Spangler Leslie, Reed Susan D, Nekhyludov Larissa, Grothaus Louis C, LaCroix Andrea Z, Newton Katherine M
Group Health Center for Health Studies, University of Washington Seattle, WA 98101, USA.
Menopause. 2009 Jul-Aug;16(4):810-16. doi: 10.1097/GME.0b013e318198e2fd.
The aim of this study was to identify provider characteristics associated with hormone therapy prescribing.
The study design is cross-sectional. In December 2005, we mailed surveys to providers practicing in two integrated healthcare delivery systems located in the northwestern and northeastern United States; 379 responded (74%) and 249 (49% of total) granted access to their automated data. Data included provider demographics, practice characteristics, and perceptions about hormone therapy. Provider-specific annual hormone therapy prescribing frequency was calculated as days supply of hormone therapy filled divided by the number of visits (among women aged 45-80 y). Factors associated with higher rates of hormone therapy prescribing were identified using bivariate and multivariate analyses.
We report results separately for primary care providers (internists and family practitioners) and obstetrician/gynecologists because significant correlates differed in these two groups. For both primary care providers and obstetrician/gynecologists, in multivariate analyses, hormone therapy prescribing varied by site (P < or = 0.002) and years at the healthcare organization (P < or = 0.01). For primary care providers only, higher hormone therapy prescribing was associated with reported expert knowledge of the hormone therapy trials (P < or = 0.001). For obstetrician/gynecologists, higher hormone therapy prescription was related to feeling well prepared to counsel women on hormone therapy (P < or = 0.007), believing that the risks of estrogen with progestogen had been exaggerated (P = 0.04), and seeing younger aged patients (P = 0.03).
After the release of the Women's Health Initiative findings and practicing under similar clinical guidelines, hormone therapy prescribing is associated with providers' confidence, practice location, and time with a healthcare organization.
本研究旨在确定与激素治疗处方相关的医疗服务提供者特征。
本研究设计为横断面研究。2005年12月，我们向在美国西北部和东北部的两个综合医疗服务体系中执业的医疗服务提供者邮寄了调查问卷；379人回复（74%），其中249人（占总数的49%）允许获取其自动化数据。数据包括医疗服务提供者的人口统计学信息、执业特征以及对激素治疗的看法。特定医疗服务提供者的年度激素治疗处方频率计算为激素治疗配药的天数供应量除以就诊次数（45 - 80岁女性中）。使用双变量和多变量分析确定与较高激素治疗处方率相关的因素。
我们分别报告初级保健提供者（内科医生和家庭医生）和妇产科医生的结果，因为这两组中的显著相关因素有所不同。对于初级保健提供者和妇产科医生，在多变量分析中，激素治疗处方因地点而异（P≤0.002）以及在医疗保健机构的工作年限而异（P≤0.01）。仅对于初级保健提供者，较高的激素治疗处方与所报告的对激素治疗试验的专业知识相关（P≤0.001）。对于妇产科医生，较高的激素治疗处方与感觉有充分准备就激素治疗向女性提供咨询相关（P≤0.007），认为雌激素与孕激素联合使用的风险被夸大（P = 0.04），以及诊治年轻患者相关（P = 0.03）。
在妇女健康倡议结果发布后，并在类似临床指南下执业，激素治疗处方与医疗服务提供者的信心、执业地点以及在医疗保健机构的工作时间相关。
