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

Author(s): 
Shien Guo, PhD, MHA; Michael A. Counte, PhD; Homer Schmitz, PhD; and Horng-Shiuann Wu, PhD, RN



The significant association between community size and adoption of HBOT may result from the fact that most hyperbaric oxygen chambers are located in urban areas.31 Hence, physicians practicing in larger communities normally have a greater chance of using HBOT. This study’s findings confirm previous reports in which patient preference was demonstrated to have a positive influence on physician adoption of medical technologies.16,28,29 Physicians in this study whose patients requested provision of HBOT at least once were more likely to adopt it than physicians who never had requests for this therapy. Such a strong association may imply that educating a select group of patients or lay population to increase service demand may be an effective way to rapidly influence physicians to adopt the therapy.

Physician knowledge of HBOT was another important factor that influenced its adoption. Physicians more familiar with HBOT were more likely than those less familiar with HBOT to use this therapy. Furthermore, level of physician HBOT knowledge was significantly associated with frequent reliance for information on peers (crude OR = 4.62, 95% CI = 2.04 to 10.43) and symposia (crude OR = 2.44, 95% CI = 1.16 to 5.15). These important information sources underscore the need for identifying and sponsoring local physician champions and supporting related clinical symposia — useful strategies to effectively disseminate information regarding HBOT among physicians.

Individual items within the knowledge measure (see Table 3) were examined using single logistic regression to determine which item(s) had the strongest effect on the adoption of HBOT. The regression analysis shows that physician familiarity with the therapeutic mechanisms of HBOT in wound healing had the greatest impact (crude OR = 17.76, 95% CI = 3.93 to 80.37) on the adoption of HBOT among all four items. A possible explanation for this finding is that an individual is more likely to adopt new technology that has relevance to his/her specific situation.15 Because the study population was comprised of physicians specializing, and board certified, in wound care, knowing more about the therapeutic mechanisms of HBOT specific to wound healing would increase the likelihood of adopting HBOT in practice. The message used to promote HBOT in a specific medical specialty should be tailored to its members’ interests.

Multiple logistic regression results indicate that physician attitude toward the beneficial effects of HBOT is significantly associated with physician adoption of this therapy. Respondents with a favorable attitude were more likely than those who had an unfavorable attitude to adopt this therapy. When items within the attitudinal measure (see Table 4) were examined to determine which had the strongest effect on the HBOT adoption, physician attitude toward the cost-effectiveness of therapy had the largest effect (crude OR = 6.50, 95% CI= 3.46 to 12.23) among all five items. This is probably because HBOT is expensive in the US and considered an adjunct treatment. As a result, a physician’s decision to use HBOT is likely to be based on whether the potential benefits outweigh its costs. This finding suggests that information or evidence used to promote HBOT use in the medical community should include evidence of cost-effectiveness.

References: 

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.



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