Integration of health technology assessment recommendations into organizational and clinical practice: A case study in Catalonia.
OBJECTIVE
Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy makers. This research sought to understand factors affecting the uptake of HTA recommendations to support decision making with respect to the introduction of three health technologies.


METHODS
Using a multidimensional framework, based upon a combination of theoretical models, a case study was conducted. A total of twenty-eight semistructured interviews were done with physicians from fifteen hospitals and other stakeholders in Catalonia. Interview content was analyzed iteratively and classified according to theoretical dimensions and contextual factors.


RESULTS
At the sociopolitical level, factors related to the organization and financing of the health system were found to affect the utilization of HTA recommendations. At the healthcare organization level, existing collaborations between the hospital and the HTA agency favored the integration of recommendations into practices. Formalism in the organization also influenced the utilization of HTA recommendations. At the professional level, the high degree of autonomy of specialists, the importance of peers and collegial control, and the definition of professional roles and responsibilities influenced physicians' willingness to integrate HTA recommendations into their practice.


CONCLUSIONS
This study offers a comprehensive framework to understand the complex dynamics that affect adoption of health technologies in organizational and professional practices. The findings suggest some avenues to promote the integration of HTA recommendations into practices and, thus, increase the utilization of scientific evidence to support decision making in health care.
Health Telematics Unit, University of Calgary Health Sciences Centre, Calgary, Alberta, Canada T2N 4N1. mpgagnon@ucalgary.ca
Marie-Pierre
MP
Gagnon
Emília
E
Sánchez
Joan M V
JM
Pons
D003657:Decision Making; D004059:Diffusion of Innovation; D006291:Health Policy; D006801:Humans; D008962:Models, Theoretical; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000458:organization & administration*