Suarez-Almazor M, Homik J E, Messina D, Davis P
Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
J Bone Miner Res. 1997 Jul;12(7):1100-7. doi: 10.1359/jbmr.1997.12.7.1100.
The objective of this study was to evaluate the attitudes and beliefs of primary care physicians (PCPs) and obstetricians/gynecologists (O&Gs) in relation to the prevention and treatment of osteoporosis (OP) in postmenopausal women. A survey was mailed to a random sample of PCPs and to all O&Gs registered in the province of Alberta (Canada). The survey evaluated their practice patterns using closed-ended questions, Likert scaled items, and two case studies. Cases 1 and 2 were 52-year-old and 62-year-old healthy postmenopausal women, respectively, with no known risks for OP. Neither had received hormone replacement therapy (HRT). One hundred fifty-seven PCPs and 57 O&Gs participated in the study. Thirty-eight percent of the PCPs and 32% of the O&Gs stated that they never requested bone mineral density measurements (BMDm) in early postmenopausal women. Most would request BMDm only in the presence of risk factors. The most important criteria to request BMDm were chronic glucocorticoid use and recent fractures. For case 1, 7% of the PCPs and 11% of the O&Gs would request BMDm; 76% of the PCPs and 80% of the O&Gs would recommend HRT. For case 2, 29% of the PCPs and 47% of the O&Gs would request BMDm (p = 0.01); 43% of the PCPs and 49% of the O&Gs would prescribe HRT. In general, O&Gs were more inclined to intervene in relation to BMDm and HRT. O&Gs were also more likely to be influenced by clinical trials than PCPs (p < 0.001). Our findings show variations in the patterns of practice of physicians in relation to the prevention of OP. In general, use of densitometry appears to be low. The results of the case studies suggest that individual physician perceptions may be more influential than patient characteristics when requesting BMDm and prescribing HRT, particularly in older postmenopausal women. This group of healthy older women have approximately equal odds of being offered versus not being offered BMDm and HRT according to the physician they consult.
本研究的目的是评估初级保健医生（PCP）和妇产科医生（O&G）对于绝经后妇女骨质疏松症（OP）预防和治疗的态度与信念。向加拿大阿尔伯塔省随机抽取的初级保健医生样本以及该省所有注册的妇产科医生邮寄了一份调查问卷。该调查使用封闭式问题、李克特量表项目以及两个案例研究来评估他们的执业模式。案例1和案例2分别是52岁和62岁的健康绝经后妇女，均无已知的骨质疏松症风险因素，且均未接受过激素替代疗法（HRT）。157名初级保健医生和57名妇产科医生参与了该研究。38%的初级保健医生和32%的妇产科医生表示，他们从未要求对绝经早期妇女进行骨密度测量（BMDm）。大多数人仅在存在风险因素时才会要求进行骨密度测量。要求进行骨密度测量的最重要标准是长期使用糖皮质激素和近期发生骨折。对于案例1，7%的初级保健医生和11%的妇产科医生会要求进行骨密度测量；76%的初级保健医生和80%的妇产科医生会推荐激素替代疗法。对于案例2，29%的初级保健医生和47%的妇产科医生会要求进行骨密度测量（p = 0.01）；43%的初级保健医生和49%的妇产科医生会开具激素替代疗法的处方。总体而言，妇产科医生在骨密度测量和激素替代疗法方面更倾向于进行干预。与初级保健医生相比，妇产科医生也更有可能受到临床试验的影响（p < 0.001）。我们的研究结果表明，医生在骨质疏松症预防方面的执业模式存在差异。总体而言，骨密度测量的使用率似乎较低。案例研究结果表明，在要求进行骨密度测量和开具激素替代疗法处方时，医生的个人认知可能比患者特征更具影响力，尤其是在年龄较大的绝经后妇女中。根据所咨询的医生不同，这组健康的老年妇女接受或不接受骨密度测量和激素替代疗法的几率大致相等。
