Perceived barriers and recommendations concerning hormone replacement therapy counseling among primary care providers

Objective: To increase our understanding of the factors that impede or prom ote counseling about hormone replacement therapy, we asked clinicians to pr ovide information concerning barriers and strategies to promote counseling. Design: We asked clinicians to consider two different scenarios: (1) what t hey do in their current practice and (2) what they would do if their health care systems implemented the United States Preventive Services Task Force recommendation regarding hormone replacement therapy counseling. A total of 49 of 50 invited clinicians participated in one of six focus group intervi ews (three women's groups and three men's groups). Our analysis consisted o f four steps: (1) identifying segments and classifying them into themes, (2 ) categorizing themes into topic areas, (3) establishing a final consensus of themes and topics, and (4) ascertaining similarities and contrasts among ,groups. Transcripts of sessions were analyzed across groups for themes usi ng a text-based analysis system. Conceptualization of themes was derived us ing a system model of preventive care. Interrater agreement before consensu s was good: Kappa (kappa) ranged from 0.70 to 1.00. Results: For current practice, identified barriers included lack of informa tion about risks and benefits, unique challenges of counseling, and lack of resources to conduct counseling. The major strategies suggested were to de velop and distribute patient education materials. Discussions about barrier s to implementing the United States Task Force recommendation focused on la ck of information and resources. Conclusions: Suggested strategies were multiple, involving individual-, rel ationship; and system-level interventions. We expect the strategies identif ied to be supportive of future efforts to promote counseling for hormone re placement therapy, (Menopause 1999,6:161-166, (C) 1999, The North American Menopause Society.)