Patients' and clinicians' attitudes after the Women's Health Initiative study.
OBJECTIVE
To assess the effect of the publication of the Women's Health Initiative (WHI) study on patients' and physicians' attitudes in relation to hormone therapy (HT).


METHODS
A survey focused on the degree of knowledge and on the reactions to the WHI study was administered to 600 women allocated in two groups according to their socioeconomic status, high (HSES) or low (LSES). Additionally, 283 physicians were surveyed to determine their attitudes regarding HT after the publication of the WHI study. The rates of HT prescription before and after publication of the study were compared.


RESULTS
Among patients, HT use and knowledge of the WHI study were less common among women of lower socioeconomic status (LSES 16.7% v HSES 47.3%, and LSES 15.7% v HSES 67.3%; P < 0.0001). Of the women in the LSES group who were HT users and had knowledge on the subject of the WHI study (n = 30), 56.7% contacted their physicians and 6.6% abandoned HT. These rates were similar for women in the HSES group. Among physicians, 97.2% of physicians referred to being aware of the WHI study, and 64.7% modified their clinical approach. The main changes were that 21.5% applied more rigorous risk/benefit assessment, 20.1% lowered hormone dosage, 18.8% decreased continuous-combined therapy use, 12.1% shortened the duration of HT, 7.7% abandoned medroxyprogesterone or conjugated estrogen use, and 5.0% increased the use of transdermal estrogens, tibolone, or other alternatives. As for prescriptions, after the publication of the WHI study, there was an 8.6% drop in the rate of HT prescriptions. This decrease was more pronounced for prescriptions based on conjugated equine estrogen and medroxyprogesterone acetate. In contrast, prescription of transdermal estrogens and tibolone increased 5.2% and 16%, respectively.


CONCLUSIONS
There was a significant change in physicians' and patients' attitudes toward HT after publication of the WHI study.
Blümel
Juan Enrique
JE
Department of Medicine, University of Chile, Santiago, Chile; Hospital Barros Luco-Trudeau, Santiago, Chile.
Castelo-Branco
Camil
C
Chedraui
Peter A
PA
Binfa
Lorena
L
Dowlani
Bravna
B
Gómez
María Soledad
MS
Sarrá
Salvador
S
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002677:Chile; D004363:Drug Utilization / Q000706:statistics & numerical data; D015914:Estrogen Replacement Therapy / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires