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美国激素治疗的处方模式。

Hormone therapy prescribing patterns in the United States.

作者信息

Buist Diana S M, Newton Katherine M, Miglioretti Diana L, Beverly Kevin, Connelly Maureen T, Andrade Susan, Hartsfield Cynthia L, Wei Feifei, Chan K Arnold, Kessler Larry

机构信息

Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101, USA.

出版信息

Obstet Gynecol. 2004 Nov;104(5 Pt 1):1042-50. doi: 10.1097/01.AOG.0000143826.38439.af.

Abstract

OBJECTIVE

We sought to examine prescribing patterns (prevalence and rates of initiation and discontinuation) for estrogen plus progestin (hormone therapy [HT] and estrogen alone [ET]) in the United States in the 2 years before the published results of Women's Health Initiative's (WHI) HT trial's early termination and for 5 months after their release.

METHODS

We conducted an observational cohort study of 169,586 women aged 40-80 years who were enrolled in 5 health maintenance organizations in the United States to estimate the prevalence of HT and ET and discontinuation and initiation rates between September 1, 1999, to June 31, 2002 (baseline), and December 31, 2002 (follow-up). We used automated pharmacy data to identify all oral and transdermal estrogen and progestin dispensed during the study period.

RESULTS

The prevalence of HT declined 46% from baseline to follow-up (14.6% to 7.9%); ET use declined 28% during the same period (12.6% to 9.1%). The discontinuation of HT increased almost immediately, from 2.5% at baseline to 13.8% in October 2002. We saw an immediate decrease in HT and ET initiation rates, from 0.4% and 0.3% at baseline, respectively, to 0.2% for HT and ET at follow-up.

CONCLUSION

The diffusion of the WHI HT trial results had an immediate impact on the discontinuation of HT and ET and is likely responsible for the 46% and 28% decline in the initiation of these respective therapies. Further exploration of why women continue to use HT and identification of methods for addressing reasons for continued use are indicated.

LEVEL OF EVIDENCE

II-2.

摘要

目的

我们试图研究在美国,在妇女健康倡议(WHI)激素治疗(HT)试验早期终止的结果公布前2年以及公布后5个月内,雌激素加孕激素(激素治疗[HT])和单纯雌激素(ET)的处方模式(使用率、起始率和停药率)。

方法

我们对169,586名年龄在40 - 80岁的女性进行了一项观察性队列研究,这些女性在美国的5个健康维护组织中登记入组,以估计1999年9月1日至2002年6月31日(基线期)以及2002年12月31日(随访期)期间HT和ET的使用率、停药率和起始率。我们使用自动化药房数据来识别研究期间发放的所有口服和经皮雌激素及孕激素。

结果

从基线期到随访期,HT的使用率下降了46%(从14.6%降至7.9%);同期ET的使用率下降了28%(从12.6%降至9.1%)。HT的停药率几乎立即上升,从基线期的2.5%升至2002年10月的13.8%。我们观察到HT和ET的起始率立即下降,分别从基线期的0.4%和0.3%降至随访期的0.2%。

结论

WHI HT试验结果的传播对HT和ET的停药率产生了立即影响,并且可能是这两种治疗方法起始率分别下降46%和28%的原因。有必要进一步探究女性继续使用HT的原因,并确定解决持续使用原因的方法。

证据水平

II - 2。

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