An empirical survey on knowledge, attitude and practice between family physicians and gynecologists toward hormone replacement therapy in Taiwan
Date Issued
2004
Date
2004
Author(s)
Cheng, Shao-Yi
DOI
en-US
Abstract
Background: Recent large- scaled randomized double-blind placebo- controlled trials have elucidated the lack of benefits of hormone replacement therapy to menopausal women for prevention of cardiovascular disease and increased speculation on the carcinogenesis of hormone replacement therapy in breast cancer.
Purpose: We want to compare and investigate the current knowledge, attitude and practices toward HRT after the impact of WHI among physicians in Taiwan regarding to specialty, site of practice, gender, age school, residency training and years of practice.
Method: A cross-sectional survey was conducted from April to June in 2004. A total of 1,000 copies of questionnaires were mailed according to the selective active name lists of Taiwan Association of Obstetrics and Gynecology and Taiwan Association of Family Medicine. 183 copies of questionnaires were returned, with a response rate equivalent to 18.3%. In addition to mailed questionnaire, another 88 copies of questionnaires out of 100 were obtained through E-mail (response rate 88%). A total of 256 copies of valid questionnaire were available. The frequencies of variables on knowledge, attitude and practice were expressed by percentage according to five-Likert scale. Factor analysis was used to assess relationship among the correlated factor of attitude, knowledge, and practice. The effects of new factor on practice were also assessed by using multiple logistic regression models.
Results: ‘Specialty’ was an important factor affecting HRT prescription in the past one year (OR 27.06), HRT prescription for menopausal symptoms (OR 3.2) and osteoporosis (OR2.6). To those menopausal women with family history of breast cancer, ‘female physicians’ were reluctant to prescribe HRT for vasomotor symptoms and osteoporosis treatment. ‘Physicians in hospitals’ tended not to prescribe HRT to those with family history of breast cancer and prescribe less calcium than private practitioners. Those who’ received residency training at medical centers’ tended to prescribe more HRT in the past one year (OR 13.89). The knowledge and attitude of ‘chronic disease prevention of HRT ‘affected HRT prescription for osteoporosis (OR 4.06), prescription of phytoestrogen (OR 4.24) and SERM (OR 5.44). ‘Assessments before the prescription of HRT’ were associated with HRT prescription for menopausal symptoms and those with CVD. The prescription of HRT to menopausal symptoms and prescription of SERM for osteoporosis were related with ‘benefits of HRT’. The prescription of HRT for menopausal symptoms and osteoprosis were related with ‘use of HRT’. ‘Propaganda of HRT by pharmaceutical industry’ strongly influenced HRT prescription of physicians (OR 28.93) in the past one year and relief of menopausal symptoms. The knowledge and attitude that’ HRT would bring harms’ such as breast cancer and thromboembolism affected the prescription of HRT to those with family history of breast cancers. Structural equation model revealed that family physicians tend to consider the chronic disease prevention benefits and evaluate the harms before prescribing HRT whereas gynecologists emphasize the beneficial effects of HRT only.
Conclusion: Although the prescription of HRT is different between family physicians and gynecologists in Taiwan, the knowledge, attitude and practice of physicians toward HRT in Taiwan are concurrent with those of the west. However, a consensus between family physicians and gynecologists is urgent in order to establish a guideline for the treatment of menopausal symptoms and chronic disease prevention in Taiwan.
Subjects
態度
知識
處方
荷爾蒙補充療法
實行
hormone replacement therapy
prescription
practice
knowledge
attitude
SDGs
Type
thesis
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