Gagnon Marie-Pierre, Sánchez Emília, Pons Joan Mv
Evaluative Research Unit, Quebec University Hospital Centre, Quebec, Canada.
Implement Sci. 2006 Mar 31;1:8. doi: 10.1186/1748-5908-1-8.
Evaluating 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.
Determinants 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.
Factors 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.
This 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.
评估基于卫生技术评估（HTA）的建议所产生的影响，对HTA机构和医疗保健政策制定者而言都是一项挑战。本研究运用社会心理理论框架，旨在探究影响医生采纳HTA建议意愿的因素。所选取的建议是针对两种外科手术（髋关节和膝关节置换术以及白内障手术）候诊患者的优先排序系统。
基于人际行为理论，通过问卷调查评估医生使用HTA建议进行患者优先排序的意愿的决定因素。来自两个医学专科（眼科和骨科手术）的96名医生回复了问卷（回复率44.2%）。进行了多变量方差分析（MANOVA），以评估医学专科在这组理论变量上的差异。鉴于专科之间的主效应差异，分别测试了两个回归模型，以评估医生使用HTA建议对手术候诊患者进行优先排序意愿的社会心理决定因素。
影响医生使用HTA建议意愿的因素在不同专科组之间存在差异。眼科医生使用白内障手术候诊患者优先排序系统的意愿与对该行为的态度、社会规范以及个人规范信念有关。骨科医生使用HTA建议对髋关节和膝关节置换患者进行优先排序的意愿可由以下因素解释：对促进行为实现的条件的认知、个人规范信念以及在临床工作中使用HTA建议的习惯。
本研究提供了一个模型，用于评估影响将卫生技术评估建议纳入专业实践意愿的因素。研究结果确定了在制定支持循证实践实施的策略时应考虑的决定因素，涉及新兴卫生技术和实践模式。然而，必须强调的是，循证实践的行为决定因素会因所考虑的具体技术而有所不同。HTA建议以及其他循证实践的循证实施，应建立在对塑造医疗保健专业人员实践的复杂力量的理论理解基础之上。
