Article Text

  1. H. M. Ismail,
  2. E. Aleveritis,
  3. B. Guha
  1. Johnson City, TN.


Background Recent studies are changing the way physicians and patients view hormone replacement therapy (HRT). This study was performed at East Tennessee State University (ETSU) internal medicine clinic to evaluate current attitudes of university physicians and patients toward HRT.

Methods A retrospective chart review was conducted at an internal medicine outpatient clinic at ETSU. 274 postmenopausal female patients were randomly selected using a computerized systematic sampling technique of ICD-9 codes of post menopause. The study period was July 2002-June 2004.

Inclusion Criteria 1) Postmenopausal women. 2) Age over 35. 3) Patients must have been seen by their physician at least twice a year during the study period.

Exclusion Criteria 1) Contraindication for HRT including cancer of any female organ. 2) Side effects, intolerance, or patient's refusal of the treatment. 3) Noncompliance with HRT, other medications or doctor's visits. 4) Patients who had been seen by resident physicians only. 5) Patients who were actively being seen by a subspecialist or a gynecologist during the study period. Demographic and other data regarding physicians' patterns in discussion and discontinuation of the therapy and patients response were collected.

Results A total of 177 patients met all the criteria, of which 140 were 35-75 years of age. Of this younger group 49 patients (35%) had CAD, 101 (72.1%) were on HRT prior to July 2002, and 30 (21.4%) had osteoporosis. Only 75 patients (53.6%) had documented discussions with their physicians about HRT after July 2002. Of the patients who were on HRT, only 36 (35.6%) continued treatments (23 continued the same dose, and 13 had the dose modified), while 65 (64.3%) had treatments discontinued. Physicians discussed treatments mostly when patients had treatments stopped or modified (p = .0032). Of these patients who had discussions, 60 (80%) were advised to stop or modify the dose and they agreed, and only 15 (20%) disagreed or received unbiased discussions from their physicians about HRT. 37 patients were over 75 years of age. This older group had a higher rate of HRT discontinuation (82%), but a lower rate of discussion (22%) than the younger group.

Conclusion Physicians should pay more attention to the importance of providing a high-quality and well-balanced patient counseling during the time of addressing uncertain treatments and adequately document discussions with patients in medical records.

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