Self-reported changes in providers' hormone therapy prescribing and counseling practices after the Women's Health Initiative.
Self-reported changes in providers' hormone therapy prescribing and counseling practices after the Women's Health Initiative.
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在妇女健康倡议之后，提供者自我报告的激素治疗处方和咨询实践发生了变化。
DOI：
10.1089/jwh.2010.2047
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Newton,KatherineM
中科院分区：
文献类型：
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作者：
Lakey,SusanL;Reed,SusanD;LaCroix,AndreaZ;Grothaus,Lou;Newton,KatherineM
背景：自妇女健康倡议 (WHI) 试验发表以来，激素治疗 (HT) 的处方和咨询实践已经发生了变化。我们的目标是比较不同执业领域和地区的变化。方法：2005 年 12 月至 2006 年 5 月期间，我们向来自美国东北部和西北部两个大型综合卫生系统的 938 名从业者邮寄了调查问卷。我们收到了 736 份回复，排除了 144 名没有开出 HT 处方/提供咨询的人，剩下 592 名。数据包括处方者特征、HT 试验知识以及自我报告的 HT 咨询和处方变更。我们按地区和执业领域（妇产科 [OB/GYN] 或初级保健）比较了提供者特征以及 HT 咨询和处方。结果：受访者包括 79 名 OB/GYN 和 513 名初级保健提供者。与初级保健提供者相比，妇产科医生更有可能认为自己是心脏和雌激素/孕激素替代研究 (HERS) 和 WHI 试验方面的专家（30.4% vs. 8.2%，p<0.001）。大多数人 (87%) 对 HT 的使用持谨慎态度，尤其是初级保健提供者（与 OB/GYN 相比，p< 0.01）。受访者报告在 WHI 后减少口服非对抗雌激素 (64%) 和雌激素/孕激素联合用药 (81%)。妇产科医生不太可能报告口服非对抗雌激素使用量的减少（p= 0.006）。低剂量和透皮产品（低剂量雌激素、阴道雌激素、雌二醇阴道环）的使用有所增加，尤其是妇产科医生。结论：我们的研究强调了初级保健和妇产科医生之间在 HT 处方和咨询方面的众多差异。这些差异的原因尚不清楚，但可能与自我报告的 WHI/HERS 知识有关。 WHI 试验中使用的 HT 制剂正在被低剂量和替代制剂所取代。需要研究来支持这种做法。
Background:Prescribing and counseling practices in hormone therapy (HT) since publication of the Women's Health Initiative (WHI) trials have changed. Our objective was to compare changes by practice field and region.Methods:Between December 2005 and May 2006, we mailed surveys to 938 practitioners from two large integrated health systems in the Northeastern and Northwestern United States. We received 736 responses and excluded 144 who do not prescribe/counsel about HT, leaving 592. Data included prescriber characteristics, knowledge about HT trials, and self-reported HT counseling and prescribing changes. We compared provider characteristics and HT counseling and prescribing by region and practice field (obstetrician/gynecology [OB/GYN] or primary care).Results:Respondents included 79 OB/GYNs and 513 primary care providers. OB/GYNs were more likely, than primary care providers to consider themselves experts regarding the Heart and Estrogen/progestin Replacement Study (HERS) and WHI trials (30.4% vs. 8.2%,p< 0.001). The majority (87%) were cautious about HT use, especially primary care providers (p< 0.01 compared to OB/GYNs). Respondents reported prescribing less oral unopposed estrogen (64%) and combination estrogen/progestin (81%) post-WHI. OB/GYNs were less likely to report decreases in oral unopposed estrogen use (p= 0.006). Use of lower-dose and transdermal products (low-dose estrogen, vaginal estrogen, estradiol vaginal ring) increased, especially by OB/GYNs.Conclusions:Our study highlights numerous HT prescribing and counseling differences between primary care and OB/GYN providers. Reasons for these differences are unknown but may be related to self-reported WHI/HERS knowledge. HT formulations used in the WHI trials are being replaced by low-dose and alternate formulations. Studies to support this practice are needed.