Background
Methods
Study sites and populations
Survey instrument
We are trying to identify colleagues who, by virtue of their views, knowledge or standing, are used as a source of advice by their peers. | |
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Please read each of the paragraphs and write in the names of up to three colleagues that best fit the description of each characteristic. The same person may be named for more than one characteristic. You can name anyone with whom you come into regular contact. | |
1. | These colleagues express themselves clearly and concisely, giving practical information. They take the time to answer you completely, and do not leave you with the feeling that they were too busy to answer your inquiry. |
2. | These colleagues are up-to-date and demonstrate a command of knowledge about clinical issues in general practice. |
3. | These colleagues are caring and demonstrate a high level of concern. They never talk down to you; they treat you as an equal. |
This section is about the degree to which you advise colleagues with whom you come into contact. Please rate yourself on the following scales relating to your interactions with colleagues regarding clinical issues in general practice, by circling the number which you feel is most appropriate. | ||||
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1. In general, do you talk to your colleagues about issues in general practice?
| ||||
Very often | Never | |||
5 | 4 | 3 | 2 | 1 |
When you talk to your colleagues about clinical issues in general practice, do you:
| ||||
Give very little information | Give a lot of information | |||
5 | 4 | 3 | 2 | 1 |
In the past six months, how many times have you given information to colleagues about clinical issues in general practice?
| ||||
Many times | Never | |||
5 | 4 | 3 | 2 | 1 |
Compared with your colleagues, how likely are you to be asked about clinical issues in general practice?
| ||||
Not at all likely to be asked | Very likely to be asked | |||
5 | 4 | 3 | 2 | 1 |
In a discussion of clinical issues in general practice, which of the following happens most often?
| ||||
You tell your colleagues about your ideas | Your colleagues tell you about their ideas | |||
5 | 4 | 3 | 2 | 1 |
Overall in your discussions with colleagues about clinical issues in general practice, are you:
| ||||
Not used as a source of advice | Often used as a source of advice | |||
5 | 4 | 3 | 2 | 1 |
Target group | Condition |
---|---|
Primary care
| |
General practitioners | Ischaemic heart disease |
Practice nurses | Ischaemic heart disease |
Practice managers | N/A |
Secondary care
| |
Physicians | Ischaemic heart disease |
Surgeons | Laparoscopic surgery |
Medical nursing staff | Management of pressure sores |
Surgical nursing staff | Post operative pain relief |
National specialty groups
| |
Obstetrics and gynaecology | Laparoscopic surgery |
Oncology | Management of breast cancer |
Survey procedure
Analysis
Characteristics of opinion leaders
Other analyses
Comparison of different identification methods
Results
Survey response rates
Total mailed | Total returned (% total mailed) | Attempted generic sociometric instrument (% respondents) | Attempted condition-specific sociometric instrument (% respondents) | |
---|---|---|---|---|
PC1 | ||||
General practitioners | 211 | 86 (40.6%) | 40 (46.5%) | 37 (43.0%) |
Practice nurses | 66 | 37 (56.1%) | 16 (43.2%) | 16 (43.2%) |
Practice managers | 62 | 32 (51.6%) | 21 (65.6%) | N/A |
Total | 339 | 155 (45.7%) | 77 (49.7%) | 53 (43.1%) |
PC2 | ||||
General practitioners | 356 | 230 (64.6%) | 130 (56.5%) | 111 (48.3%) |
Practice nurses | 202 | 151 (74.6%) | 98 (64.9%) | 85 (56.3%) |
Practice managers | 80 | 58 (72.5%) | 35 (60.3%) | N/A |
Total | 638 | 439 (68.8%) | 263 (59.9%) | 196 (51.4%) |
DH1 | ||||
Surgeons | 41 | 21 (51.2%) | 14 (66.7%) | 8 (38.1%) |
Physicians | 33 | 22 (66.7%) | 19 (86.4%) | 16 (72.7%) |
Surgical nurses | 41 | 9 (22.0%) | 6 (66.7%) | 6 (66.1%) |
Medical nurses | 78 | 30 (38.5%) | 21 (70.0%) | 18 (60.0%) |
Total | 193 | 82 (42.5%) | 60 (73.2%) | 48 (58.5%) |
DH2 | ||||
Surgeons | 11 | 7 (63.6%) | 6 (85.7%) | 3 (42.9%) |
Physicians | 10 | 4 (40.0%) | 4 (100.0%) | 4 (100.0%) |
Surgical nurses | 53 | 34 (64.2%) | 32 (94.1%) | 28 (82.4%) |
Medical nurses | 46 | 25 (54.3%) | 13 (52.0%) | 14 (56.0%) |
Total | 120 | 70 (58.2%) | 55 (78.6%) | 49 (70.0%) |
TH | ||||
Surgeons | 35 | 18 (51.4%) | 11 (61.1%) | 8 (44.4%) |
Physicians | 119 | 51 (42.9%) | 31 (60.8%) | 23 (45.1%) |
Surgical nurses | 89 | 37 (41.6%) | 13 (35.1%) | 14 (40.0%) |
Medical nurses | 58 | 39 (67.2%) | 32 (82.1%) | 28 (71.8%) |
Total | 301 | 145 (48.2%) | 87 (60.0%) | 73 (50.3%) |
National specialty groups | ||||
Obstetricians and gynaecologists | 151 | 108 (71.5%) | 78 (72.2%) | 81 (75.0%) |
Oncologists | 45 | 35 (77.7%) | 29 (82.6%) | 28 (80.0%) |
Total | 195 | 143 (73.3%) | 107 (74.8%) | 109 (76.2%) |
Identification of opinion leaders
Survey sample | Number of SOLs identified | Instrument respondent coverage | Maximum individual SOL coverage | Population respondent coverage | Comments |
---|---|---|---|---|---|
Generic | |||||
General practitioners | |||||
PC1 | 1 | 5.0% | 5.0% | 1.0% | Single, within practice nominations |
PC2 | 10 | 14.6% | 2.3% | 5.3% | Mainly, within practice nominations |
Practice nurses | |||||
PC1 | 1 | 18.8% | 18.8% | 4.6% | Single, within practice nomination |
PC2 | 17 | 28.6% | 4.1% | 13.9% | Mainly, within practice nominations |
Practice managers | |||||
PC1 | 2 | 19.1% | 9.5% | 6.5% | Limited across practice network |
PC2 | 4 | 25.7% | 11.4% | 11.3% | Limited across practice network |
Condition-specific | |||||
General practitioners | |||||
PC1 | 4 | 40.5% | 32.4% | 7.1% | Relatively simple network, with modest coverage from cardiologists |
PC2 | 9 | 27.9% | 15.3% | 11.9% | Relatively simple network, with modest coverage from cardiologists |
Practice nurses | |||||
PC1 | 0 | 0% | 0% | 0% | No SOL identified |
PC2 | 14 | 28.2% | 2.4% | 8.7% | Mainly, within practice nominations |
Survey sample | Number of SOLs identified | Instrument respondent coverage | Maximum individual SOL coverage | Population respondent coverage | Comments |
---|---|---|---|---|---|
Generic Surgeons | |||||
DGH1 | 1 | 50% | 50% | 17.1% | Single SOL identified |
DGH2 | 0 | 0% | 0% | 0% | No SOLs identified |
TH | 1 | 27.2% | 27.2% | 8.6% | Single SOL identified |
Physicians | |||||
DGH1 | 3 | 26.3% | 21.1% | 15.2% | Simple network |
DGH2 | 0 | 0% | 0% | 0% | No SOLs identified |
TH | 2 | 12.9% | 6.5% | 3.4% | Simple network |
Nurses | |||||
DGH1 | 2 | 14.8% | 7.4% | 3.4% | Simple network, within ward nominations |
DGH2 | 11 | 57.8% | 15.6% | 26.3% | Simple network, mainly within ward nominations |
TH | 6 | 33.3% | 33.3% | 10.2% | Simple network, within ward nominations |
Condition-specific Surgeons | |||||
DGH1 | 1 | 87.5% | 87.5% | 17.1% | Single SOL identified |
DGH2 | 0 | 0% | 0% | 0% | No SOL identified |
TH | 2 | 50% | 37.5% | 11.4% | Simple network |
Physicians | |||||
DGH1 | 1 | 12.5% | 12.5% | 6.1% | Single SOL identified |
DGH2 | 0 | 0% | 0% | 0% | No SOL identified |
TH | 7 | 47.8% | 21.7% | 9.2% | Simple network |
Surgical nurses | |||||
DGH1 | 1 | 33.3% | 33.3% | 4.9% | Single SOL identified |
DGH2 | 10 | 62.5% | 25.0% | 27.7% | Complex network, mainly within ward nominations |
TH | 6 | 85.7% | 35.7% | 13.5% | Complex network, within ward nominations and across ward nominations for specialist nurse teams |
Medical nurses | |||||
DGH1 | 1 | 11.1% | 11.1% | 2.6% | Single SOL identified |
DGH2 | 2 | 50.0% | 42.9% | 15.2% | Simple network |
TH | 4 | 46.4% | 28.6% | 22.4% | Simple network, within and across ward nominations for specialist nurse teams |
Generic | |||||
Obstetrics and gynaecology | 20 | 46.2% | 7.7% | 23.8% | Complex network within and across centres |
Oncology | 4 | 34.5% | 13.8% | 22.2% | Limited across centre network |
Condition-specific | |||||
Obstetrics and gynaecology | 14 | 48.2% | 17.3% | 25.9% | Complex within and across centre network |
Oncology | 9 | 53.6% | 17.9% | 33.3% | Mainly within centre networks |
Survey sample | Total respondents | Mean score of all respondents (SD) | Range of scores of all respondents (SD) | Total SDOLs | Mean score of self-designating opinion leaders (SD) | Range of scores of self-designating opinion leaders (SD) |
---|---|---|---|---|---|---|
General practitioners | ||||||
PC1 | 78 | 19.96 (4.03) | 9–30 | 16 | 25.31 (1.85) | 23–30 |
PC2 | 222 | 20.36 (3.74) | 10–30 | 47 | 25.55 (1.47) | 24–30 |
Practice nurses | ||||||
PC1 | 35 | 21.60 (4.69) | 13–30 | 7 | 28.43 (0.79) | 28–30 |
PC2 | 144 | 21.01 (4.04) | 4–30 | 29 | 26.34 (1.72) | 22–30 |
Practice managers | ||||||
PC1 | 32 | 20.50 (4.68) | 10–29 | 7 | 26.71 (1.50) | 25–29 |
PC2 | 56 | 16.80 (2.57) | 10–22 | 13 | 19.69 (1.03) | 19–22 |
Surgeons | ||||||
DGH1 | 16 | 20.13 (3.69) | 13–25 | 6 | 23.67 (0.82) | 23–25 |
DGH2 | 7 | 22.57 (5.16) | 16–29 | 1 | 29.00 (0.00) | 29–29 |
TH | 18 | 21.33 (5.39) | 11–30 | 5 | 27.20 (1.79) | 26–30 |
Physicians | ||||||
DGH1 | 21 | 19.38 (5.53) | 6–27 | 4 | 23.75 (3.20) | 21–27 |
DGH2 | 3 | 23.33 (3.51) | 20–27 | 1 | 27.00 (0.00) | 27–27 |
TH | 47 | 21.15 (4.62) | 2–27 | 12 | 25.42 (1.88) | 20–27 |
Surgical nurses | ||||||
DGH1 | 9 | 20.89 (4.11) | 16–29 | 4 | 20.00 (2.31) | 18–22 |
DGH2 | 34 | 21.32 (3.87) | 12–29 | 11 | 25.73 (1.85) | 24–29 |
TH | 37 | 19.62 (4.02) | 5–27 | 7 | 24.86 (1.35) | 23–27 |
Medical nurses | ||||||
DGH1 | 30 | 19.90 (4.84) | 6–27 | 7 | 25.14 (1.07) | 24–27 |
DGH2 | 25 | 21.04 (3.60) | 15–28 | 7 | 25.57 (1.51) | 24–28 |
TH | 34 | 21.50 (3.17) | 15–28 | 9 | 25.44 (1.74) | 23–28 |
Obstetricians and Gynaecologists | 102 | 23.08 (3.71) | 10–30 | 20 | 28.0 (1.08) | 27–30 |
Oncologists | 33 | 24.42 (3.87) | 13–29 | 10 | 28.40 (0.52) | 28–29 |
Survey sample | Total respondents | Mean score of all respondents (SD) | Range of scores of all respondents (SD) | Total SDOLs | Mean score of self-designating opinion leaders (SD) | Range of scores of self-designating opinion leaders (SD) |
---|---|---|---|---|---|---|
General practitioners | ||||||
PC1 | 77 | 16.69 (4.19) | 4–30 | 15 | 22.80 (2.96) | 20–30 |
PC2 | 216 | 17.69 (4.34) | 1–30 | 36 | 23.86 (2.22) | 22–30 |
Practice nurses | ||||||
PC1 | 32 | 16.91 (5.87) | 5–28 | 7 | 24.14 (2.12) | 22–28 |
PC2 | 139 | 16.48 (5.27) | 1–30 | 27 | 23.33 (2.27) | 21–30 |
Surgeons | ||||||
DGH1 | 12 | 16.50 (7.17) | 5–27 | 5 | 23.40 (3.21) | 20–27 |
DGH2 | 7 | 16.29 (8.42) | 5–26 | 2 | 26.00 (0.00) | 26–26 |
TH | 16 | 16.69 (7.85) | 6–30 | 3 | 28.33 (1.53) | 27–30 |
Physicians | ||||||
DGH1 | 21 | 17.81 (5.26) | 7–26 | 6 | 23.50 (1.76) | 22–26 |
DGH2 | 3 | 22.00 (4.00) | 18–26 | 1 | 26.00 (0.00) | 26–26 |
TH | 45 | 16.87 (6.11) | 6–30 | 9 | 25.8 (2.98) | 21–30 |
Surgical nurses | ||||||
DGH1 | 9 | 21.33 (2.65) | 18–27 | 3 | 20.67 (2.31) | 18–22 |
DGH2 | 34 | 21.50 (3.73) | 11–28 | 7 | 26.71 (0.76) | 26–28 |
TH | 35 | 20.23 (4.31) | 7–29 | 11 | 24.82 (2.14) | 23–29 |
Medical nurses | ||||||
DGH1 | 29 | 20.97 (4.56) | 12–28 | 7 | 26.71 (1.25) | 25–28 |
DGH2 | 25 | 19.68 (4.22) | 9–28 | 5 | 25.40 (2.70) | 21–28 |
TH | 37 | 18.81 (4.57) | 7–27 | 7 | 25.71 (1.11) | 24–27 |
Obstetricians and Gynaecologists | 100 | 16.45 (6.04) | 5–30 | 18 | 25.28 (2.11) | 23–30 |
Oncologists | 31 | 21.16 (5.54) | 12–29 | 6 | 28.00 (0.89) | 27–29 |
Characteristics of opinion leaders
Hypothesis | Generic sociometric | Condition-specific sociometric | Generic self-designating | Condition-specific self-designating |
---|---|---|---|---|
Social network related | ||||
OLs more likely to belong to professional groups | 5.27 (2.38 – 11.65)**** | 3.90 (1.63 – 9.33)** | 1.56 (1.13 – 2.17)** | 1.13 (0.79 – 1.58) |
OLs more likely to have attended local medical school | 1.32 (0.62 – 2.82) | 0.41(0.08 – 0.90)*** | 1.02 (0.65 – 1.54) | 0.87 (0.55 – 1.38) |
Experience related | ||||
OLs more likely to have been qualified longer | 1.90 (1.10 – 3.28)** | 1.18 (0.64 – 2.20) | 0.99 (0.72 – 1.36) | 1.20 (0.85 – 1.69) |
OLs more likely to be in senior posts | 6.69 (2.33 – 19.20) *** | 5.72 (1.69 – 19.34)*** | 2.02 (1.23 – 3.21)*** | 1.35 (0.85 – 2.15) |
Qualifications | ||||
OLs more likely to have qualifications | 1.05 (0.6 3 – 1.75) | 1.27 (0.68 – 2.36) | 1.80 (1.33 – 2.44)*** | 0.96 (0.68 – 1.36) |
Other | ||||
OLs more likely to spend time teaching | 0.88 (0.16 – 4.74) | 1.35 (0.31 – 5.98) | .93 (0.79 – 4.67) | 0.92 (0.34 – 2.50) |
OLs more likely to spend time on research | 2.30 (0.49 – 10.92) | 1.82 (0.41 – 8.11) | 2.14 (0.86 – 5.34) | 1.10 (0.40 – 3.04) |
Keeping up to date score | ||||
Mean Opinion Leader Score | 3.57 | 3.47 | 3.48 | 3.40 |
Mean score of other respondents | 3.29 | 3.30 | 3.25 | 3.27 |
Mean difference in up-to-date score | 0.28 | 0.17 | 0.23 | 0.13 |
95% CI and significance+
| (0.14 – 0.43)** | (-0.09 – 0.36) | (0.14 – 0.32)*** | (0.03 – 0.24)* |
Use of clinical effectiveness materials score | ||||
Mean Opinion Leader Score | 2.58 | 2.37 | 2.53 | 2.58 |
Mean score of other respondents | 2.38 | 2.42 | 2.36 | 2.38 |
Mean difference in up-to-date score | 0.3 | -0.05 | 0.17 | 0.20 |
95% CI and significance+
| (-0.02 – 0.41) | (-0.33 – 0.21) | (0.04 – 0.30)* | (0.04 – 0.30)* |
Monomorphism versus polymorphism
Sociometric instruments
Sociometric Instrument Generic vs. condition-specific Opinion Leadership | |||
---|---|---|---|
Condition-specific instrument | |||
Opinion leader | Not opinion leader | ||
Generic instrument | |||
Opinion leader | 23 | 64 | 87 |
Not opinion leader | 61 | 856 | 917 |
84 | 920 | 1001 | |
Self-designating Instrument Generic vs. condition-specific Opinion Leadership1
| |||
Condition-specific instrument | |||
Opinion leader | Not opinion leader | ||
Generic instrument | |||
Opinion leader | 77 | 116 | 193 |
Not opinion leader | 93 | 563 | 656 |
170 | 679 | 849 | |
Generic Opinion Leadership sociometric vs. self-designating instrument1
| |||
Self-designating instrument | |||
Opinion leader | Not opinion leader | ||
Sociometric instrument
| |||
Opinion leader | 23 | 37 | 60 |
Not opinion leader | 200 | 720 | 920 |
223 | 757 | 980 | |
Condition-specific Opinion Leadership sociometric vs. self-designating instrument1
| |||
Self-designating instrument | |||
Opinion leader | Not opinion leader | ||
Sociometric instrument
| |||
Opinion leader | 26 | 15 | 41 |
Not opinion leader | 149 | 678 | 827 |
175 | 693 | 868 |
Self-designating instruments
Comparison of identification methods
Generic instruments
Survey sample | Professional group | Condition-specific coverage rates by generic SOLs | Condition-specific coverage of all idenfitied SOLs |
---|---|---|---|
PC1 | General practitioners | 0.0% | 40.5% |
Practice nurses | 0.0% | 0.0% | |
PC2 | General practitioners | 2.7% | 27.9% |
Practice nurses | 12.9% | 28.2% | |
DGH1 | Surgeons | 87.5% | 87.5% |
Physicians | 0.0% | 12.5% | |
Surgical nurses | 0.0% | 33.3% | |
Medical nurses | 0.0% | 11.1% | |
DGH2 | Surgeons | 0.0% | 0.0% |
Physicians | 0.0% | 0.0% | |
Surgical nurses | 46.4% | 62.5% | |
Medical nurses | 50.0% | 50.0% | |
TH | Surgeons | 37.5% | 50.0% |
Physicians | 8.7% | 47.8% | |
Surgical nurses | 21.4% | 85.7% | |
Medical nurses | 10.7% | 46.4% | |
Obstetrics and gynaecology | 21.0% | 48.1% | |
Oncology | 0.0% | 53.6% |