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

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.


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