Factors influencing the uptake of technologies to minimize perioperative allogeneic blood transfusion: an interview study of national and institutional stakeholders

Background: Alternatives to allogeneic blood transfusion exist and are bein g used to varying extents in Australian hospitals. Evidence on effectivenes s and cost-effectiveness is generally inconclusive and provides a suboptima l basis for policy development. Aim: To describe the influences on uptake of transfusion technologies as pe rceived by national and institutional stakeholders. Methods: Qualitative interview study. Interview transcripts were coded and analysed independently by at least two researchers. Participants had opport unity to comment on their transcript and the manuscript. Results: A total of 71 interviews were conducted with representatives of th e media, specialist medical societies, consumer special interest groups, th e Australian Red Cross Blood Service (ARCBS), government, private health in surers, technology manufacturers, prominent clinicians in the area and a sa mple of clinicians drawn from hospitals with variable use of blood-saving t echnologies. Technical advances and acceptance of lower transfusion trigger s were identified as the main influences on the decrease in use of allogene ic blood transfusion in the past decade. Participants indicated that patien ts were most aware and supportive of autologous predonation. Participants n oted that 'enthusiasts' were involved in educating about the need for alter natives, negotiating resourcing and maintaining the use of a technology. Fu nding mechanisms were seen as main barriers to use of alternatives. A discr epancy was noted in the rigour of evaluation and regulation of pharmaceutic als and devices/procedures. Conclusions: Uptake of blood transfusion technologies by institutions was d ependent mostly on funding arrangements and the presence of an 'enthusiast' . Critical review of the evidence for effectiveness or cost-effectiveness o f these technologies was rarely mentioned. Opportunities exist for evidence -based medicine principles to play a greater role in policy decisions in th is area.