Hormone therapy discontinuation: physician practices after the Women's Health Initiative.
Hormone therapy discontinuation: physician practices after the Women's Health Initiative.
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DOI：
10.1097/gme.0b013e3181d2ce57
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发表时间：
2010-07
期刊：
影响因子：
--
通讯作者：
Ludman EJ
中科院分区：
文献类型：
--
作者：
Newton KM;Reed SD;Grothaus LC;La Croix AZ;Nekhlyudov L;Ehrlich K;Ludman EJ
没有指南或随机试验涉及激素治疗 (HT) 停止的最佳实践。我们进行了一项调查研究，探讨美国西北部和东北部大型综合卫生系统 Group Health 和Harvard Vanguard 的 HT 停药实践，重点关注专业和研究地点之间的差异。书面调查问卷（2005年12月至2006年5月期间邮寄）的答复率为78.5%（736/928）；本文报告了 483 名合格医生的结果。为了停止口服激素治疗，大多数医生 (91%) 建议逐渐减量，而不是立即停止 (8%)，大多数医生 (60%) 建议减少剂量和每周天数。近 60% 的医生表示没有使用锥形贴片的经验。哈佛先锋医生比团体健康医生更有可能鼓励停止 HT，并且当女性在停止 HT 后症状复发时不太可能建议恢复 HT。在选择停药策略时，医生受自身经验（48%）、同事建议（25%）和患者偏好（19%）的影响最大；只有 2% 依赖研究证据。医生认可各种方法来控制 HT 停止后的症状，最常见的是行为改变 (44%) 和增加运动 (37%)，这些方法更常得到哈佛先锋医生和妇产科医生的认可，而不是团体健康医生或家庭医生或内科医生的认可。美国西北部和东北部的两个健康计划没有关于停止 HT 的标准方案。医生根据所在地、同事和专业的影响定制治疗方法。需要进行研究来确定其他因素并指导停止 HT 的方法。
No guidelines or randomized trials address best practices for hormone therapy (HT) discontinuation. We conducted a survey study to explore HT discontinuation practices at Group Health and Harvard Vanguard, large integrated health systems in the northwest and northeast United States, focusing on differences between specialties and study site. The response rate to the written questionnaire (mailed between December 2005 and May 2006) was 78.5% (736/928); this paper reports the results for 483 eligible physicians. To discontinue oral HT, most physicians (91%) advised tapering, not immediate cessation (8%), and most (60%) suggested decreasing both dose and days per week. Almost 60% of physicians reported no experience with tapering patches. Harvard Vanguard physicians were more likely than Group Health physicians to encourage discontinuing HT, and less likely to recommend resuming HT when a woman’s symptoms returned after discontinuing HT. Physicians were most strongly influenced by their own experience (48%), advice from colleagues (25%), and patient preference (19%) when choosing a discontinuation strategy; only 2% relied on research evidence. Physicians endorsed various approaches to manage symptoms after HT discontinuation, most often behavioral changes (44%) and increased exercise (37%), and these approaches were more often endorsed by Harvard Vanguard physicians and obstetrician/gynecologists than Group Health physicians or family practitioners or internists. Two health plans, in the northwestern and northeastern United States, had no standard protocol for HT discontinuation. Physicians customized approaches, influenced by their location, colleagues, and specialty. Research is needed to identify other factors and guide approaches to HT discontinuation.
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影响因子：
7.2
作者：
Grady, D;Ettinger, B;Macer, JL
通讯作者：
Macer, JL
影响因子：
4.9
作者：
Newton, KM;LaCroix, AZ;Delaney, K
通讯作者：
Delaney, K
DOI：
10.1097/00042192-200109000-00011
发表时间：
2001-09-01
影响因子：
2.7
作者：
Newton, KM;LaCroix, AZ;Anderson, LA
通讯作者：
Anderson, LA
DOI：
10.1097/01.gme.0000185753.77704.65
发表时间：
2006-05-01
影响因子：
2.7
作者：
Power, ML;Zinberg, S;Schulkin, J
通讯作者：
Schulkin, J
影响因子：
7.2
作者：
Buist, DSM;Newton, KM;Kessler, L
通讯作者：
Kessler, L