title: Trends in provision of photodynamic therapy and clinician attitudes: a tracker survey of a new health technology.
abstract: BACKGROUND
  There has been debate about the cost-effectiveness of photodynamic therapy (PDT), a treatment for neovascular age-related macular degeneration. We have been monitoring trends for the provision of PDT in the UK National Health Service. The fourth annual 'tracker' survey took place as definitive National Institute for Clinical Excellence (NICE) guidance was issued. We assessed trends in PDT provision up to the point of release of the NICE guidance and identified likely sources of pressure on ophthalmologists to provide PDT.
  
  
  METHODS
  National postal questionnaire survey of clinicians with potential responsibility for PDT provision. The survey explored reported local provision, beliefs about the effectiveness of PDT and what sources of opinion might influence attitudes towards providing PDT.
  
  
  RESULTS
  The response rate was 73% (111/150). Almost half of the surveyed ophthalmology units routinely provided PDT, as part of a trend of steady growth in provision. The proportion of respondents who believed that further proof of effectiveness was required has also declined despite the absence of any new substantial evidence. Attitudes towards providing PDT were positive, on average, and were more strongly associated with perceived social pressure from local colleagues than from other sources. Local colleagues were seen as being most approving of PDT.
  
  
  CONCLUSIONS
  Those responsible for implementing the NICE guidance need to address ophthalmologists' beliefs about the evidence of effectiveness for PDT and draw upon supportive local individuals or networks to enhance the credibility of the guidance.
authors.affiliation: The Centre for Health Services Research, University of Newcastle upon Tyne, UK. R.C.Foy@newcastle.ac.uk
authors.forename: Robbie C
authors.initials: RC
authors.lastname: Foy
authors.forename: Barny
authors.initials: B
authors.lastname: Foot
authors.forename: Jill
authors.initials: J
authors.lastname: Francis
authors.forename: Usha
authors.initials: U
authors.lastname: Chakravarthy
authors.forename: Richard P L
authors.initials: RP
authors.lastname: Wormald
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy*; D008875:Middle Aged; D009885:Ophthalmology / Q000592:standards* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010778:Photochemotherapy / Q000706:statistics & numerical data*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012925:Social Conformity; D011795:Surveys and Questionnaires; D013673:Technology Assessment, Biomedical
chemical_list: D017319:Photosensitizing Agents