The North American Menopause Society 1998 menopause survey: Part II. Counseling about hormone replacement therapy: Association with socioeconomic status and access to medical care

Objective: The purpose of this study was to examine two predictors of women 's obtaining hormone replacement therapy (HRT) counseling: socioeconomic st atus and access to health care. Design: During May-July 1998, by means of random-digit telephone dialing, 7 49 postmenopausal women who were living in the United States and aged 50-65 years were interviewed. On average, they were 56.8 years and 11.8 years po stmenopausal. Most (86.0%) were Caucasian, and their median annual income w as approximately $40,000. Nearly all (90.8%) had medical insurance coverage ; 47.6% of those insured received care from a managed care organization. Ac cess to medical care was evidenced by 92.3% being under the care of a prima ry care physician, 92.3% ever having had a mammogram, 96.9% ever having had a pelvic examination, and 91.1% ever having had a serum cholesterol determ ination. Results: Of these 749 women, 75.4% reported that they had received counseli ng about postmenopausal HRT from healthcare providers. Both level of educat ion and level of income were associated with an increased likelihood that H RT counseling would be obtained. Having a personal physician, and particula rly receiving care from a gynecologist, increased the likelihood that couns eling would be available. There were no substantial differences in counseli ng frequency between women in managed care plans and those having other typ es of health insurance. In a multivariate model, adjusted odds ratios for r eceiving HRT counseling were 2.9 (95% confidence interval [CI] = 1.7-4.8) f or having an annual income of $50,000 or more versus less than $30,000, 2.8 (95% CI = 1.7-4.5) for receiving care from a gynecologist versus other pri mary care physician, 1.9 (95% CI = 1.1-3.2) for being Caucasian versus not, and 1.5 (95% CI 1.0-2.2) for having a hysterectomy versus not. Conclusions: Three quarters of a sample of US postmenopausal women aged 50- 65 years reported that they had been counseled about HRT. However, women of lowest socioeconomic status and those who did not have a primary care phys ician were least likely to have received counseling. No differences were ob served in prevalence of counseling between women in managed care settings a nd those with other types of health insurance. The findings suggest that sp ecial efforts are necessary to provide menopause education and counseling t o underserved women. (Menopause 2000,7: 143-148. (C) 2000, The North Americ an Menopause Society.).