables analysis was used to estimate the causal effect of peer adoption (fraction of peers in each network adopting the new drug) on physician adoption (prescribing at least the median number prescriptions within 15 months of the new drug’s introduction). We illustrate how physician network position can inform targeting of interventions to physicians by computing a social multiplier. Dabigatran was adopted by 25.2%, sitagliptin by 24.5% and aliskiren by 8.3% of physicians. A 10-percentage point increase in peer adoption in the patient-sharing network led to a 5.90% (SE = 1.50%, p<0.001) increase in physician adoption of dabigatran, 8.32% (SE = 1.51%, p<0.001) increase in sitagliptin, and 7.84% increase in aliskiren adoption (SE = 2.93%, p<0.001). Peer effects through shared hospital affiliation were positive but not significant, and medical group and training network effects were not reliably estimated. Physicians in the top decile of patient-sharing network peers were estimated to have nearly 2-fold stronger influence on their peers’ adoption compared to physicians in the top decile of prescribing volume. Limitations include lack of detailed clinical information and pharmaceutical promotion, variables which may influence physician adoption but which are unlikely to bias our peer effect estimates. Peer adoption, especially by those with whom physicians share patients, strongly influenced physician adoption of new drugs. Our study shows the potential for using information on physician peer networks to improve technology diffusion.
Highlights
Diffusion of technology in US healthcare, while influenced partly by payer policies regarding coverage and reimbursement, is to a large extent driven by the individual decisions of practicing physicians
We find that physician adoption of new drugs is heavily influenced by the extent to which their peers have adopted those new drugs
We sought to measure and test the effects of a rich set of peer influences derived from the institutional affiliations that physicians have with medical group practices, hospitals, and health systems
Summary
Diffusion of technology in US healthcare, while influenced partly by payer policies regarding coverage and reimbursement, is to a large extent driven by the individual decisions of practicing physicians. The relative absence of centralized technology assessment in the US reflects the importance of physician autonomy, allows for flexible responses to rapidly changing evidence, and creates opportunities to tailor decisions to individual patients. It comes at the cost of wide geographic variation,[1, 2] excess spending, and sluggish translation of evidence into practice.[3, 4] Recognizing that no US regions provide uniformly better care, an Institute of Medicine report recommended that efforts to achieve high-value healthcare target the loci of decision-making–hospitals, physician groups, and individual providers[5]. The extant studies applying social network methods to technology diffusion among physicians,[11, 13,14,15,16,17,18,19,20,21,22] have been limited to uptake of a single technology, and small physician samples.[16, 21, 23, 24] Prior studies have relied primarily on physicians’ self-reported information on peer connections—information that, while informative, would be cost-prohibitive to collect on a large scale
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