gms | German Medical Science

Background: Technology acquisition at hospital level usually involves difficult decisions with an increasing push from industry and clinicians, but few formalised or standardized procedures are available. However, these decisions are shaping services provided in public hospitals and it seems that science and innovation progresses much faster than assessment possibilities or the regulatory environment can evolve. Relevant decisions are often included within other purchasing process of several items or within the renewal of equipment and clinical services requests are addressed to different instances with variable arguments (fastest, higher, stronger). Therefore there seems to be a perceived need of doing more research in this area and to develop guidelines to improve the processes of decision-making and acquisition of new technologies.

In Andalusia (Spain) a guideline for the acquisition of new technologies (GANT) was developed and published in 1999, aimed to facilitate decision-making in public hospitals. It includes concepts and tools of health technology assessment, questionnaire for applicants, checklist with basic requirements and recommendations to classify the proposals. The decision support tool was distributed to all 32 hospitals and recommended for use by executive managers. Different efforts have been made to assess the users' knowledge and utilisation of the guide and to identify possible aspects to be improved and barriers for implementation, linked with other related HTA and health services research initiatives.

Methods: This presentation is based on various research studies performed at AETSA on the introduction of new technologies to illustrate the situation and context of Spanish health services, including PET, Automated Implantable Defibrillators, Genetic Testing and Citostatic drugs. In regards to GANT, a database was built with all formularies referred to AETSA and a survey was carried out to all hospitals in 2002, complemented with key informants inputs, particularly on local experiences and updating the information. The survey has been repeated in summer 2005.

Results: Traditionally in Spain there has been a lack of good quality information on utilization and introduction of new technologies. New programs and research networks have allowed a better knowledge of the situation. This is case of Health Technology Assessment Commissioned Research, Health Services Research Network or Evidence Based Medicine and Guidelines Network. All technologies analysed by AETSA share two characteristics: quick increase and high variability between hospital areas or provinces. This is particularly the case for PET and chemotherapy treatments for advanced cancer patients.

As for the introduction of new technologies in public hospitals, GANT instrument is a well-known and attempts to implement it or a has been made in nearly all hospitals. In 2001, 20 out of 30 hospitals (66.7%) were aware and familiar with it, while in 2005 all of them know it. Availability and use of the instrument also increased substantially, and 12 hospitals are currently using it frequently (see Table 1 [Tab. 1]). Main barriers for implementation identified: established routines and bureaucracy, lack of appropriate knowledge for assessment and resources for HTA, and low priority in decision-makers agenda.

Discussion: From the data analysed, in Spain new technologies seems to be rapidly introduced during the last decade with a strong drive and imperative for clinicians and managers. This fact together with high geographical variations in the rate of these technologies may be interpreted in the view of a lack of effective regulatory mechanisms and impact of HTA reports. The instrument GANT is perceived as an useful tool in most hospitals of Andalusia, but has not reached all potential users and is only used approximately by a third of them. Experience gained and barriers identified are being taken into account for current planning of implementation strategies.

The complete lecture can be found on the website of DIMDI: http://www.dimdi.de/static/de/hta/symposien/2005/index.htm