Changes in newspaper coverage about hormone therapy with the release of new medical evidence

Evolution of postmenopausal hormone therapy between 2002 and 2009

OBJECTIVE

The results of the Women's Health Initiative led to a sharp decline in postmenopausal hormone therapy use. Subsequently, treatment guidelines were revised to recommend hormone therapy at the lowest effective dose for the shortest possible duration. The objective of this analysis was to assess trends in nationwide hormone therapy prescription claims from 2002 to 2009.

METHODS

This study was a retrospective database analyses of pharmacy claims from MedImpact Healthcare Systems Inc. Data from women with claims for oral or transdermal hormone therapy were analyzed to assess trends in hormone therapy claims, including route of administration, dose, and physician specialty.

RESULTS

By the end of 2002, the total number of hormone therapy claims dropped approximately 30% from 2002 second quarter claims. This trend continued during the next 7 years, and by 2009, hormone therapy claims were reduced by more than 70%. The proportion of low-dose oral claims rose fourfold, whereas the proportion of standard/high-dose claims decreased 30%. The proportion of claims for transdermal formulations more than doubled, and the proportion of claims for low-dose transdermal hormone therapy increased 10-fold. Although reductions in overall claims, routes of administration, and dose categories were similar between physician specialties, obstetrician/ gynecologists prescribed transdermal hormone therapy nearly twice as often as all other types of providers.

CONCLUSIONS

Since the publication of the Women's Health Initiative results, there has been a sustained decrease in hormone therapy claims. The proportional use of low-dose oral and transdermal formulations has increased, but as of 2009, claims for these formulations accounted for approximately one in four total hormone therapy claims.

Sources of information influencing the state-of-the-science gap in hormone replacement therapy usage

Objective

Medical reviews and research comprise a key information source for news media stories on medical therapies and innovations as well as for physicians in updating their practice. The present study examined medical review journal articles, physician surveys and news media coverage of hormone replacement therapy (HT) to assess the relationship between the three information sources and whether/if they contributed to a state-of-the-science gap (a condition when the evaluation of a medical condition or therapy ascertained by the highest standards of investigation is incongruent with the science-in-practice such as physician recommendations and patient actions).

Methods

We content-analyzed 177 randomly sampled HT medical reviews between 2002 and 2014, and HT news valence in three major TV networks, newspapers and magazines/internet sites in 2002–2003, 2008–2009 and 2012–14. The focus in both analyses was whether HT benefits outweighed risks, risks outweighed benefits or both risks and benefits were presented. We also qualitatively content-analyzed all 19 surveys of US physicians’ HT recommendations from 2002 to 2009, and 2012 to 2014.

Results

Medical reviews yielded a mixed picture about HT (40.1% benefits, 26.0% risks, and 33.9% both benefits and risks). While a majority of physician surveys were pro-HT 10/19), eight showed varied attitudes and one was negative. Newspaper and television coverage reflected a pro and con balance while magazine stories were more positive in the later reporting period.

Conclusion

Medical journal review articles, physicians, and media reports all provide varying view points towards hormone therapy use thus leading to limited knowledge about the actual risks and benefits of HT among peri- and menopausal women and a state-of-the-science gap.

What your patient reads: creating a value-added tool for physicians

Through a number of media sources, today's consumers have unprecedented access to health information of varying reliability and authority. Empowered by this information, patients are more involved in their health care decisions and more willing to question physicians' advice. This poses a challenge for physicians who must now find time to read mass media health reports in addition to medical research. In order to help physicians with this task, librarians at the University of Manitoba Health Sciences Libraries created What Your Patient Reads - one-page summaries of health-related media reports supplemented with references to evidence-based medical literature.

Too much of a good thing? Physician practices and patient willingness for less frequent pap test screening intervals

BACKGROUND

Recent guidelines recommend longer Pap test intervals. However, physicians and patients may not be adopting these recommendations.

OBJECTIVES

Identify (1) physician and practice characteristics associated with recommending a less frequent interval, and (2) characteristics associated with women's willingness to adhere to a 3-year interval.

RESEARCH DESIGN

We used 2 national surveys: (1) a 2006/2007 National Survey of Primary Care Physicians for physician cervical cancer screening practices (N = 1114), and (2) the 2005 Health Information Trends Survey for women's acceptance of longer Pap intervals (N = 2206). MEASURES AND METHODS: Physician recommendation regarding Pap intervals was measured using a clinical vignette involving a 35-year-old with no new sexual partners and 3 consecutive negative Pap tests; associations with independent variables were evaluated with logistic regression. In parallel models, we evaluated women's willingness to follow a 3-year Pap test interval.

RESULTS

A minority of physicians (32%) have adopted-but more than half of women are willing to adopt-3-year Pap test intervals. In adjusted models, physician factors associated with less frequent screening were: serving a higher proportion of Medicaid patients, white, non-Hispanic race, fewer years since medical school graduation, and US Preventive Services Task Force being very influential in physician clinical practice. Women were more willing to follow a 3-year interval if they were older, but less willing if they had personal or family experiences with cancer or followed an annual Pap test schedule.

CONCLUSIONS

Many women are accepting of a 3-year interval for Pap tests, although most primary care physicians continue to recommend shorter intervals.

Changes in postmenopausal hormone replacement therapy use among women with high cardiovascular risk

After randomized trials failed to support the use of hormone replacement therapy (HRT) for preventing cardiovascular disease (CVD), HRT use for postmenopausal women declined. Our analysis of 1999-2000 and 2003-2004 National Health and Nutrition Surveys (NHANES) shows that HRT use decreased 19% (from 27.6 to 8.4%; P<.001) among women with CVD versus 3% (from 19.8 to 16.8%; P=.68) among low-risk women, suggesting that most of the drop in HRT use may be among women prescribed HRT as an unproven treatment to prevent CVD.

Did news reporters get it right? Translation of the 2002 hormone study findings

BACKGROUND

The news media play a critical role in communicating health information to the public. The unexpected findings in July 2002 about increased health risks associated with hormone therapy provided an opportunity to examine the process of translating scientific findings to reporters through communication intermediaries and appraise subsequent reporting in newspapers in the United States.

METHODS

Using qualitative research software, a qualitative analysis was conducted in 2006 to consider four types of messages: (1) hormone therapy health risks outweighed benefits (balance); (2) adverse hormone therapy health outcomes (health risk); (3) positive hormone therapy health outcomes (benefit); and (4) risk level (magnitude). The print materials analyzed included the original 2002 Journal of American Medical Association (JAMA) article and editorial; JAMA and National Institutes of Health (NIH) press releases; the NIH press conference transcript; and 198 articles about hormone therapy in 22 U.S. newspapers published from July to September 2002.

RESULTS

The major study finding that hormone therapy risks outweighed benefits was reported consistently and accurately. Analyses of language and numbers on risk magnitude, and its interpretation revealed some variability, both within the translation materials and news stories. When risk numbers were included in newspaper stories, absolute risk was used more often than relative risk.

CONCLUSIONS

Despite much criticism of journalists' coverage of health issues, U.S. newspaper reporting about hormone therapy in 2002 was generally consistent. Several translational and communication strategies used with hormone therapy may be applicable to other efforts that involve working with reporters on major health stories or events. An important process oversight was the absence of hormone therapy communication efforts and guidance directed specifically to medical practitioners.

How the Women's Health Initiative (WHI) influenced physicians' practice and attitudes

BACKGROUND

The landmark Women's Health Initiative (WHI) Postmenopausal Hormone Therapy Trial published in 2002 showed that the health risks of combination hormone therapy (HT) with estrogen and progestin outweighed the benefits in healthy postmenopausal women. Dissemination of results had a major impact on prescriptions for, and physician beliefs about HT. No study has fully examined the influence of the widely publicized WHI on physicians' practice and attitudes or their opinions of the scientific evidence regarding HT; in addition, little is known about how physicians assist women in their decisions regarding HT.

DESIGN AND PARTICIPANTS

We conducted in-depth telephone interviews with family practitioners, internists, and gynecologists from integrated health care delivery systems in Washington State (n = 10 physicians) and Massachusetts (n = 12 physicians). Our objectives were to obtain qualitative information from these physicians to understand their perspectives on use of HT, the scientific evidence regarding its risks and benefits, and counseling strategies around HT use and discontinuation.

APPROACH

We used Template Analysis to code transcribed telephone interviews and identify themes.

RESULTS

Physicians were conflicted about the WHI results and its implications. Seven themes identified from in-depth interviews suggested that the WHI (1) was a ground-breaking study that changed clinical practice, including counseling; (2) was not applicable to the full range of patients seen in clinical practice; (3) raised concerns over the impact of publicized health information on women; (4) created uncertainty about the risks and benefits of HT; (5) called for the use of decision aids; (6) influenced discontinuation strategies; and (7) provided an opportunity to discuss healthy lifestyle options with patients. As a result of the WHI, physicians reported they no longer prescribe HT for prevention and were more likely to suggest discontinuation, although many felt women should be in charge of the HT decision.

CONCLUSIONS

Physicians varied in their opinions of HT and the scientific evidence (positive and negative). Whereas the WHI delineated the risks and benefits of HT, physicians reported that decision aids are needed to guide discussions with women about menopause and HT. Better guidance at the time of WHI study publication might have been valuable to ensure best practices.

Average household exposure to newspaper coverage about the harmful effects of hormone therapy and population-based declines in hormone therapy use

BACKGROUND

The news media facilitated the rapid dissemination of the findings from the estrogen plus progestin therapy arm of the Women's Health Initiative (EPT-WHI).

OBJECTIVE

To examine the relationship between the potential exposure to newspaper coverage and subsequent hormone therapy (HT) use. DESIGN/POPULATION: Population-based cohort of women receiving mammography at 7 sites (327,144 postmenopausal women).

MEASUREMENTS

The outcome was the monthly prevalence of self-reported HT use. Circulation data for local, regional, and national newspapers was used to create zip-code level measures of the estimated average household exposure to newspaper coverage that reported the harmful effects of HT in July 2002.

RESULTS

Women had an average potential household exposure of 1.4 articles. There was substantial variation in the level of average household exposure to newspaper coverage; women from rural sites received less than women from urban sites. Use of HT declined for all average potential exposure groups after the publication of the EPT-WHI. HT prevalence among women who lived in areas where there was an average household exposure of at least 3 articles declined significantly more (45 to 27%) compared to women who lived in areas with <1 article (43 to 31%) during each of the subsequent 5 months (relative risks 0.86-0.92; p < .006 for all).

CONCLUSIONS

Greater average household exposure to newspaper coverage about the harms associated with HT was associated with a large population-based decline in HT use. Further studies should examine whether media coverage directly influences the health behavior of individual women.

A Canadian observational study of the optimal method of transition from postmenopausal hormone therapy to raloxifene

OBJECTIVE

To determine the optimal method of transition from postmenopausal hormone therapy (HT) to raloxifene (RLX) therapy in order to minimize hot flashes and night sweats.

METHODS

Postmenopausal women in Canada who had discontinued HT (estrogen with or without progestogen) in the preceding nine months and who were starting RLX were followed for approximately nine months in this observational study. The method of transition from HT to RLX therapy (method and duration of tapering HT, duration of washout) and the frequency and severity of hot flashes during the transition and RLX treatment periods were recorded.

RESULTS

There were 373 women who participated in this study. Most women (86.3%) had a washout period between HT and RLX, and 55.2% had tapered their HT in some fashion. After beginning RLX, women who had had a washout duration of more than one week were found to be more likely to have an improvement in the severity of hot flashes (odds ratio [OR] = 6.3), and in the frequency of hot flashes (OR = 4.6), than women with a shorter washout or no washout period at all. The method of tapering of HT did not seem to affect either the severity or the frequency of hot flashes once on RLX. Women who had undergone a tapering period of more than one week's duration were more likely (OR = 2.6) to experience an improvement in the frequency (but not the severity) of hot flashes on RLX.

CONCLUSION

Women who had a washout period following HT had better amelioration of hot flashes on RLX therapy.