Physician Adoption of Hyperbaric Oxygen Therapy in the Treatment of Chronic Wounds

Shien Guo, PhD, MHA; Michael A. Counte, PhD; Homer Schmitz, PhD; and Horng-Shiuann Wu, PhD, RN

Gaining knowledge about an innovation usually is the initial step in the individual-level adoption process. An individual with more knowledge about an innovation is more likely to adopt it.1 This study also evaluated current physician knowledge of HBOT. Based on the study’s results, most (60%) of the respondents reported adequate knowledge of HBOT regarding its therapeutic mechanisms, applications, and potential risks. This high percentage corresponds to the high level of adoption of HBOT among the respondents. It is important to note that the survey of physician knowledge of HBOT in this study was a subjective self-assessment and not validated by ascertaining exact physician knowledge or skill. Nonetheless, nearly 40% of respondents had only “some” or “little knowledge” about HBOT. Among those respondents who had less knowledge about HBOT, most (88%) were podiatrists. Thus, if anyone in the wound care industry wants to significantly increase the use of HBOT, educational or promotional efforts should be targeted to podiatrists.

Developing attitudes toward an innovation is usually the second step in the adoption process. Because a person with a favorable attitude toward an innovation is more likely to adopt it,15 physician attitudes toward HBOT in the treatment of chronic wounds were assessed. Two inferences can be drawn from the study’s findings. First, the majority of respondents strongly agreed with the various beneficial effects of HBOT in the treatment of chronic wounds, with adopters having a more favorable attitude toward HBOT than non-adopters. Despite lack of strong evidence from well-designed clinical studies as reported by Wunderlich et al,14 this finding indicates that most wound care specialists agree with the survey statement that HBOT has beneficial effects on chronic ischemic wounds. Second, considerable disagreement was noted regarding the statement about HBOT cost-effectiveness in the treatment of chronic wounds. Only 48% of the respondents believed HBOT is cost-effective. This disagreement may result from insufficient evidence of the cost-effectiveness of HBOT in the treatment of chronic wounds.30 Since the issue of cost will become increasingly important as stakeholders, especially payors and providers, become more cost conscious, HBOT cost-effectiveness studies are needed.

Another purpose of this study was to examine additional variables in Rogers’ diffusion of innovation framework that can potentially influence physician adoption of HBOT. In the bivariate analysis, the adoption of HBOT was significantly associated with multiple factors, including physician gender (crude OR = 2.60, 95% CI = 1.26 to 5.39), podiatrist certification (crude OR = 0.30, 95% CI = 0.16 to 0.56), hospital-based wound care facilities (crude OR =2.49, 95% CI = 1.41 to 4.39), size of community >100,000 residents (crude OR = 2.48, 95% CI = 1.41 to 4.38), patient volume >30 per week (crude OR = 4.25, 95% CI = 1.98 to 9.10), voluntary patient request of HBOT (crude OR = 9.48, 95% CI = 5.13 to 17.50), location (crude OR = 4.72, 95% CI = 2.13 to 10.48), frequent use of peers as a information source (crude OR = 1.88, 95% CI = 1.09 to 3.22), and physician knowledge of (crude OR = 13.93, 95% CI = 5.45 to 35.60) and attitude toward (crude OR = 4.17, 95% CI = 2.29 to 7.59) HBOT. Of these factors, only five remained significant after adjusting for the effects of the other factors in the multiple logistic regression model: community size >100,000 residents, voluntary patient request of HBOT, physician knowledge of and attitude toward HBOT, and practice location (see Table 5).


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