@article{2bef2c1e72d346de80dfe14b01631d50,
title = "Physician Network Connections Associated With Faster De-Adoption of Dronedarone for Permanent Atrial Fibrillation",
abstract = "Background: Physicians' professional networks are an important source of new medical information and have been shown to influence the adoption of new treatments, but it is unknown how physician networks impact the de-adoption of harmful practices. Methods: We analyzed changes in physicians' use of dronedarone after the PALLAS trial (Palbociclib Collaborative Adjuvant Study; November 2011) showed that dronedarone increased the risk of death from cardiovascular events among patients with permanent atrial fibrillation. Deidentified administrative claims from the OptumLabs Data Warehouse were combined with physicians' demographic information from the Doximity database and publicly available data on physicians' patient-sharing relationships compiled by the Centers for Medicare and Medicaid Services. We used a linear probability model with an interrupted linear time trend specification to model the impact of the PALLAS trial on physicians' dronedarone usage between 2009 and 2014. Results: Before the PALLAS trial, the use of dronedarone was increasing by 0.22 percentage points per quarter (95% CI, 0.19-0.25) in our Medicare Advantage sample (N=343 429 patient-quarter observations) and 0.63 percentage points per quarter (95% CI, 0.52-0.75) in our commercially insured sample (N=44 402 patient-quarter observations). After the PALLAS trial and subsequent United States Food and Drug Administration black box warning, physicians in the Medicare Advantage sample with an above-median number of network connections to other physicians decreased their quarterly usage of dronedarone by 0.12 percentage points more per quarter (95% CI, -0.20 to -0.04; P=0.031) than physicians with equal to or below the median number of network connections. Similar patterns existed in the commercially insured sample (P=0.0318). Conclusions: After controlling for a wide range of patient, physician, and geographic characteristics, physicians with a greater number of network connections were faster de-adopters of dronedarone for patients with permanent atrial fibrillation after the PALLAS trial and subsequent United States Food and Drug Administration black box warning detailed the harmfulness of dronedarone for these patients. Policies for improving physicians' responsiveness to new medical information should consider utilizing the influence of these important professional network relationships.",
keywords = "atrial fibrillation, dronedarone, guideline adherence, harm reduction, practice patterns, physicians",
author = "Chad Stecher and Alexander Everhart and Smith, {Laura Barrie} and Anupam Jena and Ross, {Joseph S.} and Desai, {Nihar R.} and Nilay Shah and Pinar Karaca-Mandic",
note = "Funding Information: In the past 36 months, A. Everhart was a paid research fellow at Medtronic for unrelated Projects. Support to Dr Jena was provided by the Office of the Director, National Institutes of Health (NIH; 1DP5OD017897). Dr Jena reports receiving consulting fees unrelated to this work from Pfizer, Hill Rom Services, Bristol Myers Squibb, Novartis, Amgen, Eli Lilly, Vertex Pharmaceuticals, AstraZeneca, Celgene, Tesaro, Sanofi Aventis, Biogen, Precision Health Economics, and Analysis Group. Dr Ross currently receives research support through Yale University from Johnson and Johnson to develop methods of clinical trial data sharing, from the Food and Drug Administration to establish Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation (CERSI) program (U01FD005938), from the Medical Device Innovation Consortium as part of the National Evaluation System for Health Technology (NEST), from the Agency for Healthcare Research and Quality (R01HS022882), from the National Heart, Lung, and Blood Institute of NIH (R01HS025164 and R01HL144644) and from the Laura and John Arnold Foundation to establish the Good Pharma Scorecard at Bioethics International. Dr Desai works under contract with the Centers for Medicare and Medicaid Services to develop and maintain performance measures used for public reporting and pay for performance programs. He reports research grants and consulting for Amgen, Astra Zeneca, Boehringer Ingelheim, Cytokinetics, Medicines Company, Relypsa, Novartis, and SCPharmaceuticals. Dr Shah has received research support through Mayo Clinic from the Food and Drug Administration to establish the Yale-Mayo Clinic CERSI program (U01FD005938), from the Centers of Medicare and Medicaid Innovation under the Transforming Clinical Practice Initiative (TCPI), from the Agency for Healthcare Research and Quality (R01HS025402 and R03HS025517), from the National Heart, Lung, and Blood Institute of NIH (R01HL131535), National Science Foundation, and from the Patient-Centered Outcomes Research Institute (PCORI) to develop a Clinical Data Research Network (LHSNet). Dr Karaca-Mandic serves as the Principal Investigator to grants that funded this study (Agency for Healthcare Research and Quality/R01 HS025164) as well as to other supportive grants (NIA/P01AG005842 and NIH/R56 HL130496). She is also the Principal Investigator to an American Cancer Society funded study on biosimilar drug uptake (131611-RSGI17-154-01-CPHPS). In the past 2 years, she reports receiving consulting fees unrelated to this work from Precision Health Economics and Sempre Health. All disclosed relationships are modest. The other authors report no conflicts. Funding Information: The research reported in this publication was funded by Agency for Healthcare Research and Quality (R01 HS025164). We also acknowledge support from the National Heart, Lung, and Blood Institute (R56 HL130496) and a pilot grant by the National Institute on Aging of the National Institutes of Health under Award Number P01AG005842 for the development of the study cohorts in earlier stages of the research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2021 Lippincott Williams and Wilkins. All rights reserved.",
year = "2021",
month = oct,
day = "1",
doi = "10.1161/CIRCOUTCOMES.121.008040",
language = "English (US)",
volume = "14",
pages = "E008040",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "10",
}