Huang Weng-Foung, Tsai Yi-Wen, Hsiao Fei-Yuan, Liu Wen-Chun
Institutes of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
BMC Public Health. 2007 Apr 17;7:56. doi: 10.1186/1471-2458-7-56.
To evaluate the impact of the 2002 Women's Health Initiative (WHI) study results on the prescription of menopausal hormone therapy (MHT) to treat menopause-related symptoms in Taiwan.
This retrospective study participant data collected from women interviewed in 2001 Taiwan's National Health Interview Survey (NHIS) and the National Health Insurance (NHI) outpatient claims for women being treated for menopause-related symptoms. We compared prescriptions made for MHI to women seeking outpatient treatment for menopause-related symptoms before and after the publication of the 2002 WHI to study its effect of prescription behavior in Taiwan. There was one dichotomous outcome variable, which was whether MHT was prescribed or not in an outpatient visit to treat menopause-related symptoms.
Our study included 504 women 45 years old or above whose outpatient visits for menopause-related symptoms were covered by National Health Insurance in 2002. In total, these 504 women made 2549 outpatient visits to be treated for these symptoms. The proportion of outpatient visits in which MHT was prescribed dropped from 83.0% (n = 1,155) before WHI to 73.0% (n = 844) after WHI. We found a decrease in likelihood that women would be prescribed MHT for menopause-related symptoms after the release of the WHI report (OR = 0.36, 95% CI = 0.25 to 0.52, p < 0.05). Gynecologists and obstetricians are more likely to prescribe MHT than physicians with other medical specialties (5.34; 95% CI = 3.45 to 8.26, p < 0.05). Women with college level educations or higher became less likely to be prescribed MHT (Model 2; OR 0.30; 95% CI 0.11-0.83), and academic medical centers became less likely to prescribe MHT than other medical care institutions (Model 3; OR 0.15; 95% CI 0.34-0.63).
The WHI report caused a substantial decline in the use of MHT to treat menopause-related symptoms in Taiwan. It was found to exert most of its influence in patients with higher educations, physicians with specialties other than gynecologists and obstetricians, and academic medical centers.
评估2002年妇女健康倡议（WHI）研究结果对台湾地区用于治疗绝经相关症状的绝经激素治疗（MHT）处方的影响。
这项回顾性研究的数据来自于2001年台湾国民健康访谈调查（NHIS）中接受访谈的女性参与者，以及国民健康保险（NHI）针对治疗绝经相关症状女性的门诊索赔记录。我们比较了2002年WHI研究结果公布前后，为寻求绝经相关症状门诊治疗的女性开具的MHT处方，以研究其对台湾地区处方行为的影响。有一个二分结果变量，即门诊就诊治疗绝经相关症状时是否开具了MHT。
我们的研究纳入了2002年年龄在45岁及以上、其绝经相关症状门诊就诊费用由国民健康保险支付的504名女性。这504名女性总共进行了2549次治疗这些症状的门诊就诊。开具MHT的门诊就诊比例从WHI研究结果公布前的83.0%（n = 1155）降至公布后的73.0%（n = 844）。我们发现，WHI报告发布后，女性因绝经相关症状开具MHT的可能性降低（比值比 = 0.36，95%置信区间 = 0.25至0.52，p < 0.05）。妇产科医生比其他医学专科医生更有可能开具MHT（5.34；95%置信区间 = 3.45至8.26，p < 0.05）。受过大学及以上教育的女性开具MHT的可能性降低（模型2；比值比0.30；95%置信区间0.11 - 0.83），学术医疗中心比其他医疗机构开具MHT的可能性降低（模型3；比值比0.15；95%置信区间0.34 - 0.63）。
WHI报告导致台湾地区用于治疗绝经相关症状的MHT使用量大幅下降。研究发现，它对受过高等教育的患者、非妇产科专科医生以及学术医疗中心的影响最大。
