Physician Adoption of Hyperbaric Oxygen Therapy in the Treatment of Chronic Wounds
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Statistical analysis. Descriptive statistics were used to provide an overview of the distribution of scores on each measure. In the descriptive statistics, particular emphasis was placed on assessing the current status of physician knowledge of and attitudes toward HBOT. Second, the chi-square test of independence was used to determine the bivariate association between each independent factor and the dependent variable. Finally, multiple logistic regression analysis was used to estimate the strength of association while controlling for the effects of other individual factors. The significance level for all statistical analyses was set at .05. SPSS 10.0 for Windows (SPSS Inc., Chicago, Ill.) was used to conduct all statistical analyses.
A total of 653 surveys were distributed; 44 were returned as undeliverable. Of the remaining 609 potential respondents, 260 (43%) physicians answered the study questionnaire during the data collection period. Of those, 14 were excluded from analysis because the physicians no longer practiced wound care. Respondents were unevenly distributed across 42 states in the US (see Table 1). Most practiced wound care in Florida, Pennsylvania, New York, and Texas, accounting for 109 (44%) of the respondents. No respondents practiced in Minnesota, West Virginia, Idaho, North Dakota, South Dakota, and Montana. The difference in geographic distribution of the respondents and non-respondents was examined using the chi-square test. No significant difference (P = .061) in geographic distribution was found between these two groups.
Descriptive statistics of respondent characteristics are shown in Table 2. Most (211, 86%) of the respondents were men, age 40 years or older (183, 74%), who specialized in podiatric medicine (89, 36%), practiced wound care in a community with a population size of >100,000 residents (168, 69%), and treated <30 wound patients per week (178, 73%). Table 2 also displays the distribution of each independent variable stratified by the dependent variable (adopters versus non-adopters) and the results of the chi-square tests of bivariate relationships between the dependent and independent variables — 167 (68%) of the respondents reported they have used HBOT to treat their patients or referred their patients to other facilities for HBOT over the past 12 months. In addition, the results of the chi-square analyses indicate that several factors were significantly associated with the adoption of HBOT in the treatment of chronic wounds. These factors include: gender (P = .008), medical specialty (P <.001), type of wound care facility (P =.001), size of community (P = .002), geographic location (P <.001), patient volume (P <.001), voluntary patient request of HBOT (P <.001), physician attitude toward (P <.001) and physician knowledge of (P <.001) HBOT, and reliance on peers (P = .022) as a communication channel. No significant differences between groups were found with respect to physician age, years of medical practice, type of facility ownership, level of local wound care competition, and type of communication channels.
More than 60% of the respondents reported a relatively high level of familiarity with HBOT with respect to its therapeutic mechanisms, potential risks, and applications. The average scores on each knowledge item ranged from 3.71 to 4.02. When the respondents’ subjective knowledge was stratified into two groups (adopters and non-adopters), a larger percentage (71% to 84%) of the respondents in the adopter group expressed a higher level of familiarity with HBOT across the four items than the non-adopter group (32% to 47%). Results also indicate that some (16% to 29%) of the respondents who adopted HBOT still had inadequate knowledge of this therapy (see Table 3).
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