Authors (including presenting author) :
Ng WWS(1), Leung KC (2), Lam SM (1), Yan WW (1), Sin CF (3), King HS (4), Shum HP (1)
Affiliation :
(1) Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
(2) Department of Medicine and Geriatrics, Tuen Mun Hospital
(3) Department of Pathology, Queen Mary Hospital, The University of Hong Kong
(4) Department of Intensive Care Unit, Kwong Wah Hospital
Introduction :
Hyperbaric oxygen therapy (HBOT) is a relatively young and budding specialty in Hong Kong. A wide spectrum of both acute and chronic conditions is indicated for treatment by HBOT, as approved by the Undersea and Hyperbaric Medical Society (UHMS). The first hospital based HBOT centre in Hong Kong was set up in 2018 and the availability of this recently developed service may be in the blind spot of doctors’ awareness.
Objectives :
We conducted this questionnaire-based study to evaluate doctors’ awareness of HBOT service, knowledge regarding correct indications for referral and recognition of contraindications. Our study also aimed to identify difficulties in prior referrals and willingness for future referrals.
Methodology :
Eligible participants were recruited via email-based invitations where anonymized questionnaires were distributed using Google Forms. The questionnaire comprises 21 questions in 2 divided sections. The first section contains 6 questions on doctor’s characteristics, including age, gender, medical background, and clinical experience. The second section includes 15 questions on physician’s knowledge on HBOT, previous experience of HBOT referral and willingness for future referrals.
Result & Outcome :
A total of 230 doctors submitted full replies to the questionnaire. 71% of the respondents had visited a hyperbaric oxygen unit and 62.6% previously attended talks or courses on HBOT. 63% of the respondents had the experience of referring patients to a HBOT centre. Major difficulties encountered during HBOT referrals included uncertainties about logistics (35.6%) and cumbersome logistics (32.2%). Most respondents could correctly identify the more well-known indications of HBOT: carbon monoxide poisoning (90.9%), decompression sickness (87.4%), necrotizing soft tissue infections (73.5%), arterial gas embolism (72.2%), and compromised grafts and flaps (57%). However, less than half of the respondents were aware of other indications including central retinal artery occlusion (49.6%), delayed radiation injuries (33.9%), and idiopathic sudden sensorineural hearing loss (27.8%). Correctly identified contraindications to HBOT included claustrophobia (80.9%), history of pneumothorax (68.7%), severe bronchospasm (44.3%), recent bleomycin treatment (43.9%), and epilepsy (40.4%). Alarmingly, pregnancy (47%) and mechanical ventilation (19.1%) were wrongly identified as contraindications by significant number of respondents. While most respondents correctly chose middle ear trauma (89.6%) as an adverse effect of HBOT, only minority of respondents were able to recognize the other adverse effects including convulsion (46.5%), subcutaneous emphysema (43%), arterial gas embolism (25.2%), and tunnel vision (16.5%). Majority of the respondents (81.3%) did not consider themselves well informed about this mode of treatment and 92.6% wished to be more informed about HBOT service. 79.1% of the respondents expressed willingness to make referrals to HBOT centre in the future.
Conclusion: This questionnaire study identified knowledge gaps regarding the use of HBOT. Majority of the respondents were receptive to education on HBOT service and indicated willingness to make future referrals. Arrangement of future educational interventions could encourage referrals to HBOT centre to maximize its utility.
