From recommendation to action: psychosocial factors influencing physician intention to use Health Technology Assessment (HTA) recommendations.

Marie-Pierre Gagnon,Joan Mv Pons,Emília Sánchez

doi:10.1186/1748-5908-1-8

Abstract

BackgroundEvaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers. Using a psychosocial theoretical framework, this study aimed at exploring the factors affecting physician intention to adopt HTA recommendations. The selected recommendations were prioritisation systems for patients on waiting lists for two surgical procedures: hip and knee replacement and cataract surgery.MethodsDeterminants of physician intention to use HTA recommendations for patient prioritisation were assessed by a questionnaire based upon the Theory of Interpersonal Behaviour. A total of 96 physicians from two medical specialties (ophthalmology and orthopaedic surgery) responded to the questionnaire (response rate 44.2%). A multiple analysis of variance (MANOVA) was performed to assess differences between medical specialties on the set of theoretical variables. Given the main effect difference between specialties, two regression models were tested separately to assess the psychosocial determinants of physician intention to use HTA recommendations for the prioritisation of patients on waiting lists for surgical procedures.ResultsFactors influencing physician intention to use HTA recommendations differ between groups of specialists. Intention to use the prioritisation system for patients on waiting lists for cataract surgery among ophthalmologists was related to attitude towards the behaviour, social norms, as well as personal normative beliefs. Intention to use HTA recommendations for patient prioritisation for hip and knee replacement among orthopaedic surgeons was explained by: perception of conditions that facilitated the realisation of the behaviour, personal normative beliefs, and habit of using HTA recommendations in clinical work.ConclusionThis study offers a model to assess factors influencing the intention to adopt recommendations from health technology assessment into professional practice. Results identify determinant factors that should be considered in the elaboration of strategies to support the implementation of evidence-based practice, with respect to emerging health technologies and modalities of practice. However, it is important to emphasise that behavioural determinants of evidence-based practice vary according to the specific technology considered. Evidence-based implementation of HTA recommendations, as well as other evidence-based practices, should build on a theoretical understanding of the complex forces that shape the practice of healthcare professionals.

Highlights

Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers
According to a multi-method study of the implementation of guidance issued by the National Institute for Clinical Excellence (NICE) in England and Wales, [12] the extent to which HTA led to changes in practices was variable
The criteria used in the selection were: 1) publication time sufficient for the HTA recommendation to have been largely disseminated; 2) recommendations representing administrative and clinical health technologies, since the literature reports important variations in factors affecting the adoption of these two types of innovations;[34] and 3) similar recommendations that would allow comparisons between cases for a greater internal validity

Summary

Introduction

Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers. Health Technology Assessment (HTA) is a multidisciplinary field of applied research that aims to provide the best evidence available on health technologies in order to inform policy-making [1,2]. It is generally recognised that there is a gap between the production of scientific evidence and its utilisation to inform decision-making, [4], and this applies to the field of HTA [5,6,7,8]. Despite growing interest in HTA, both in the governmental and scientific spheres, few efforts have been made to assess HTA impact on decision-making at different levels of the healthcare system [6]. A review of HTA utilisation in four European countries indicates that, in spite of substantial human and financial investments, the actual impact of HTA on policy-making was still limited [13]

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