Physician Adoption of Hyperbaric Oxygen Therapy in the Treatment of Chronic Wounds
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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).
1. Eaglstein WH, Falanga V. Chronic wounds. Surg Clin North Am. 1997;77:689–700.
2. Mandracchia VJ, John KJ, Sanders SM. Wound healing. Clin Podiatr Med Surg. 2001;181–133.
3. Ragnarson Tennvall G, Apelqvist J. Health-related quality of life in patients with diabetes mellitus and foot ulcers. J Diabetes Complications. 2000;14:235–241.
4. Williams RL, Armstrong DG. Wound healing. Clin Podiatr Med Surg. 1998;15:117–128.
5. Kindwall EP. A history of hyperbaric medicine. In: Kindwall EP, Whelan HT, eds. Hyperbaric Medicine Practice. Flagstaff, Ariz.: Best Publishing Co.;1999.
6. Ramasastry SS. Chronic problem wounds. Clin Plastic Surg. 1998;25:367–396.
7. Baroni G, Porro T, Faglia E, et al. Hyperbaric oxygen in diabetic gangrene treatment. Diabetes Care. 1987;10:81–86.
8. Doctor N, Pandya S, Supe A. Hyperbaric oxygen therapy in the diabetic foot. J Postgrad Med. 1992;38:112–114.
9. Faglia E, Favales F, Aldeghi A, et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. Diabetes Care. 1996;19:1338–1343.
10. Lee SS, Chen CY, Chan YS, et al. Hyperbaric oxygen in the treatment of diabetic foot. Chang Geng Med J. 1997;20:17–22.
11. Zamboni WA, Wong HP, Stephenson LL, Pfeifer MA. Evaluation of hyperbaric oxygen for diabetic wounds: a prospective study. Undersea Hyperb Med. 1997;24:175–179.
12. Hammarlund C, Sundberg T. Hyperbaric oxygen reduced size of chronic leg ulcers: a randomized double-blind study. Plastic Reconstr Surg. 1994;93:829–833.
13. The Department of Health and Human Services Office of Inspector General. Hyperbaric oxygen therapy: its use and appropriateness. 2000;October. Available at: http://www.uhms.org/Legislation/OIG%20Report%20on%20HBO%2010-00.pdf. Accessed: September 20, 2005.
14. Wunderlich RP, Peters EJG, Lavery LA. Systemic hyperbaric oxygen therapy: lower-extremity wound healing and the diabetic foot. Diabetes Care. 2000;23:1551–1555.
15. Rogers EM. Diffusion of Innovations. New York, NY: Free Press;1995.
16. Buban GM, Link BK, Doucette WR. Influences on oncologists’ adoption of new agents in adjuvant chemotherapy of breast cancer. J Clin Oncol. 2001;19:954–959.
17. McKinney MM, Barnsley JM, Kaluzny AD. Organizing for cancer control: the diffusion of dynamic innovation in a community cancer network. Int J Technol Assess Health Care. 1992;8:268–288.
18. Hagen N, Young J, MacDonald N. Diffusion of standards of care for cancer pain. Can Med Assoc J. 1995;152:1205–1209.
19. Freiman MP. The rate of adoption of new procedures among physicians: the impact of specialty and practice characteristics. Med Care. 1985;23:939–945.
20. Gross CP, Cruz-Correa M, Canto MI, et al. The adoption of ablation therapy for Barrett’s esophagus: a cohort study of gastroenterologists. Am J Gastroentrol. 2002;97:279–286.
21. Hlatky MA, Cotugno H, O’Connor C, et al. Adoption of thrombolytic therapy in the management of acute myocardial infarction. Am J Cardiol. 1988;61:510–514.
22. Majumdar SR, Inui TS, Gurwitz JH, et al. Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction. J Gen Intern Med. 2001;16:351–359.
23. Munstedt K, Entezami A, Wartenberg A, Kullmer U. The attitudes of physicians and oncologists toward unconventional cancer therapies. Eur J Cancer. 2000;36:2090–2095.
24. Grilli R, Scorpiglione N, Nicolucci A, et al. Variation in use of breast surgery and characteristics of hospitals’ surgical staff. Int J Qual Health Care. 1994;6:233–238.
25. James PA, Cowan TM, Graham RP, Majeroni BA. Family physicians’ attitudes about the use of clinical practice guidelines. J Fam Pract. 1997;5:341–347.
26. Tziraki C, Graubard BI, Manley M. Effect of training on adoption of cancer prevention nutrition-related activities by primary care practices: results of a randomized, controlled study. J Gen Internal Med. 2000;15:155–162.
27. Liberati A, Patterson WB, Biener L, McNeil BJ. Determinants of physicians’ preferences for alternative treatments in women with early breast cancer. Tumori. 1987;73:601–609.
28. Bourgeault IL. Physicians’ attitudes toward patients’ use of alternative cancer therapies. Can Med Assoc J. 1996;155:1679–1685.
29. Freed GL, Freeman AV, Clark SJ, et al. Pediatrician and family physician agreement with and adoption of universal hepatitis B immunization. J Fam Pract. 1996;42:587–592.
30. Guo S, Counte MA, Romeis JR. Hyperbaric oxygen technology: an overview of its applications, efficacy, and cost-effectiveness. Int J Technol Assess Health Care. 2003;19:339–346.
31. Undersea and Hyperbaric Medical Society. A directory of hyperbaric treatment chambers (2001). Available at: http://www.uhms.org/Chambers/CHAMBER%20DIRECTORY2.asp. Accessed October 2, 2002.