SUMMARIES FOR PATIENTS

Reducing the Prescription of Hormone Replacement Therapy after the Release of Study Results

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The summary below is from the full report titled "A Three-Part Intervention To Change the Use of Hormone Replacement Therapy in Response to New Evidence." It is in the 20 July 2004 issue of Annals of Internal Medicine (volume 141, pages 118-125). The authors are C.L. Roumie, E.L. Grogan, W. Falbe, J. Awad, T. Speroff, R.S. Dittus, and T.A. Elasy.

What is the problem and what is known about it so far?

At menopause, a woman's ovaries permanently decrease their production of the hormones estrogen and progesterone, leading to the end of menstruation. In the years around menopause, the changes in hormone levels result in symptoms including hot flashes, night sweats, mood swings, and vaginal dryness. The lower hormone levels also put women at risk for osteoporosis and heart disease. Postmenopausal hormone replacement therapy (HRT) refers to regimens of the female hormone estrogen with or without progesterone. This therapy reduces the uncomfortable symptoms of menopause. It also influences the development (favorably and unfavorably) of conditions such as thinning of the bones, heart disease, stroke, blood clots, dementia, and some cancers. Before the July 2002 publication of the results of a large, high-quality study called the Women's Health Initiative (WHI), research suggested that the benefits of combination HRT (estrogen and progesterone) outweighed the risks. However, the WHI study showed that women receiving HRT actually had a higher risk of heart disease and stroke than did women not receiving HRT. The results of the WHI study received a lot of media attention. However, there is often a delay before patients and doctors change practice after study results become available.

Why did the researchers do this particular study?

To determine whether they could decrease the prescription of combination HRT by delivering information about the WHI study to doctors and patients.

Who was studied?

91 women who had a prescription for combination HRT between January and July 2002 in a Veterans Affairs health system in Tennessee.

How was the study done?

The researchers developed a 3-part program for notifying patients and doctors about the results of the WHI study. First, they sent a personal letter describing the study results from the health system pharmacy to patients. Second, they sent an e-mail describing study results to each of the patients' primary care doctors or nurses. Third, they placed a reminder in each patient's electronic medical record that asked the health care providers to evaluate the need for HRT. The researchers examined patients' records through December 31, 2002, to see whether patients had stopped taking HRT. They examined the numbers of women who stopped taking HRT before the media release of the WHI results, after the media release but before their 3-part program, and after the 3-part program.

What did the researchers find?

Of the 91 patients, 5 discontinued HRT use before the media release, 20 discontinued HRT use after the media release but before the program, and 39 discontinued HRT use after the program.

What were the limitations of the study?

The study did not follow any women who were not exposed to the program. It is possible that the rates of stopping HRT in these women might have been the same as the rates in women exposed to the program.

What are the implications of the study?

Communicating study results to patients and their health care providers through e-mail, personal letters, and chart alerts might help to speed the adoption of study findings.