Nursing Research Institute - St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Daniel Mannix Building, Brunswick Street, Fitzroy, Vic 3000, Australia; and School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Daniel Mannix Building, Brunswick Street, Fitzroy, Vic 3000, Australia. Email:
Adelaide Nursing School, University of Adelaide, Adelaide Health and Medical Sciences Building, Corner of North Terrace and George Street, Adelaide SA 5005, Australia. Email:
Aust Health Rev. 2021 Feb;45(1):66-73. doi: 10.1071/AH19250.
Objective To identify factors that influence procurement and disinvestment decisions for wound care products in the acute care setting. Methods A qualitative descriptive study was undertaken. Eighteen face-to-face semi-structured interviews were conducted with purposively sampled senior clinical and non-clinical managers from three Australian acute care hospitals with responsibility for consumables procurement and disinvestment decisions. Data were coded and analysed thematically. Results Three main themes (Systems and triggers, Evidence-free zone, Getting the governance right) with sub-themes were identified that reflect that: (1) procurement processes were often ad hoc and workarounds common. Disinvestment was poorly understood and opportunities were missed to reduce use of low value products ; (2) product selection was commonly based on clinician preference, contractual obligations and information from industry representatives; and (3) improved evidence-based governance and processes are needed to connect procurement and disinvestment decisions and to minimise the influences of clinician preference and industry representatives on product selection. Conclusions Systematic and evidence-based approaches are needed to strengthen procurement and disinvestment decisions related to consumables such as wound care products and to minimise the purchasing of low-value products Decision-making frameworks should consider cost and clinical effectiveness and enable the identification of opportunities to disinvest from low-value products. What is known about the topic? High volume-low unit cost healthcare consumables such as wound care products are a major component of healthcare expenditure. Disinvestment from low-value wound care products has potential to improve patient outcomes and optimise health resources. What does this paper add? Disinvestment was poorly understood and considered in isolation from procurement decisions. Procurement decisions were rarely informed by research evidence, with clinicians exercising considerable freedom to make purchasing decisions based on product preference and industry information. Frameworks and guidelines are needed to guide procurement and disinvestment decision-making for wound care products. What are the implications for practitioners? New models for procurement and disinvestment decision-making for wound care products could help to strengthen decision-making processes, facilitate evidence-based product choices and also prompt consideration of removal of low-value products.
确定影响急性护理环境中伤口护理产品采购和撤资决策的因素。
采用定性描述性研究。从澳大利亚三家急性护理医院中，有针对性地抽取了负责消耗品采购和撤资决策的 18 名临床和非临床高级管理人员，进行了 18 次面对面半结构式访谈。对数据进行了编码和主题分析。
确定了三个主要主题（系统和触发因素、无证据区、正确治理）及其子主题，反映出：（1）采购流程通常是临时性的，常用替代方案。对撤资的理解很差，错失了减少使用低价值产品的机会；（2）产品选择通常基于临床医生的偏好、合同义务和来自行业代表的信息；（3）需要改进循证治理和流程，以连接采购和撤资决策，并尽量减少临床医生偏好和行业代表对产品选择的影响。
需要系统和循证方法来加强与伤口护理产品等消耗品相关的采购和撤资决策，并尽量减少低价值产品的采购。决策框架应考虑成本和临床效果，并能够确定从低价值产品中撤资的机会。
主题是什么？
高数量-低单位成本的医疗保健消耗品，如伤口护理产品，是医疗保健支出的主要组成部分。从低价值的伤口护理产品中撤资有可能改善患者的结果并优化卫生资源。
本文增加了什么？
对撤资的理解很差，而且与采购决策分开考虑。采购决策很少由研究证据告知，临床医生根据产品偏好和行业信息自由做出购买决策。需要有框架和准则来指导伤口护理产品的采购和撤资决策。
对从业者的影响是什么？
新的伤口护理产品采购和撤资决策模型可以帮助加强决策过程，促进基于证据的产品选择，并促使考虑去除低价值产品。
