Network Of Physicians Research Articles

Promotion included in prevention (PIP)

Abstract Issue/problem Every year in Europe more than 20 million visits are carried out on workers. The opportunity to integrate health promotion into prevention is now under the attention of large companies, according to the American model known as Total Worker Health©. Description of the problem The main critical points of this strategy are the correct balance between promotion and prevention efforts and the extension of the projects to small companies. Furthermore, coordination is necessary between all the figures who promote health, particularly in the national health service. Results Occupational risk prevention activities, mandatory in all European countries, have been integrated with health promotion campaigns, addressing health topics chosen in a participatory way. The costs of designing the campaign, information material for employees and data processing are borne by the university, which covers the costs with research funds. No costs are borne by workers or companies. During their medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. In the last 15 years, as many annual campaigns have been conducted. Projects have dealt with: Eating behavior disorders; Post-COVID syndrome; Syncope and presyncope; Headache; Musculoskeletal disorders; Work engagement; Sleep health promotion; Aging; Violence at work; Work organization; Indoor air quality; Mediterranean Diet; Hand skin disorders; Teleworking; Work Ability. More than 30,000 workers from 38 companies participated. Lessons The participatory character of the projects, their simplicity and cost-effectiveness, the integration between occupational medicine and basic medicine demonstrate that PIP projects are economical, sustainable, and effective. Key messages • Health promotion can be integrated into the prevention of occupational risks, without additional costs. • The creation of a network of occupational physicians who are involved in PIP projects respects corporate and professional independence and improves the work culture, health, and safety of workers.

Association Between Insurance Status and Nonelderly Penile Squamous Cell Carcinoma Survivorship: A National Retrospective Analysis

Background: Penile squamous cell carcinoma is an aggressive malignancy with significant physical and psychological impacts. Socioeconomic factors influence prognosis in genitourinary cancers, making the investigation of insurance status critical for reducing cancer burden and promoting health equity. Materials and Methods: Men diagnosed with primary penile squamous cell carcinoma from 2007 to 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) national database. Participants were categorized based on insurance status: privately insured, Medicaid, and uninsured. Pearson’s chi-squared test assessed the distribution of observed frequencies between the patient demographics, socioeconomic status, tumor characteristics, and surgical variables across the insurance groups. Overall and cancer-specific survival was estimated using a multivariate Cox hazards proportional model analysis. Results: The multivariate Cox hazards proportional model showed that, compared to privately insured patients, Medicaid patients had an increased risk for overall death (hazard ratio [HR] = HR 1.54; 95% CI, 1.12–2.07). For cancer-specific mortality, Medicaid patients had an increased risk of death compared to privately insured patients (HR 1.58; 95% CI, 1.11–2.25). Conclusions: Medicaid does not mitigate the differences caused by health insurance status due to health insurance disparities for overall or cancer-specific mortality. Lower Medicaid reimbursements and out-of-pocket costs lead to a narrow network of physicians, hospitals, and treatment modalities that compromise health equity. Increasing awareness of health insurance disparities and improving access to care via a clinician–community–governmental partnership can potentially lead to improved predictive outcomes.

Implementation of a Clinical Decision Support System for Antimicrobial Prescribing in Sub-Saharan Africa: Multisectoral Qualitative Study.

Suboptimal use of antimicrobials is a driver of antimicrobial resistance in West Africa. Clinical decision support systems (CDSSs) can facilitate access to updated and reliable recommendations. This study aimed to assess contextual factors that could facilitate the implementation of a CDSS for antimicrobial prescribing in West Africa and Central Africa and to identify tailored implementation strategies. This qualitative study was conducted through 21 semistructured individual interviews via videoconference with health care professionals between September and December 2020. Participants were recruited using purposive sampling in a transnational capacity-building network for hospital preparedness in West Africa. The interview guide included multiple constructs derived from the Consolidated Framework for Implementation Research. Interviews were transcribed, and data were analyzed using thematic analysis. The panel of participants included health practitioners (12/21, 57%), health actors trained in engineering (2/21, 10%), project managers (3/21, 14%), antimicrobial resistance research experts (2/21, 10%), a clinical microbiologist (1/21, 5%), and an anthropologist (1/21, 5%). Contextual factors influencing the implementation of eHealth tools existed at the individual, health care system, and national levels. At the individual level, the main challenge was to design a user-centered CDSS adapted to the prescriber's clinical routine and structural constraints. Most of the participants stated that the CDSS should not only target physicians in academic hospitals who can use their network to disseminate the tool but also general practitioners, primary care nurses, midwives, and other health care workers who are the main prescribers of antimicrobials in rural areas of West Africa. The heterogeneity in antimicrobial prescribing training among prescribers was a significant challenge to the use of a common CDSS. At the country level, weak pharmaceutical regulations, the lack of official guidelines for antimicrobial prescribing, limited access to clinical microbiology laboratories, self-medication, and disparity in health care coverage lead to inappropriate antimicrobial use and could limit the implementation and diffusion of CDSS for antimicrobial prescribing. Participants emphasized the importance of building a solid eHealth ecosystem in their countries by establishing academic partnerships, developing physician networks, and involving diverse stakeholders to address challenges. Additional implementation strategies included conducting a local needs assessment, identifying early adopters, promoting network weaving, using implementation advisers, and creating a learning collaborative. Participants noted that a CDSS for antimicrobial prescribing could be a powerful tool for the development and dissemination of official guidelines for infectious diseases in West Africa. These results suggest that a CDSS for antimicrobial prescribing adapted for nonspecialized prescribers could have a role in improving clinical decisions. They also confirm the relevance of adopting a cross-disciplinary approach with participants from different backgrounds to assess contextual factors, including social, political, and economic determinants.

Estimating the impact of physician risky-prescribing on the network structure underlying physician shared-patient relationships

Social network analysis and shared-patient physician networks have become effective ways of studying physician collaborations. Assortative mixing or “homophily” is the network phenomenon whereby the propensity for similar individuals to form ties is greater than for dissimilar individuals. Motivated by the public health concern of risky-prescribing among older patients in the United States, we develop network models and tests involving novel network measures to study whether there is evidence of homophily in prescribing and deprescribing in the specific shared-patient network of physicians linked to the US state of Ohio in 2014. Evidence of homophily in risky-prescribing would imply that prescribing behaviors help shape physician networks and would suggest strategies for interventions seeking to reduce risky-prescribing (e.g., strategies to directly reduce risky prescribing might be most effective if applied as group interventions to risky prescribing physicians connected through the network and the connections between these physicians could be targeted by tie dissolution interventions as an indirect way of reducing risky prescribing). Furthermore, if such effects varied depending on the structural features of a physician’s position in the network (e.g., by whether or not they are involved in cliques—groups of actors that are fully connected to each other—such as closed triangles in the case of three actors), this would further strengthen the case for targeting groups of physicians involved in risky prescribing and the network connections between them for interventions. Using accompanying Medicare Part D data, we converted patient longitudinal prescription receipts into novel measures of the intensity of each physician’s risky-prescribing. Exponential random graph models were used to simultaneously estimate the importance of homophily in prescribing and deprescribing in the network beyond the characteristics of physician specialty (or other metadata) and network-derived features. In addition, novel network measures were introduced to allow homophily to be characterized in relation to specific triadic (three-actor) structural configurations in the network with associated non-parametric randomization tests to evaluate their statistical significance in the network against the null hypothesis of no such phenomena. We found physician homophily in prescribing and deprescribing. We also found that physicians exhibited within-triad homophily in risky-prescribing, with the prevalence of homophilic triads significantly higher than expected by chance absent homophily. These results may explain why communities of prescribers emerge and evolve, helping to justify group-level prescriber interventions. The methodology may be applied, adapted or generalized to study homophily and its generalizations on other network and attribute combinations involving analogous shared-patient networks and more generally using other kinds of network data underlying other kinds of social phenomena.

Exploring global barriers to optimal ovarian cancer care: thematic analysis

ObjectiveTo explore the barriers to ovarian cancer care, as reported in the open ended responses of a global expert opinion survey, highlighting areas for improvement in global ovarian cancer care....

How a Robust Community Clinical Practice Arm Can Support an Academic Health System’s Tripartite Mission

Natural tension exists between the community clinical practice arm and the academic clinical practice arm within a large academic health system (AHS). Disparate salary structures, overlapping geography, competition for patients, and inequitable application of standards and resources can all lead to suboptimal system performance, as each clinical practice works to maximize individual outcomes. These tensions can lead to unnecessary duplication of resources and wasting time and energy focusing on internal politics and competition rather than on addressing external competitive threats, such as the influence of venture capital, virtual services, and retail entrants into the clinical space. At the same time, the health care landscape continues to shift, as physician ownership of practices has fallen below 50%, creating both challenges and opportunities for health systems. This article describes how, over the last 15 years, UNC Health has built a robust community practice arm called UNC Physicians Network (UNCPN) alongside the academic department structure that fully supports UNC Health’s tripartite mission. The authors describe how a community arm within an AHS can expand its clinical footprint and harmonize research and teaching efforts to support the AHS mission in a community setting. To accomplish this harmonization, UNCPN identified three high-priority focus areas for intentional investment in collaboration between the community and academic arms: (1) partnering to increase community-based research; (2) growing internal capacity for learners; and (3) scaling care delivery quality and population health initiatives across a wide geography. These intentional efforts have allowed UNC Health to improve the performance of all AHS missions: research, education, and population-based clinical care. Specifically, the number of community clinics that were actively participating in research more than doubled, from 23 practices in 2019 to 49 in 2023. In association with the UNC Schools of Medicine and Nursing, for the last few years, approximately 65–70 preceptors have been committing as many as 23,000 hours to teaching about 95 students each academic year. In addition, during that same period, the percentage of School of Medicine student learners precepted nearly doubled in UNCPN adult clinics (Family Medicine and Internal Medicine) and increased by 50% in UNCPN pediatric clinics. As the number of UNCPN clinicians increased from 44 in 2010 to 697 in 2024, the number of primary care–empaneled patients grew from 200,000 in 2019 to more than 350,000 in 2024, with currently more than 540,000 patients in total, inclusive of primary and specialty care, which has allowed scaling of high-quality care, leading to top-tier performance in value-based contracts.

Stereotactic Body Radiation Adoption Impacts Prostate Cancer Treatment Patterns

ObjectivesTo investigate stereotactic body radiation (SBRT) adoption for prostate cancer. As evidence supporting SBRT mounts, its utilization and impact relative to other prostate cancer treatments is unknown. MethodsWe used SEER-Medicare to identify patients diagnosed with localized prostate cancer from 2008-2017. We then identified physician networks by identifying the primary treating physician of each patient based on primary treatment, then linking each physician to a practice. We examined trends in prostate cancer treatment between networks performing SBRT or not using chi-squared tests and logistic regression models. ResultsThere were 35,972 patients who received treatment for prostate cancer at 234 physician networks. Of these patients, 30,635 were treated in a non-SBRT network (n=190), while 5,337 received treatment in a SBRT network (n=44). Patients who received care in an SBRT network were more likely to live in metropolitan areas ≥1 million (70% v. 46%, p<0.001), have a higher median income >$60,000 (62% v. 42%, p<0.001), and live in the northeast (35% v. 12%) or west (40% v. 38%, p<0.001) compared to non-SBRT networks. In SBRT networks, more patients received IMRT (31% v. 23%), and fewer patients received prostatectomy (16% v. 23%) or active surveillance (15% v. 19%) compared to non-SBRT networks. Black men were 45% less likely to receive SBRT (OR=0.55, CI-0.36-0.85) compared to White men. ConclusionsSBRT utilization is increasing relative to other prostate cancer treatments. Prostate cancer treatment mix is different in networks that offer SBRT, and SBRT is less available to some patient groups, raising concern for novel treatment inequity.

'You mean you're not doing it already?' A national sentinel toxico-surveillance system for detecting illicit, emerging and novel psychoactive drugs in presentations to emergency departments.

Patients presenting to the ED after using illicit drugs, including novel psychoactive substances, are a unique source of information on substances that are directly causing acute harm in the community. Conventionally, illicit drug intoxications are assessed and managed in EDs based on self-report and presenting symptoms, with no objective data on the causative agent. The Emerging Drugs Network of Australia (EDNA) is a national toxico-surveillance system that provides analytic data on these drugs, from sentinel Emergency Departments. It is a collaborative national network of emergency physicians, toxicologists, forensic laboratories and public health authorities. The key benefit of EDNA is the capacity to provide timely laboratory-confirmed toxicology data on emerging drug-related threats in the community. This leads to improvements in clinical, forensic laboratory and public health harm reduction responses, reflecting rapid translation of the research.

Socio-Cultural and Professional Integration of Foreign-Born and Foreign-Educated Physicians in German Outpatient Care: an Interview-Based Study in Baden-Württemberg and Hessen

Introduction In recent years, it has become increasingly hard to fill outpatient physician vacancies in all parts of Germany. This development is particularly pronounced in general practice. At the same time, the number of doctors trained abroad is increasing, predominantly in the inpatient sector. In the next few years, foreign-born and -trained physicians will presumably be increasingly active also in the field of family medicine. The aim of this study was to explore experiences, support needs and possible improvements from the perspective of such physicians in the outpatient sector with a focus on primary care.Method In this qualitative study, semi-structured interviews were conducted with physicians not raised and trained in Germany and working in the outpatient setting in Germany. The evaluation was carried out by means of qualitative content analysis. Categories were derived in a deductive-inductive manner.Results Thirteen physicians (of which nine were primary care physicians) were interviewed. Next to the deductively derived main categories (departure, des-orientation, adaptation) four subcategories as overarching problems emerged in the interviews: Administrative tasks, communication and professional as well as social adaptation / integration in Germany. Proposed solutions were categorized in structuring measures (official, easily accessible guidelines for physician migration, paid qualification period), specific preparatory courses for the outpatient sector, and personal support such as mentoring and networking of outpatient physicians in training.Conclusions Some of the problem areas mentioned were similar to those known from the inpatient setting. To support sustainable recruitment in the outpatient sector, specific preparatory courses and the promotion of networking among physicians appeared to be additional measures that would benefit physicians applying for positions in the outpatient sector and also easy to implement.

No Association Between Medicare Advantage Providers' Network Restrictiveness and Star Rating Between 2013 and 2017: An Observational Study.

Medicare beneficiaries are increasingly enrolling in Medicare Advantage (MA), which employs a wide range of practices around restriction of the networks of providers that beneficiaries visit. Though Medicare beneficiaries highly value provider choice, it is unknown whether the MA contract quality metrics which beneficiaries use to inform their contract selection capture the restrictiveness of contracts' provider networks. We evaluated whether there are meaningful associations between provider network restrictiveness (across primary care, psychiatry, and endocrinology providers) and contracts' overall star quality rating, as well as between network restrictiveness and contracts' performance on access to care measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Medicare Advantage contracts with health maintenance organization (HMO), local preferred provider organization (PPO), and point of service (POS) plans with available data. A cross-sectional analysis using multivariable linear regressions to assess the relationship between provider network restrictiveness and contract quality scores in 2013 through 2017. Statistical significance in the relationship between network restrictiveness and contract performance on quality measures. Across all study years, we included 562 unique contracts and 2801 contract-years. We find no evidence of consistent relationships between MA physician network restrictiveness and contract star rating. For primary care, psychiatry, and endocrinology, respectively, a 10 percentage point increase in restrictiveness was associated with a 0.02 (95% confidence interval [CI] -0.01 to 0.04), 0.0008 (95% CI, -0.01 to 0.02), and -0.01 (95% CI, -0.01 to 0.001) difference in star rating (p-value > 0.05 for all). Similarly, we find no evidence of consistent relationships between network restrictiveness and access to care measures. Our findings suggest that existing MA contract quality measures are not useful for indicating differences in network restrictiveness. Given the importance of provider choice to beneficiaries, more specific metrics may be needed to facilitate informed decisions about MA coverage.

Formation of professional social networks via physicians’ online engagement: Evidence from Sina Weibo and Sina Health

The professional social networks of physicians are an essential source of health-related user-generated content and online social capital. Yet limited research has examined how social networks of physicians emerge at the level of relationships between physicians. To help fill this gap, this study investigates the formation of followship between physicians (i.e., when one physician follows another) from the perspectives of network structures, actor attributes, and external contextual factors. Using exponential random graph models and strategic network formation models, this study analyzes the effects of reciprocity and transitive closure, physicians’ social media and online healthcare community (OHC) engagement, and physicians’ interaction networks. The results reveal that physicians’ professional social networks have a reciprocated and open structure. Physicians’ social media connectivity and content, online service performance, professional capital, and social identity homophily facilitate the formation of professional social networks. In addition, the interaction networks have an entrainment effect on professional social networks. This study reveals the mechanism of social processes, including reciprocity, preferential attachment, and homophily, in the formation of social networks. The results also extend social cognitive theory and signaling theory into the context of physicians’ professional social networks.

Polygenic scores for longitudinal prediction of incident type 2 diabetes in an ancestrally and medically diverse primary care physician network: a patient cohort study

BackgroundThe clinical utility of genetic information for type 2 diabetes (T2D) prediction with polygenic scores (PGS) in ancestrally diverse, real-world US healthcare systems is unclear, especially for those at low clinical phenotypic risk for T2D.MethodsWe tested the association of PGS with T2D incidence in patients followed within a primary care practice network over 16 years in four hypothetical scenarios that varied by clinical data availability (N = 14,712): (1) age and sex; (2) age, sex, body mass index (BMI), systolic blood pressure, and family history of T2D; (3) all variables in (2) and random glucose; and (4) all variables in (3), HDL, total cholesterol, and triglycerides, combined in a clinical risk score (CRS). To determine whether genetic effects differed by baseline clinical risk, we tested for interaction with the CRS.ResultsPGS was associated with incident T2D in all models. Adjusting for age and sex only, the Hazard Ratio (HR) per PGS standard deviation (SD) was 1.76 (95% CI 1.68, 1.84) and the HR of top 5% of PGS vs interquartile range (IQR) was 2.80 (2.39, 3.28). Adjusting for the CRS, the HR per SD was 1.48 (1.40, 1.57) and HR of the top 5% of PGS vs IQR was 2.09 (1.72, 2.55). Genetic effects differed by baseline clinical risk ((PGS-CRS interaction p = 0.05; CRS below the median: HR 1.60 (1.43, 1.79); CRS above the median: HR 1.45 (1.35, 1.55)).ConclusionsGenetic information can help identify high-risk patients even among those perceived to be low risk in a clinical evaluation.

“That is when I understood everything”: Ideological trajectories of pro-choice female doctors in Mexico

ObjectivesThere is little global evidence about how physicians become abortion clinicians or advocates. We describe the ideological trajectories of self-identified pro-choice female Mexican doctors and the factors that made them become pro-choice. Study DesignIn this qualitative study we conducted semi-structured interviews with members of the Mexican Network of Female Pro-choice Physicians (Red de Médicas por el Derecho a Decidir - México). Participants came from 8 diverse states in Mexico. We used a feminist epistemology approach and analyzed data using inductive coding as well as a priori categories (becoming pro-choice, trajectories, and training). ResultsWe included 24 female pro-choice physicians. We identified five intersecting factors that influenced becoming pro-choice: feminism, personal experiences, confrontation with the inequalities and violence that women experience, role models, and routine exposure to abortion care. Participants described three ideological trajectories: being pro-choice before studying medicine, not having a specific opinion, and changing from “pro-life” to “pro-choice”. Participants described an absence of abortion training in medical schools or stigmatizing training, and the use of alternative training sources. ConclusionIn the absence of training on abortion during the medical education, a combination of intersecting personal as well as work-related experience may turn doctors in to pro-choice abortion clinicians and/or advocates. Training on abortion care in medical education and stigma reduction in Mexican society is essential. The findings of this study may be used to develop comprehensive medical curricula as well as strategies directed at doctors in who have never received training on abortion care, such as promoting interactions between doctors and non-medical abortion providers, education on inequalities and violence against women, moving beyond a public health to a human rights and gender perspective, and exposure to routine safe abortion care. ImplicationsMexican female doctors become pro-choice clinicians who provide abortion care and/or advocates in spite of their medical education.

P137 A multinational survey to identify the clinicians perspectives concerning proton pump inhibitors in patients with systemic sclerosis

Abstract Background/Aims Proton Pump Inhibitors (PPIs) are widely used in Systemic Sclerosis (SSc) for the treatment of gastroesophageal reflux disease (GERD). However, there is scarce evidence to support their use while long-term safety has been questioned. The aim of our study was to identify healthcare providers’ perspectives and experience regarding PPIs therapy in SSc patients. Methods An online survey in English language targeting clinicians involved in the care of SSc patients, was developed and distributed through social media and international physician networks. The survey was launched on 27th November 2022 and kept open for three weeks. Results Responses from 227 clinicians from 36 countries were recorded: most of them (86%) were between 30-70 years and gender was equally represented (F: 52%; M: 48%). The majority ‘agreed’ (41%) or ‘strongly agreed’ (45%) that GERD is a major cause of morbidity in SSc. Lifestyle modifications and non-pharmacological approaches alone were seldom (16%) considered effective. Only half of respondents ‘agreed’ (43%) or ‘strongly agreed’ (11%) there is solid evidence supporting PPIs efficacy in SSc. A range of PPIs was prescribed by clinicians, most frequently pantoprazole (74%), esomeprazole (72%), omeprazole (72%), and lansoprazole (68%). The most common reasons for PPIs prescription (Table 1) were symptomatic GERD unresponsive to lifestyle modification (95%), objective evidence of GERD (82%), and hoarseness or respiratory symptoms (71%). Multiple concerns were raised about PPI long-term safety. The three highest (mean, 10 being very concerned) reasons were: small intestinal bacterial overgrowth (5.5), osteoporosis (5.4), and drug interactions (5.2). There were significant differences in attitudes towards surgery for refractory GERD: ‘strongly disagreed’ (14%), ‘disagreed’ (26%) ‘neutral’ (52%), ‘agreed’ (13%), ‘strongly agreed’ (3%). Furthermore, half of respondents had concerns about potential complications (i.e., worsening of dysphagia): ‘disagreed’ (26%) or ‘strongly disagreed’ (6%), ‘neutral (52%), ‘agreed’ (13%), ‘strongly agreed’ (3%). Conclusion Our survey confirms that PPIs are frequently prescribed for GERD in SSc patients, despite the absence of randomized clinical trials demonstrating their efficacy and safety. Clinicians are concerned about side effects, especially regarding long-term use. There is significant heterogeneity in attitudes towards surgery for refractory GERD. Future research and practical treatment recommendation are urgently needed. Disclosure G. Bandini: None. A. Alunno: None. F. Oliveira Pinheiro: None. C. Campochiaro: None. I. Galetti: None. P. Matucci Cerinic: None. B. Ruaro: None. A. Moggi Pignone: None. L. Dagna: None. M. Matucci Cerinic: None. Z. McMahan: None. M. Hughes: None.

Remote Monitoring and Data Collection for Decentralized Clinical Trials

Less than 5% of patients with cancer enroll in a clinical trial, partly due to financial and logistic burdens, especially among underserved populations. The COVID-19 pandemic marked a substantial shift in the adoption of decentralized trial operations by pharmaceutical companies. To assess the current global state of adoption of decentralized trial technologies, understand factors that may be driving or preventing adoption, and highlight aspirations and direction for industry to enable more patient-centric trials. The Bloomberg New Economy International Cancer Coalition, composed of patient advocacy, industry, government regulator, and academic medical center representatives, developed a survey directed to global biopharmaceutical companies of the coalition from October 1 through December 31, 2022, with a focus on registrational clinical trials. The data for this survey study were analyzed between January 1 and 31, 2023. Adoption of decentralized clinical trial technologies. The survey measured (1) outcomes of different remote monitoring and data collection technologies on patient centricity, (2) adoption of these technologies in oncology and all therapeutic areas, and (3) barriers and facilitators to adoption using descriptive statistics. All 8 invited coalition companies completed the survey, representing 33% of the oncology market by revenues in 2021. Across nearly all technologies, adoption in oncology trials lags that of all trials. In the current state, electronic diaries and electronic clinical outcome assessments are the most used technology, with a mean (SD) of 56% (19%) and 51% (29%) adoption for all trials and oncology trials, respectively, whereas visits within local physician networks is the least adopted at a mean (SD) of 12% (18%) and 7% (9%), respectively. Looking forward, the difference between the current and aspired adoption rate in 5 years for oncology is large, with respondents expecting a 40% or greater absolute adoption increase in 8 of the 11 technologies surveyed. Furthermore, digitally enabled recruitment, local imaging capabilities, and local physician networks were identified as technologies that could be most effective for improving patient centricity in the long term. These findings may help to galvanize momentum toward greater adoption of enabling technologies to support a new paradigm of trials that are more accessible, less burdensome, and more inclusive.

Primary Care Physician Network Overlap Between Medicaid and the Patient Protection and Affordable Care Act Marketplace

This cross-sectional study quantifies Medicaid and the Patient Protection and Affordable Care Act (ACA) Marketplace overlap among primary care physicians.

Canadian Addiction Treatment Centre (CATC) opioid agonist treatment cohort in Ontario, Canada

PurposeThe Canadian Addiction Treatment Centre (CATC) cohort was established during a period of increased provision of opioid agonist treatment (OAT), to study patient outcomes and trends related to the treatment...

A multi-national survey to identify clinicians’ perspectives concerning Proton Pump inhibitors in patients with systemic sclerosis

ObjectivesProton Pump Inhibitors (PPIs) are widely used in SSc for gastroesophageal reflux disease (GERD). However, there is little evidence to support their empirical use and long-term safety has been questioned. Our objective was to better describe clinicians’ attitudes toward PPIs prescription and use in SSc patients. MethodsClinicians involved in the care of SSc patients were invited through international physician networks and social media to participate in an online survey. ResultsResponses from 227 clinicians from 36 countries were evaluable. The majority ‘agreed’ (41.4 %) or ‘strongly agreed’ (45.4 %) that GERD is a major cause of morbidity in SSc. Lifestyle modifications are seldom (16 %) considered effective. Only half ‘agreed’ (43 %) or ‘strongly agreed’ (11 %) there is solid evidence supporting PPIs efficacy in SSc. The most common reasons for PPIs prescription were symptomatic GERD unresponsive to lifestyle modification (95 %), objective evidence of GERD (82 %), and hoarseness or respiratory symptoms (71 %). There are variable concerns about PPIs long-term safety in SSc. The three highest (mean) reasons (0–10, here 10 is ‘very concerned’) were: small intestinal bacterial overgrowth (5.5), osteoporosis (5.4), and drug interactions (5.2). There are significant differences in attitudes towards surgery for refractory GERD, and concerns about potential complications. PPIs may have a putative role for disease modification (e.g., ILD and calcinosis), and the role of immunosuppression is uncertain for GI (gastrointestinal) disease in SSc. ConclusionPPIs are frequently prescribed in SSc. Side effects are a recognized concern, especially regarding long-term therapy. There is significant variation in attitudes towards surgical intervention. Future research and practical treatment recommendation for PPIs in SSc are urgently needed.

Influence of physician networks on the implementation of pharmaceutical alternatives to a toxic drug supply in British Columbia

BackgroundCharacterizing the diffusion of adopted changes in policy and clinical practice can inform enhanced implementation strategies to ensure prompt uptake in public health emergencies and other rapidly evolving disease areas. A novel guidance document was introduced at the onset of the COVID-19 pandemic in British Columbia (BC), Canada, which supported clinicians to prescribe opioids, stimulants, and benzodiazepines. We aimed to determine the extent to which uptake and discontinuation of an initial attempt at a prescribed safer supply (PSS) program were influenced through networks of prescribers.MethodsWe executed a retrospective population-based study using linked health administrative data that captured all clinicians who prescribed to at least one client with a substance use disorder from March 27, 2020, to August 31, 2021. Our main exposure was the prescribing patterns of an individuals’ peers, defined as the proportion of a prescribers’ professional network (based on shared clients), which had previously prescribed PSS, updated monthly. The primary outcome measured whether a clinician had prescribed their initial PSS prescription during a given calendar month. The secondary outcome was the discontinuation of PSS prescribing, defined as an absence for PSS prescriptions for at least 3 months. We estimated logistic regression models using generalized estimated equations on monthly repeated measurements to determine and characterize the extent to which peer networks influenced the initiation and discontinuation of PSS prescribing, controlling for network, clinician, and caseload characteristics. Innovators were defined as individuals initiating PSS prior to May 2020, and early adopters were individuals initiating PSS after.ResultsAmong 14,137 prescribers treating clients with substance use disorder, there were 228 innovators of prescribed safer supply and 1062 early adopters through the end of study follow-up, but 653 (50.6%) were no longer prescribing by August 2021. Prescribers with over 20% of peers whom had adopted PSS had a nearly fourfold higher adjusted odds of PSS prescribing themselves (aOR: 3.79, 95% CI: (3.15, 4.56)), compared to those with no connected safer supply prescribers.ConclusionsThe uptake of PSS in BC was highly dependent on the behavior of prescribers’ peer networks. Future implementation strategies to support PSS or other policies would benefit from leveraging networks of prescribers.

The segregation of physician networks providing care to black and white patients with heart disease: Concepts, measures, and empirical evaluation

Black-White disparities in cardiac care may be related to physician referral network segregation. We developed and tested new geographic physician network segregation measures. We used Medicare claims to identify Black and White Medicare heart disease patients and map physician networks for 169 hospital referral regions (HRRs) with over 1000 Black patients. We constructed two network segregation indexes ranging from 0 (integration) to 100 (total segregation): Dissimilarity (the unevenness of Black and White patient distribution across physicians [Dn]) and Absolute Clustering (the propensity of Black patients’ physicians to have closer ties with each other than with other physicians [ACLn]). We employed conditional logit models to estimate the probability of using the best (lowest mortality) geographically available hospital for Black and White patients undergoing coronary artery bypass grafting (CABG) surgery in 126 markets with sufficient sample size at increasing levels of network segregation and for low vs. high HRR Black patient population. Physician network segregation was lower than residential segregation (Dissimilarity 21.9 vs. 48.7, and Absolute Clustering 4.8 vs. 32.4) and positively correlated with residential segregation (p < .001). Network segregation effects differed by race and HRR Black patient population. For White patients, higher network segregation was associated with a higher probability of using the best available hospitals in HRRs with few black patients but unchanged (ACLn) or lower (Dn) probability of best hospital use in HRRs with many Black patients. For Black patients, higher network segregation was not associated with a substantial change in the probability of best hospital use regardless of the HRR Black patient population size. Measuring physician network segregation is feasible and associated with nuanced effects on Black-White differences in high-quality hospital use for heart disease. Further work is needed to understand underlying mechanisms and potential uses in health equity policy.