Abstract 74: Identifying Barriers to Adoption of New Interventional Techniques: Transradial Coronary Angiography (TRA) as a Case Study

Abstract

Background: TRA is associated with reduced vascular complications and costs; however, studies show low adoption of TRA in the United States (US) relative to other countries. The underlying reasons for this are unclear. Methods: Applying the framework of the Theory of Planned Behavior (TPB), a psychological construct that links attitudes, perceptions, & behavior, we developed a survey to identify factors associated with TRA use. TPB has 3 domains: attitudes (beliefs about TRA outcomes), normative beliefs (perceptions of how other physicians judge TRA use), and control beliefs (awareness of factors that facilitate or impede TRA use). A survey that included questions specific to each domain was developed, tested for construct & content validity, & administered to 201 US interventional cardiologists with varying self-reported rates of TRA use. Multivariable logistic regression was used to determine factors associated with TRA use; the model included domains of TPB and characteristics of the respondents. Results: The mean time since completion of interventional training for the study sample was 14.4 ± 10.2 yrs. The mean number of patients/week was 69, with 32% requiring catheterization, & 25% requiring PCI. Factors associated with TRA use included physician attitudes toward TRA, practice environment (e.g. support from the hospital or colleagues) and to a lesser extent, patient volume and number of operators using the catheterization laboratory (Table). Conclusions: Using principles from TPB, we identified factors associated with TRA use. These data are useful in refining TRA educational initiatives and suggest that broadening the scope beyond individual providers may increase TRA adoption. In addition, this methodology may provide a future model for initiating the adoption of other novel techniques into interventional cardiology practice. Table. Significant predictors of TRA use