Abstract
BackgroundSince 2016, the combination of sacubitril/valsartan, which combines an angiotensin receptor and neprilysin inhibitor (ARNI), has been recommended in the guidelines for the treatment of heart failure. The adoption of new drugs may be influenced by collaboration and exchange between physicians. We aimed to determine whether characteristics of the professional networks of prescribing physicians were associated with the prescribing of ARNI in Germany.MethodsWe conducted a longitudinal analysis based on claims data in 2016–2018 in Germany. The characteristics of ambulatory care physicians’ networks were determined in the analysis of the patient-sharing networks of physicians in 2017. Binary logistic regression analysis with the outcome ‘prescribes ARNI in 2018’ (present or absent) was carried out, using network characteristics as predictors, adjusted for specialty and sociodemographic characteristics of physicians.ResultsThe network analysis included 8370 physicians, who had 144,636 connections. Prescribers had more connections to other physicians compared to non-prescribers (median 31 vs. 23). Regression analysis showed that the numbers of linkages to prescribers of ARNI were positively associated with prescribing ARNI. For 6–10 connections, the average marginal effect (AME) was 0.04 (confidence interval [CI] 95% 0.01–0.06) and for > 10 links the AME 0.07 (CI 95% 0.05–0.10) compared to 0–5 connections to prescriber.ConclusionPhysicians who shared patients with many other physicians were more likely to prescribe ARNI, independent of physicians’ specialty. This suggested that collaboration and exchange on the basis of patient-sharing with other physicians influenced their medication prescribing decisions.
Highlights
Since 2016, the combination of sacubitril/valsartan, which combines an angiotensin receptor and neprilysin inhibitor (ARNI), has been recommended in the guidelines for the treatment of heart failure
Since the treatment guidelines were updated in 2016, the European Society of Cardiology and the national guidelines in Germany have recommended the prescription of a combination of sacubitril and valsartan, if symptoms persist despite administration of basic therapy [4, 5]
We explored the role of collaboration and exchange between ambulatory care physicians in their prescription of sacubitril/valsartan, a new ingredient combination in Germany
Summary
Since 2016, the combination of sacubitril/valsartan, which combines an angiotensin receptor and neprilysin inhibitor (ARNI), has been recommended in the guidelines for the treatment of heart failure. Cardiovascular diseases, including HF, are among the most frequent causes of death worldwide [2]. Each year in Europe, cardiovascular diseases cause more than 4 million deaths—45% of all deaths [3]. Since the treatment guidelines were updated in 2016, the European Society of Cardiology and the national guidelines in Germany have recommended the prescription of a combination of sacubitril and valsartan, if symptoms persist despite administration of basic therapy [4, 5]. Sacubitril/valsartan, which combines an angiotensin receptor and neprilysin inhibitor (ARNI), has been available in Germany since 2016 [6]. To achieve the best possible treatment for patients, it is important to optimize the adoption of effective medicines
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