Provider attitudes and self-reported behaviors related to hormone replacement therapy

Objective: The put-pose of this study was to survey providers within a larg e health maintenance organization regarding their attitudes and practice pa tterns related to counseling women about hormone replacement therapy (HRT). Design: A total of 260 providers from gynecology (n = 81), family practice (n = 96), and internal medicine (n = 83) from owned and contracted clinics were surveyed. Each was asked about prescribing philosophies, behaviors, an d barriers to providing counseling regarding HRT. Results: Respondents reported HRT's greatest benefit to be in the preventio n of osteoporosis (99%) and cardiovascular conditions (96%). Gynecologists were more likely to report the benefits of HRT for Alzheimer's than were cl inicians in internal medicine or family practice (p < 0.05), and women prov iders were more likely than men to report this (p < 0.01). There was no sta tistical difference based on years in practice. Providers did not vary sign ificantly by specialty or sex in their concerns of risk for breast cancer o r endometrial cancer. However, those in family practice and internal medici ne were significantly more likely to report concern about thromboembolism ( p < 0.01). Only 42% of physicians claimed to initiate discussion with their patients mon than 75% of the time, The two factors most often mentioned as barriers to counseling were time and lack of adequate knowledge. Conclusions: Providers want to be an integral part of their patient's educa tion regarding HRT; however, time constraints and a need for adequate infor mation make this difficult. Now health systems must examine models of educa tion for both providers and patients to ensure that women have access to cu rrent information with which to make informed decisions. (C) 1999, The Nort h American Menopause Society.