title: Factors affecting influential discussions among physicians: a social network analysis of a primary care practice.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  All 38 primary care physicians in a hospital-based academic practice.
  
  
  METHODS
  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.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. keating@hcp.med.harvard.edu
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
authors.forename: Peter V
authors.initials: PV
authors.lastname: Marsden
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D033183:Interdisciplinary Communication; D008297:Male; D011320:Primary Health Care; D011364:Professional Practice; D012944:Social Support; D016387:Women's Health