Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN.
College of Nursing, University of Tennessee Health Science Center, Memphis, TN.
Menopause. 2021 Aug 30;28(11):1239-1246. doi: 10.1097/GME.0000000000001847.
This study explored the clinical management practices of healthcare providers who treat menopausal women in an urban Mid-South area. The study specifically examined their knowledge of prescribing and counseling related to the care of women who present with complaints or clinical findings of genitourinary syndrome of menopause.
An electronic questionnaire was distributed to healthcare providers involved in the care of women undergoing menopausal transition spanning a variety of medical specialties. The questionnaire was distributed to academic program directors, coordinators, and ListServ administrators to forward to targeted respondents. Items included demographic questions, clinical knowledge, management practices, and preferences. Statistical analysis for associations between demographics was performed using Chi-squared tests and between age groups with Kruskal Wallis tests.
The final sample contained 106 healthcare providers. Respondents were demographically diverse and encompassed multiple levels of professional training including Attendings, Trainees (Residents and Fellows), as well as Advanced Practice Registered Nurses. Significant differences were noted in many areas examined in our questionnaire, comprising knowledge, management, counseling, and prescribing practices surrounding the treatment of genitourinary syndrome of menopause when accounting for training level, specialty, and years in practice. Among all respondents, 10.4% reported rarely or never discussing menopausal symptoms with their patients. Most respondents (76.4%) stated they had prescribed topical therapies for genitourinary syndrome of menopause, with over 90% of practitioners prescribing lubricants/moisturizers and estradiol cream; however, only 55% reported being familiar with the US Food and Drug Administration's boxed warning on low-dose vaginal estrogen. Nearly half of the respondents (49%) reported being uncomfortable counseling about the boxed warning on low-dose vaginal estrogen.
This study identifies gaps in Mid-South healthcare providers' awareness of the boxed warning on low-dose vaginal estrogen as well as their comfort level in providing counseling regarding the risks, benefits, and alternatives to vaginal estrogen. Integrated practice between physicians and Advanced Practice Registered Nurses can lead to a significant benefit to patients experiencing menopause as shared experience and knowledge are shared between each group. Our survey does reveal gaps in knowledge and practice for optimal outcomes for patients experiencing genitourinary syndrome of menopause. These results will be useful in providing continuing education to providers and more effective communication, evaluation, and treatment to patients.
本研究探讨了美国中南部城市地区治疗更年期女性的医疗保健提供者的临床管理实践。该研究专门研究了他们在治疗出现泌尿生殖系统绝经后综合征相关投诉或临床发现的女性时的处方和咨询知识。
向参与绝经过渡期女性护理的医疗保健提供者分发电子问卷，涵盖了各种医学专业。问卷分发给学术项目主任、协调员和 ListServ 管理员，以便向目标受访者转发。项目包括人口统计问题、临床知识、管理实践和偏好。使用卡方检验和年龄组的 Kruskal Wallis 检验对人口统计学之间的关联进行统计分析。
最终样本包含 106 名医疗保健提供者。受访者在人口统计学上存在差异，涵盖了包括主治医生、受训者（住院医师和研究员）以及高级实践注册护士在内的多个专业培训层次。在考虑培训水平、专业和实践年限的情况下，我们的问卷中检查了许多领域，发现了在治疗泌尿生殖系统绝经后综合征方面的知识、管理、咨询和处方实践方面存在显著差异。在所有受访者中，10.4%的人表示很少或从不与患者讨论更年期症状。大多数受访者（76.4%）表示他们曾开出过治疗泌尿生殖系统绝经后综合征的局部治疗药物，超过 90%的从业者开出润滑剂/保湿剂和雌二醇乳膏；然而，只有 55%的人表示熟悉美国食品和药物管理局（FDA）对阴道低剂量雌激素的盒装警告。近一半的受访者（49%）表示在咨询阴道低剂量雌激素的盒装警告时感到不舒服。
本研究确定了美国中南部医疗保健提供者对阴道低剂量雌激素盒装警告的认识差距，以及他们在提供关于阴道雌激素的风险、益处和替代方案的咨询方面的舒适度。医生和高级实践注册护士之间的综合实践可以为经历更年期的患者带来显著的益处，因为每个群体之间都可以共享经验和知识。我们的调查确实揭示了在为经历泌尿生殖系统绝经后综合征的患者提供最佳结果方面存在知识和实践差距。这些结果将有助于为提供者提供继续教育，并为患者提供更有效的沟通、评估和治疗。
