Department of Head and Neck Oncology and Surgery, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Health Technology and Services Research, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands.
Oral Oncol. 2019 Apr;91:56-64. doi: 10.1016/j.oraloncology.2019.02.017. Epub 2019 Mar 1.
Patient access to the voice prosthesis and heat and moisture exchanger (HME) is not always guaranteed in Europe. Therefore, the aim of this qualitative study is to evaluate factors influencing physician's prescription and reimbursement of these devices in eight European countries, and to identify barriers of and facilitators to effective patient access.
In this mixed methods study, we conducted a survey among stakeholders evaluating prescription (Part 1 of the survey), reimbursement (Part 2), and barriers of and facilitators to effective patient access (Part 3). Part 1 was completed by head and neck surgeons employed in France, Germany, the United Kingdom, Italy, Spain, Belgium, the Netherlands and Poland. Part 2 and 3 were completed by medical device company representatives in respective countries, followed by semi-structured interviews.
Based on the survey, filled in by 36 surgeons, all prescribed the voice prosthesis. Four surgeons didn't prescribe the HME in Italy and Poland due to lack of both reimbursement and experience/training, and feeling uncomfortable with device use. Most restrictive factors (e.g. increased workload, insufficient staff) occurred in countries with decentralized healthcare systems including Spain and Italy.
Non-HME-usage was influenced by economical and physician-related factors. Restrictive factors were related to limited regional device reimbursement and provision. Nationwide reimbursement, guideline implementation, support for physicians by training/education and providing a rehabilitation team will increase device use.
在欧洲，患者并非总能获得声门上假体和热湿交换器（HME）。因此，本定性研究旨在评估影响这些设备在 8 个欧洲国家的医生处方和报销的因素，并确定影响患者有效获得设备的障碍和促进因素。
在这项混合方法研究中，我们对利益相关者进行了一项评估处方（调查第 1 部分）、报销（调查第 2 部分）和有效患者获得的障碍和促进因素（调查第 3 部分）的调查。第 1 部分由在法国、德国、英国、意大利、西班牙、比利时、荷兰和波兰工作的头颈外科医生完成。第 2 部分和第 3 部分由各自国家的医疗器械公司代表填写，随后进行半结构化访谈。
根据对 36 名外科医生进行的调查，所有医生都开了声门上假体的处方。由于缺乏报销和经验/培训，意大利和波兰的 4 名外科医生不开 HME 的处方，而且他们对设备的使用感到不舒服。在西班牙和意大利等实行分散式医疗体系的国家，最具限制性的因素（例如增加工作量、人员不足）。
不使用 HME 受到经济和医生相关因素的影响。限制因素与有限的区域设备报销和供应有关。全国范围内的报销、指南的实施、对医生的培训/教育支持以及提供康复团队将增加设备的使用。
