Not in Isolation: How Physician Networks Influence Evidence-Based Prescribing of Psychotropics to Older People with Dementia

Clinical guidelines and the social environment can facilitate a reduction of low-value care. Peer influence within physician networks can significantly impact clinical behaviours, including the adoption or abandonment of certain prescribing practices. We examine the influence of physician peer networks on the de-implementation of prescribing psychotropics to people with dementia in the context of a change in the Finnish Clinical Guidelines on Memory Disorders in January 2017. Using data from the Finnish prescription register and instrumental variable estimation, which captures intransitive triads and relies on the peer relationships, we found that a one percentage point higher share of psychotropic prescribing within physicians’ patient-sharing peer network was associated with a 0.7 percentage point increase in the physician’s psychotropic prescribing when controls and time-invariant physician characteristics were fixed. The publication of clinical guidelines alone is not sufficient to de-implement low-value care and underscores the need for consensus among physicians to facilitate de-implementation.