Patient access to voice prostheses and heat and moisture exchangers: Factors influencing physician's prescription and reimbursement in eight European countries

A. C.C. Beck* (Corresponding Author), V. P. Retèl, M. W.M. van den Brekel, W. H. van Harten

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objectives: Patient access to the voice prosthesis and heat and moisture exchanger (HME) is not always guaranteed in Europe. Therefore, the aim of this qualitative study is to evaluate factors influencing physician's prescription and reimbursement of these devices in eight European countries, and to identify barriers of and facilitators to effective patient access. Materials and methods: In this mixed methods study, we conducted a survey among stakeholders evaluating prescription (Part 1 of the survey), reimbursement (Part 2), and barriers of and facilitators to effective patient access (Part 3). Part 1 was completed by head and neck surgeons employed in France, Germany, the United Kingdom, Italy, Spain, Belgium, the Netherlands and Poland. Part 2 and 3 were completed by medical device company representatives in respective countries, followed by semi-structured interviews. Results: Based on the survey, filled in by 36 surgeons, all prescribed the voice prosthesis. Four surgeons didn't prescribe the HME in Italy and Poland due to lack of both reimbursement and experience/training, and feeling uncomfortable with device use. Most restrictive factors (e.g. increased workload, insufficient staff) occurred in countries with decentralized healthcare systems including Spain and Italy. Conclusion: Non-HME-usage was influenced by economical and physician-related factors. Restrictive factors were related to limited regional device reimbursement and provision. Nationwide reimbursement, guideline implementation, support for physicians by training/education and providing a rehabilitation team will increase device use.

Original languageEnglish
Pages (from-to)56-64
Number of pages9
JournalOral Oncology
Volume91
DOIs
Publication statusPublished - 1 Apr 2019

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Artificial Larynges
Prescriptions
Hot Temperature
Physicians
Equipment and Supplies
Italy
Poland
Spain
Training Support
Belgium
Workload
Netherlands
France
Germany
Emotions
Neck
Rehabilitation
Head
Guidelines
Interviews

Keywords

  • UT-Hybrid-D
  • Europe
  • Facilitators
  • Heat and moister exchanger (HME)
  • Laryngectomy rehabilitation
  • Medical devices
  • Prescription
  • Reimbursement
  • Technology acceptance model
  • Voice prosthesis
  • Barriers

Cite this

@article{aefe16dbe60a4958927175a8db7b28a4,
title = "Patient access to voice prostheses and heat and moisture exchangers: Factors influencing physician's prescription and reimbursement in eight European countries",
abstract = "Objectives: Patient access to the voice prosthesis and heat and moisture exchanger (HME) is not always guaranteed in Europe. Therefore, the aim of this qualitative study is to evaluate factors influencing physician's prescription and reimbursement of these devices in eight European countries, and to identify barriers of and facilitators to effective patient access. Materials and methods: In this mixed methods study, we conducted a survey among stakeholders evaluating prescription (Part 1 of the survey), reimbursement (Part 2), and barriers of and facilitators to effective patient access (Part 3). Part 1 was completed by head and neck surgeons employed in France, Germany, the United Kingdom, Italy, Spain, Belgium, the Netherlands and Poland. Part 2 and 3 were completed by medical device company representatives in respective countries, followed by semi-structured interviews. Results: Based on the survey, filled in by 36 surgeons, all prescribed the voice prosthesis. Four surgeons didn't prescribe the HME in Italy and Poland due to lack of both reimbursement and experience/training, and feeling uncomfortable with device use. Most restrictive factors (e.g. increased workload, insufficient staff) occurred in countries with decentralized healthcare systems including Spain and Italy. Conclusion: Non-HME-usage was influenced by economical and physician-related factors. Restrictive factors were related to limited regional device reimbursement and provision. Nationwide reimbursement, guideline implementation, support for physicians by training/education and providing a rehabilitation team will increase device use.",
keywords = "UT-Hybrid-D, Europe, Facilitators, Heat and moister exchanger (HME), Laryngectomy rehabilitation, Medical devices, Prescription, Reimbursement, Technology acceptance model, Voice prosthesis, Barriers",
author = "Beck, {A. C.C.} and Ret{\`e}l, {V. P.} and {van den Brekel}, {M. W.M.} and {van Harten}, {W. H.}",
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doi = "10.1016/j.oraloncology.2019.02.017",
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Patient access to voice prostheses and heat and moisture exchangers : Factors influencing physician's prescription and reimbursement in eight European countries. / Beck, A. C.C. (Corresponding Author); Retèl, V. P.; van den Brekel, M. W.M.; van Harten, W. H.

In: Oral Oncology, Vol. 91, 01.04.2019, p. 56-64.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Patient access to voice prostheses and heat and moisture exchangers

T2 - Factors influencing physician's prescription and reimbursement in eight European countries

AU - Beck, A. C.C.

AU - Retèl, V. P.

AU - van den Brekel, M. W.M.

AU - van Harten, W. H.

N1 - Elsevier deal

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Objectives: Patient access to the voice prosthesis and heat and moisture exchanger (HME) is not always guaranteed in Europe. Therefore, the aim of this qualitative study is to evaluate factors influencing physician's prescription and reimbursement of these devices in eight European countries, and to identify barriers of and facilitators to effective patient access. Materials and methods: In this mixed methods study, we conducted a survey among stakeholders evaluating prescription (Part 1 of the survey), reimbursement (Part 2), and barriers of and facilitators to effective patient access (Part 3). Part 1 was completed by head and neck surgeons employed in France, Germany, the United Kingdom, Italy, Spain, Belgium, the Netherlands and Poland. Part 2 and 3 were completed by medical device company representatives in respective countries, followed by semi-structured interviews. Results: Based on the survey, filled in by 36 surgeons, all prescribed the voice prosthesis. Four surgeons didn't prescribe the HME in Italy and Poland due to lack of both reimbursement and experience/training, and feeling uncomfortable with device use. Most restrictive factors (e.g. increased workload, insufficient staff) occurred in countries with decentralized healthcare systems including Spain and Italy. Conclusion: Non-HME-usage was influenced by economical and physician-related factors. Restrictive factors were related to limited regional device reimbursement and provision. Nationwide reimbursement, guideline implementation, support for physicians by training/education and providing a rehabilitation team will increase device use.

AB - Objectives: Patient access to the voice prosthesis and heat and moisture exchanger (HME) is not always guaranteed in Europe. Therefore, the aim of this qualitative study is to evaluate factors influencing physician's prescription and reimbursement of these devices in eight European countries, and to identify barriers of and facilitators to effective patient access. Materials and methods: In this mixed methods study, we conducted a survey among stakeholders evaluating prescription (Part 1 of the survey), reimbursement (Part 2), and barriers of and facilitators to effective patient access (Part 3). Part 1 was completed by head and neck surgeons employed in France, Germany, the United Kingdom, Italy, Spain, Belgium, the Netherlands and Poland. Part 2 and 3 were completed by medical device company representatives in respective countries, followed by semi-structured interviews. Results: Based on the survey, filled in by 36 surgeons, all prescribed the voice prosthesis. Four surgeons didn't prescribe the HME in Italy and Poland due to lack of both reimbursement and experience/training, and feeling uncomfortable with device use. Most restrictive factors (e.g. increased workload, insufficient staff) occurred in countries with decentralized healthcare systems including Spain and Italy. Conclusion: Non-HME-usage was influenced by economical and physician-related factors. Restrictive factors were related to limited regional device reimbursement and provision. Nationwide reimbursement, guideline implementation, support for physicians by training/education and providing a rehabilitation team will increase device use.

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KW - Medical devices

KW - Prescription

KW - Reimbursement

KW - Technology acceptance model

KW - Voice prosthesis

KW - Barriers

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VL - 91

SP - 56

EP - 64

JO - Oral Oncology

JF - Oral Oncology

SN - 1368-8375

ER -