Rolnick S J, Kopher R A, Compo R B, Kelley M E, DeFor T A
HealthPartners Research Foundation, Minneapolis, Minnesota, USA.
Menopause. 1999 Fall;6(3):257-63. doi: 10.1097/00042192-199906030-00013.
The purpose of this study was to survey providers within a large health maintenance organization regarding their attitudes and practice patterns related to counseling women about hormone replacement therapy (HRT).
A total of 260 providers from gynecology (n = 81), family practice (n = 96), and internal medicine (n = 83) from owned and contracted clinics were surveyed. Each was asked about prescribing philosophies, behaviors, and barriers to providing counseling regarding HRT.
Respondents reported HRT's greatest benefit to be in the prevention of osteoporosis (99%) and cardiovascular conditions (96%). Gynecologists were more likely to report the benefits of HRT for Alzheimer's than were clinicians in internal medicine or family practice (p < 0.05), and women providers were more likely than men to report this (p < 0.01). There was no statistical difference based on years in practice. Providers did not vary significantly by specialty or sex in their concerns of risk for breast cancer of endometrial cancer. However, those in family practice and internal medicine were significantly more likely to report concern about thromboembolism (p < 0.01). Only 42% of physicians claimed to initiate discussion with their patients more than 75% of the time. The two factors most often mentioned as barriers to counseling were time and lack of adequate knowledge.
Providers want to be an integral part of their patient's education regarding HRT; however, time constrains and a need for adequate information make this difficult. Now health systems must examine models of education for both providers and patients to ensure that women have access to current information with which to make informed decisions.
本研究旨在调查一家大型健康维护组织内的医疗服务提供者对为女性提供激素替代疗法（HRT）咨询的态度和实践模式。
对来自自有和签约诊所的260名医疗服务提供者进行了调查，其中妇科81名、家庭医学96名、内科83名。每位提供者都被问及关于HRT的处方理念、行为以及提供咨询的障碍。
受访者认为HRT的最大益处在于预防骨质疏松症（99%）和心血管疾病（96%）。与内科或家庭医学的临床医生相比，妇科医生更有可能报告HRT对阿尔茨海默病的益处（p<0.05），女性提供者比男性更有可能报告这一点（p<0.01）。根据从业年限没有统计学差异。不同专业或性别的提供者对乳腺癌或子宫内膜癌风险的担忧没有显著差异。然而家庭医学和内科的提供者更有可能报告对血栓栓塞的担忧（p<0.01）。只有42%的医生声称超过75%的时间会与患者展开讨论。最常被提及的咨询障碍是时间和缺乏足够的知识。
医疗服务提供者希望在患者关于HRT的教育中发挥重要作用；然而，时间限制和对充分信息的需求使其难以做到。现在卫生系统必须审视针对医疗服务提供者和患者的教育模式，以确保女性能够获取最新信息以便做出明智的决策。
