Blümel Juan Enrique, Castelo-Branco Camil, Chedraui Peter A, Binfa Lorena, Dowlani Bravna, Gómez María Soledad, Sarrá Salvador
Department of Medicine, University of Chile, Santiago, Chile; Hospital Barros Luco-Trudeau, Santiago, Chile.
Menopause. 2004 Jan-Feb;11(1):57-61. doi: 10.1097/01.GME.0000075503.60230.61.
To assess the effect of the publication of the Women's Health Initiative (WHI) study on patients' and physicians' attitudes in relation to hormone therapy (HT).
A survey focused on the degree of knowledge and on the reactions to the WHI study was administered to 600 women allocated in two groups according to their socioeconomic status, high (HSES) or low (LSES). Additionally, 283 physicians were surveyed to determine their attitudes regarding HT after the publication of the WHI study. The rates of HT prescription before and after publication of the study were compared.
Among patients, HT use and knowledge of the WHI study were less common among women of lower socioeconomic status (LSES 16.7% v HSES 47.3%, and LSES 15.7% v HSES 67.3%; P < 0.0001). Of the women in the LSES group who were HT users and had knowledge on the subject of the WHI study (n = 30), 56.7% contacted their physicians and 6.6% abandoned HT. These rates were similar for women in the HSES group. Among physicians, 97.2% of physicians referred to being aware of the WHI study, and 64.7% modified their clinical approach. The main changes were that 21.5% applied more rigorous risk/benefit assessment, 20.1% lowered hormone dosage, 18.8% decreased continuous-combined therapy use, 12.1% shortened the duration of HT, 7.7% abandoned medroxyprogesterone or conjugated estrogen use, and 5.0% increased the use of transdermal estrogens, tibolone, or other alternatives. As for prescriptions, after the publication of the WHI study, there was an 8.6% drop in the rate of HT prescriptions. This decrease was more pronounced for prescriptions based on conjugated equine estrogen and medroxyprogesterone acetate. In contrast, prescription of transdermal estrogens and tibolone increased 5.2% and 16%, respectively.
There was a significant change in physicians' and patients' attitudes toward HT after publication of the WHI study.
评估妇女健康倡议（WHI）研究的发表对患者及医生关于激素疗法（HT）态度的影响。
一项针对知识程度及对WHI研究反应的调查，根据社会经济地位将600名女性分为两组，即高社会经济地位组（HSES）和低社会经济地位组（LSES）。此外，对283名医生进行调查，以确定他们在WHI研究发表后对HT的态度。比较研究发表前后HT处方率。
在患者中，社会经济地位较低的女性中HT的使用和对WHI研究的了解较少（LSES组为16.7%，HSES组为47.3%；LSES组为15.7%，HSES组为67.3%；P<0.0001）。在LSES组中，使用HT且了解WHI研究相关主题的女性（n = 30）中，56.7%联系了她们的医生，6.6%停用了HT。HSES组女性的这些比例与之相似。在医生中，97.2%的医生表示知晓WHI研究，64.7%改变了他们的临床方法。主要变化包括：21.5%进行了更严格的风险/效益评估，20.1%降低了激素剂量，18.8%减少了连续联合疗法的使用，12.1%缩短了HT疗程，7.7%停用了甲羟孕酮或结合雌激素，5.0%增加了经皮雌激素、替勃龙或其他替代药物的使用。至于处方，WHI研究发表后，HT处方率下降了8.6%。基于结合马雌激素和醋酸甲羟孕酮的处方下降更为明显。相比之下，经皮雌激素和替勃龙的处方分别增加了5.2%和16%。
WHI研究发表后，医生和患者对HT的态度发生了显著变化。
