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Provider attributes associated with hormone therapy prescribing frequency

Spangler, Leslie PhD, VMD1; Reed, Susan D. MD, MPH1,2,3,4; Nekhyludov, Larissa MD, MPH5,6; Grothaus, Louis C. MA1; LaCroix, Andrea Z. PhD1,4; Newton, Katherine M. PhD1,2

doi: 10.1097/gme.0b013e318198e2fd

Objective: The aim of this study was to identify provider characteristics associated with hormone therapy prescribing.

Methods: The study design is cross-sectional. In December 2005, we mailed surveys to providers practicing in two integrated healthcare delivery systems located in the northwestern and northeastern United States; 379 responded (74%) and 249 (49% of total) granted access to their automated data. Data included provider demographics, practice characteristics, and perceptions about hormone therapy. Provider-specific annual hormone therapy prescribing frequency was calculated as days supply of hormone therapy filled divided by the number of visits (among women aged 45-80 y). Factors associated with higher rates of hormone therapy prescribing were identified using bivariate and multivariate analyses.

Results: We report results separately for primary care providers (internists and family practitioners) and obstetrician/gynecologists because significant correlates differed in these two groups. For both primary care providers and obstetrician/gynecologists, in multivariate analyses, hormone therapy prescribing varied by site (P ≤ 0.002) and years at the healthcare organization (P ≤ 0.01). For primary care providers only, higher hormone therapy prescribing was associated with reported expert knowledge of the hormone therapy trials (P ≤ 0.001). For obstetrician/gynecologists, higher hormone therapy prescription was related to feeling well prepared to counsel women on hormone therapy (P ≤ 0.007), believing that the risks of estrogen with progestogen had been exaggerated (P = 0.04), and seeing younger aged patients (P = 0.03).

Conclusions: After the release of the Women's Health Initiative findings and practicing under similar clinical guidelines, hormone therapy prescribing is associated with providers' confidence, practice location, and time with a healthcare organization.

In this post-Women's Health Initiative cross-sectional study, self-rated provider attributes were associated with an objective measure of hormone therapy prescribing frequency. Higher prescribing frequency was associated with years at the organization, practicing at the northwest versus the northeast study site, self-rated trial knowledge, and feeling prepared to counsel.

From the 1Group Health Center for Health Studies, and 2Department of Epidemiology, University of Washington Seattle, WA; 3Department of Obstetrics and Gynecology, University of Washington School of Medicine Seatle, WA; 4Fred Hutchinson Cancer Research Center, Seattle, WA; 5Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, Boston, MA; and 6Division of Internal Medicine, Harvard Vanguard Medical Associates, Boston, MA.

Received October 6, 2008; revised and accepted December 15, 2008.

Funding/support: This work was supported by National Institutes of Health R01 AG022578.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Leslie Spangler, VMD, PhD, Group Health Center for Health Studies, MPE 1600, 1730 Minor Ave, Ste 1600, Seattle, WA 98101. E-mail:

©2009The North American Menopause Society