title: Factors influencing the uptake of technologies to minimize perioperative allogeneic blood transfusion: an interview study of national and institutional stakeholders.
abstract: BACKGROUND
  Alternatives to allogeneic blood transfusion exist and are being used to varying extents in Australian hospitals. Evidence on effectiveness and cost-effectiveness is generally inconclusive and provides a suboptimal basis for policy development.
  
  
  OBJECTIVE
  To describe the influences on uptake of transfusion technologies as perceived by national and institutional stakeholders.
  
  
  METHODS
  Qualitative interview study. Interview transcripts were coded and analysed independently by at least two researchers. Participants had opportunity to comment on their transcript and the manuscript.
  
  
  RESULTS
  A total of 71 interviews were conducted with representatives of the media, specialist medical societies, consumer special interest groups, the Australian Red Cross Blood Service (ARCBS), government, private health insurers, technology manufacturers, prominent clinicians in the area and a sample of clinicians drawn from hospitals with variable use of blood-saving technologies. Technical advances and acceptance of lower transfusion triggers were identified as the main influences on the decrease in use of allogeneic blood transfusion in the past decade. Participants indicated that patients were most aware and supportive of autologous predonation. Participants noted that 'enthusiasts' were involved in educating about the need for alternatives, negotiating resourcing and maintaining the use of a technology. Funding mechanisms were seen as main barriers to use of alternatives. A discrepancy was noted in the rigour of evaluation and regulation of pharmaceuticals and devices/procedures.
  
  
  CONCLUSIONS
  Uptake of blood transfusion technologies by institutions was dependent mostly on funding arrangements and the presence of an 'enthusiast'. Critical review of the evidence for effectiveness or cost-effectiveness of these technologies was rarely mentioned. Opportunities exist for evidence-based medicine principles to play a greater role in policy decisions in this area.
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, School of Population Health Sciences, Faculty of Medicine and Health Sciences, The University of Newcastle, Australia.
authors.forename: C J
authors.initials: CJ
authors.lastname: Treloar
authors.forename: P J
authors.initials: PJ
authors.lastname: Hewitson
authors.forename: K M
authors.initials: KM
authors.lastname: Henderson
authors.forename: G
authors.initials: G
authors.lastname: Harris
authors.forename: D A
authors.initials: DA
authors.lastname: Henry
authors.forename: K M
authors.initials: KM
authors.lastname: McGrath
mesh_terms: D001782:Blood Donors; D001803:Blood Transfusion / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D013677:Medical Laboratory Science / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*