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



Practice location was significantly associated with the adoption of HBOT. Physicians practicing wound care in Florida and Texas were significantly more likely to use HBOT than those who practice in other states. No difference in physician knowledge (P = 0.072) and attitude (P = 0.101) across locations (Florida and Texas versus other states) was found based on the chi-square test. However, Florida and Texas have more HBOT treatment centers. According to the 2001 Chamber Registry of the Undersea and Hyperbaric Medical Society (UHMS),31 110 (29%) of the 377 registered HBOT treatment centers in the US are in Florida and Texas. Given the greater availability, physicians in these states may be more likely to use HBOT to treat their patients or refer their patients to other local facilities for HBOT. Another factor potentially contributing to the higher adoption of HBOT in both states may be the higher level of local wound care competition perceived by the respondents. In this study, respondents reported that the mean level of local wound care competition in Florida and Texas was significantly higher (P < 0.001) than in other states based on the one-way analysis of variance (ANOVA). Future research in this area is needed to clarify the reasons underlying such a major geographic difference in the adoption of HBOT.

Limitations

Several limitations of this study need to be recognized in order to properly interpret the study findings. First, generalizing the findings of the study to all physicians specializing in wound care may be problematic because more than 50% of the potential study population did not participate and not all wound care physicians are certified by the AAWM. In addition, sampling bias may have resulted in a sample that is particularly interested in HBOT and, therefore, more likely to adopt it or report more knowledge and favorable attitudes. Based on the available information, respondents were no different from non-respondents with regard to geographic location. Second, because this is a cross-sectional study in which self-reported data were collected at only one point in time, the causality of relationships between the dependent and independent variables is difficult to determine. Longitudinal studies of physician adoption of HBOT would provide useful information regarding the dynamics of the adoption process.

Conclusion

Modern HBOT technology has existed for more than five decades and has been approved by the US Food and Drug Administration for the treatment of many medical conditions, including chronic wounds. Growing evidence of its efficacy in wound healing has increased the adoption of HBOT among physicians practicing in wound care. However, the increase seems to have been limited by several factors. The study’s findings offer useful insights to those interested in promoting the use of HBOT in the medical community. First, educating patients or the lay population about the benefits of HBOT will likely influence physicians to adopt it. Second, local physician champions and symposia are effective communication channels that may facilitate the adoption of HBOT in a specific geographic area or medical specialty. Finally, when promoting its uses, focusing on the cost-effectiveness in addition to the therapeutic effectiveness of HBOT will likely have a positive influence on physician adoption of this therapy.

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