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      Promoting rational antibiotic prescribing for non-complicated infections: understanding social influence in primary care networks in Germany

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          Abstract

          Background

          Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified.

          Methods

          For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories ‘social support’, ‘social learning’, ‘social normative pressures’ and ‘social contagion’ to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks’ potential impact on antibiotic prescribing.

          Results

          Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as a great asset, the main reason for membership and affirmative for own perspectives. All interviewed physicians ( n = 27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflective management of antibiotic prescribing. Non-physician health professionals ( n = 11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders ( n = 7) expected networks and their members to be drivers for care optimization.

          Conclusion

          Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotic prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics.

          Trial registration

          ISRCTN, ISRCTN58150046. Registered 24 August 2017.

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          Most cited references 25

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          Social Contagion and Innovation: Cohesion versus Structural Equivalence

           Ronald S Burt (1987)
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            Social contagion theory: examining dynamic social networks and human behavior.

            Here, we review the research we have conducted on social contagion. We describe the methods we have employed (and the assumptions they have entailed) to examine several datasets with complementary strengths and weaknesses, including the Framingham Heart Study, the National Longitudinal Study of Adolescent Health, and other observational and experimental datasets that we and others have collected. We describe the regularities that led us to propose that human social networks may exhibit a 'three degrees of influence' property, and we review statistical approaches we have used to characterize interpersonal influence with respect to phenomena as diverse as obesity, smoking, cooperation, and happiness. We do not claim that this work is the final word, but we do believe that it provides some novel, informative, and stimulating evidence regarding social contagion in longitudinally followed networks. Along with other scholars, we are working to develop new methods for identifying causal effects using social network data, and we believe that this area is ripe for statistical development as current methods have known and often unavoidable limitations. Copyright © 2012 John Wiley & Sons, Ltd.
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              Network Studies of Social Influence

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                Author and article information

                Contributors
                regina.poss-doering@med.uni-heidelberg.de
                martina.kamradt@med.uni-heidelberg.de
                katharina.glassen@med.uni-heidelberg.de
                edith.andres@aqua-institut.de
                p.kaufmann-kolle@aqua-institut.de
                michel.wensing@med.uni-heidelberg.de
                Journal
                BMC Fam Pract
                BMC Fam Pract
                BMC Family Practice
                BioMed Central (London )
                1471-2296
                14 March 2020
                14 March 2020
                2020
                : 21
                Affiliations
                [1 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Dept. of General Practice and Health Services Research, , University Hospital Heidelberg, ; Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
                [2 ]aQua Institut, Maschmuehlenweg 8-10, 37073 Goettingen, Germany
                Article
                1119
                10.1186/s12875-020-01119-8
                7073012
                32171252
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Funding
                Funded by: Ministerium für Wissenschaft, Forschung und Kunst Baden-Württemberg (DE)
                Award ID: IN-1150438
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

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