IDENTIFICATION OF PHYSICIAN OPINION LEADERS AND THE RELEVANCE OF THEIR COMMUNICATION NETWORK FOR CONTINUING MEDICAL EDUCATION.

摘要

Using a mail questionnaire, physicians within a medical practice community were identified as opinion leaders (OLs). The OL's patterns of communication were also mapped to define the type of network in which the total medical community participated. The desire to identify OLs and their networks was based on the recognition of their crucial role in the dissemination of information and practices to other physicians. The OL's role is considered vital to the development of alternative methods of continuing medical education (CME) for community doctors.;A five phase procedure was adapted for encouraging high responses resulting in a 90.1 percent (N = 101) response rate. Respondent categories were subdivided to account for the physicians' reports of their relationships or nonrelationships with colleagues. There were 11 non-respondent physicians.;Six OLs were identified on the basis of the number of nominations in response to the first question and the strength of their links (frequency x clincial importance) with colleagues. Few of the remaining physicians received more than two nominations; the OLs received from 15 to 36 nominations. The OLs were internists and on the active staff of the county's referral hospital. In turn, the OLs' opinion leaders were either in the nearest major medical center or were one of the other five OLs in the county.;Analysis of the patterns of communication revealed the network to be one of referral and consutation. Information flow was uni-directional from tertiary specialist (the OLs' OLs) to secondary specialist (the OLs) to the generalists.;All physicians (N = 112) in Texas county and its vicinity were surveyed by mail and asked to respond to only two questions: (1) "When you have questions concerning patients with heart disease, which of your colleagues do you usually turn to for advice and information?"; and (2) Which of your colleagues usually asks you for advice and information about patients with heart disease?" Richards" (1975) network analysis program was used to analyze the data.;A total of 75 respondents (physicians who report a relationship in answer to question one) made a total of 202 nominations distributed among 39 physicians. Of the 202 nominations, 18 Victoria county and vicinity physicians received 173 nominations and 21 physicians outside of Victoria county and vicinity received 29. Primary care specialists from the Victoria county vicinity made 62.6 percent (N = 144) of the total nominations. According to the mode, OLs were generally contacted by their peers once a month with considerable clinical importance attributed to the interaction. Strength of OL links with followers was in the range 77 to 185 for OLs, and 2 to 37 for the remaining 33 doctors.;As an alternative approach to CME, OLs can be employed to transmit new ideas and practices to colleagues in the context of referral and consultation. Information exchanged while providing medical care has more opportunity to be retained and used than does information presented in the formal setting of a conference. Such information can also be tailored to the needs of the individual.;The network method also enables investigators to monitor the diffusion and adoption of information and practices to evaluate the validity of both opinion leadership and the network.