title: Determinants of hormone therapy discontinuation among female veterans nationally.
abstract: OBJECTIVE
  The growing presence of female veterans within the Department of Veterans Affairs (VA) health care system highlights the need to assess the quality of and access to gender-specific care for menopause. We assessed the use of hormone therapy (HT) among female veterans before and after the release of the Women's Health Initiative clinical trial results and evaluated whether the structure of women's health care services within the VA system affects the use of HT.
  
  
  METHODS
  We identified all female veterans using HT in 2001 by using the VA pharmacy benefits management database and administrative data. Subjects identified as using HT in 2001 were evaluated to determine estrogen use status in 2003 and 2004. We calculated the change in HT use over time and performed multivariate analyses to identify patient and utilization determinants of HT discontinuation.
  
  
  RESULTS
  In 2001, 36,222 female veterans used HT. By 2004, 23,924 (66%) had discontinued HT. Subjects who had used a VA women's clinic or were younger (40-54 years of age) were significantly less likely to discontinue HT. However, Hispanic ethnicity, African American race, and clinical diagnoses such as heart disease and mastectomy were significantly associated with discontinuation.
  
  
  CONCLUSIONS
  Discontinuation rates in the VA system parallel those in the private sector. However, patients with any use of VA women's clinics were less likely to discontinue HT, indicating a practice setting variation that may indicate either more specific care or differential implementation of the new HT guidelines. Further research is warranted to assess whether a disparity occurs according to practice setting (or provider factors) with rapid shifts in guidelines.
authors.affiliation: Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT 06515, USA.
authors.forename: Sally G
authors.initials: SG
authors.lastname: Haskell
authors.forename: Bevanne
authors.initials: B
authors.lastname: Bean-Mayberry
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Goulet
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.forename: Chester B
authors.initials: CB
authors.lastname: Good
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D000328:Adult; D005260:Female; D020249:Hormone Replacement Therapy; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D008887:Military Medicine; D010342:Patient Acceptance of Health Care; D010594:Pharmacies / Q000706:statistics & numerical data; D016312:Treatment Refusal; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D016387:Women's Health