Inter-Physician Interaction Across Levels of Care and EBM Adoption in Pediatric Care

Abstract

Physicians around the globe are increasingly encouraged to adopt guidelines, protocols and other scientific material when making clinical decisions. Extant research suggests that the clinicians’ propensity to scientifically ground their practice, an approach called evidence-based medicine (EBM), is strongly associated with the professional collaborative networks they establish and maintain with peers. But how do professional networks across levels of care influence the frequency with which physicians adopt EBM? In this paper we explore whether and how the connectedness of primary care physicians with colleagues working in hospital settings is related to their frequency of EBM adoption in clinical practice. We used survey data from 120 pediatricians working in six different local health authorities (LHAs) in the Italian NHS. Social network and attribute data concerning single physicians were collected, as well as their self-reported frequency of EBM adoption. Professional networks and EBM adoption were studied for three major pathologies in pediatric care: asthmatic, gastro-enteric and urinary pathologies. Network measures were used to capture the degree of connectivity that physicians exhibited with hospital colleagues. Ordinal regression analysis was employed to test the association between the territorial pediatricians’ connectedness with their hospital colleagues and the reported frequency with which they use EBM. Our findings documented that there is a positive association between the number of relationships with hospital colleagues and the frequency of use EBM in all the pathologies investigated. Results also indicated that a number of contingencies reflecting the different organizational contexts to which physicians are affiliated to influence the frequency with which pediatricians use EBM. Contrary to our expectations, it was found that clinicians’ affiliation to formal collaborative arrangements is at odds with the likelihood of reporting higher frequency of EBM use.