Adopting New Medical Technology (1994) / Chapter Skim
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5. PHYSICIAN'S DECISIONS REGARDING THE ACQUISITION OF TECHNOLOGY
5. PHYSICIAN'S DECISIONS REGARDING THE ACQUISITION OF TECHNOLOGY
Pages 71-84
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From page 71... ...
Further understanding of the physician's decisionmaking process for the adoption of medical innovations may aid in the enormous task of bringing significant health care reform to the United States. INCENTIVES FOR THE ADOPTION OF MEDICAL INNOVATIONS Medical tradition emphasizes giving the best care that is technically possible; the only legitimate and explicitly recognized constraint is the state of the art (Fuchs, 1968~.
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From page 72... ...
Limitations on time, expense, and practicality are primarily responsible for the absence of controlled experiments in many clinical areas. In today's competitive health care environment, decisions regarding the adoption and reimbursement of medical technology must be made quickly and, often, those who make the decisions must rely on imperfect or nonexistent effectiveness data generated by evaluative methodologies of suboptimal rigor.
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From page 73... ...
However, the evidence available to date indicates that it is difficult to change physician behavior on a significant level (Eisenberg, 1986; Eisenberg and Williams, 1981; Kanouse and Jacoby, 1988~. Innovation Characteristics Factors inherent to an innovation itself can influence its adoption by physicians and other health care providers (Lee and Waldman, 1986~.
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From page 74... ...
MARK FENDRICK AND J SANFORD SCHWARTZ incentives are neutral "breakthrough" technologies, such as antibiotics for bacterial infections or chemotherapy for childhood malignancies, are likely to be adopted more rapidly than "me-too" innovations, such as an additional entry into a class of established pharmaceutical drugs that can offer only marginal benefits over the drugs currently in use (Warner, 1975~.
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From page 75... ...
Because of the rapid evolution of medical innovations, changes occur in the real and perceived values of benefit and cost parameters and, moreover, there are difficulties generalizing assessments of efficacy (measured under optimal operating conditions) to effectiveness (measured under average operating conditions)
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From page 76... ...
MARK FENDRICK AND J SANFORD SCHWARTZ The disadvantages of the use of surrogate outcomes are well illustrated by the case of thrombolytic therapy used in the setting of an acute myocardial infarction.
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From page 77... ...
Reporting in the lay press should not be viewed as an exclusively negative influence; use of the mass media can lead to increased awareness of effective underutilized technologies and lead to societal health gains (e.g., immunization information programs) (Herlitz et al., 1989~.
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From page 78... ...
The Diabetic Retinopathy Study was a randomized controlled trial which demonstrated that timely treatment of diabetic retinopathy reduced by one-half severe vision loss in the diabetic population (Diabetic Retinopathy Study Research Group, 1976~. But the results from this trial were published in the ophthalmology literature, sources that are not widely read by primary-care practitioners, who provide the majority of medical care to individuals with diabetes (Stross and Harlan, 19791.
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From page 79... ...
may lead to the loss of patients. This concern over the loss of market share stimulated the adoption of computed tomography and magnetic resonance imaging scanners by hospitals (Baker, 1979; Creditor and Garrett, 1977; Ramsey et al., 1993~.
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From page 80... ...
For diagnostic tests and devices, a less straightforward reimbursement pattern exists that is more dependent on the payers' particular decisionmaking processes. For example, it was not until six months after the approval of magnetic resonance imaging by the FDA that the Health Care Financing Administration announced reimbursement of this imaging technique for Medicare recipients.
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From page 81... ...
Research in understanding physician adoption of an innovation should continue to play a significant role as the nation studies ways to reform the health care delivery system. In addition to the development of clinical guidelines based on outcomes research and medical appropriateness (e.g., the Patient Outcomes Research Team initiative funded by the Agency for Health Care Policy and Research)
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From page 82... ...
1989. Effect of a media campaign on delay times and ambulance use in suspected acute myocardial infarction.
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From page 83... ...
1992. ISIS-3: A randomized comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial infarction.
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From page 84... ...
1987. Community hospital administration of intravenous tissue plasminogen activator in acute myocardial infarction.
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