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Impact of WHI study in patients and doctors

Abstract:

Objective: To assess the effect of the publication of the WHI study on patient and physician attitudes in relation to hormone replacement therapy (HRT). Methods: A survey on the degree of knowledge and on the reactions to the WHI study was administered to 600 women allocated in two groups according their socio-economic level (high H and low L). Additionally, 283 physicians were surveyed to determine their attitudes regarding HRT following the publication of the WHI study. HRT prescription before and after publication of the study were compared. Results: Patients: HRT use and knowledge of the WHI study were less common among women of lower socioeconomic status (L 16.7% vs. H 47.3% and L 15.7% vs. H 67.3%, p< 0.0001). Of the women in group L who were HRT users and had knowledge on the subject of the WHI study (n= 30), 56.7% contacted their physicians and 6.6% abandoned HRT. Physicians: 97.2% of physicians referred to be aware of the WHI study and 64.7% modified their clinical approach. The main changes were: 21.5% applied more rigorous risk/benefit assessment; 20.1% lowered dosage; 18.8% reduced continuous-combined HRT use; 12.1% shortened the duration of HRT; 7.7% ceased medroxyprogesterone and/or conjugated estrogen use; 5.0%. increased the use of other alternatives. Prescriptions: Following the publication of the WHI study, there was an 8.6% drop in the rate of HRT prescriptions. This decrease was more pronounced for prescriptions based on conjugated estrogen and medroxyprogesterone acetate. In contrast, prescription of transdermal estrogens and tibolone increased 5.2% and 16%, respectively. Conclusions: There was a significant change in physician and patient attitudes towards HRT following publication of the WHI study.