Changes of the prescription of hormone therapy in menopausal women: an observational study in Taiwan.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Huang
Weng-Foung
WF
Institutes of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan. huang@ym.edu.tw
Tsai
Yi-Wen
YW
Hsiao
Fei-Yuan
FY
Liu
Wen-Chun
WC
D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends*; D015914:Estrogen Replacement Therapy / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006176:Gynecology / Q000592:standards; D006801:Humans; D008511:Medicine / Q000592:standards* / Q000706:statistics & numerical data; D008593:Menopause / Q000187:drug effects / Q000502:physiology*; D008875:Middle Aged; D009774:Obstetrics / Q000592:standards; D010024:Osteoporosis / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D013038:Specialization; D013624:Taiwan; D016387:Women's Health