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

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.


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.


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.


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: 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: Accessed October 2, 2002.

Post new comment

  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
  • Use to create page breaks.

More information about formatting options

Enter the characters shown in the image.