Trends in early-career general practitioners’ prescribing of hormone and non-hormone therapy for menopausal symptoms

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

J.15

Presenter:

Parker Magin

Co-authors:

Jasmine De Giovanni, Amanda Tapley, Elizabeth Holliday, Mieke van Driel

Author institutions:

University of Newcastle (Australia), University of Queensland

Problem

Menopausal hormone therapy (MHT) is effective in managing menopausal vasomotor symptoms, but is not without risk. The Women’s Health Initiative (WHI) study in 2002 demonstrated associations between oestrogen plus progestin therapy and invasive breast cancer, coronary heart disease, stroke and pulmonary embolism. With WHI’s initial publication in 2002, MHT prescribing reduced markedly. Recent studies, though, (including further WHI findings) have suggested that MHT is not associated with increased risk for all-cause, cardiovascular, or cancer mortality.We aimed to investigate temporal trends in menopausal hormone therapy (MHT) and non-MHT symptomatic drug prescribing by early-career general practitioners (GPs) for menopause-related problems in the eight-to-fifteen years post-WHI’s initial 2002 publication. Specifically, we sought to establish any increase in MHT prescribing (and in the ratio of MHT to non-MHT symptomatic prescribing) following publication of further findings from WHI.

Approach

A longitudinal analysis from the Registrar Clinical Encounters in Training (ReCEnT) study of GP registrars’ in-consultation clinical and educational experiences in five Australian states. In ReCEnT, registrars (early-career GP vocational trainees) document 60 consecutive general practice consultations, six-monthly, on three occasions. Data collected in ReCEnT include registrar, patient, practice, consultation, and educational variables.The outcome factor for this analysis was MHT (estrogen and/or progestogen) prescribed. All menopause-related problems were included in the primary analysis. The secondary analysis included only menopause-related problems for which MHT or non-MHT symptomatic medicines were prescribed. Associations of MHT-prescribing, including year (2010-2017), were assessed by univariate and multivariable logistic regression.

Findings

1,736 individual registrars documented 1,569 menopause-related problems for female patients aged 25 years or over during data collection periods from 2010 to 2017. There were 756 menopause-related problems for which patients were prescribed MHT or a non-MHT symptomatic drug; 626 (39.3% [95% CI 37.4- 42.5] of the total) were prescribed MHT at the index consultation. There was no linear trend in MHT prescription over time. 130 (17.2% [95% CI 14.6-20.1] of the total) had a non-MHT symptomatic drug prescribed. For MHT prescription versus non-MHT symptomatic menopause medications by year, there was no significant time trend.

Consequences

Our finding of the proportion of women prescribed MHT for menopause-related problems by GP registrars remaining constant in the period eight-to-15 years following the initial WHI publication is in the context of publication of follow-up studies providing nuance and context to the initial WHI findings. These studies might be thought to encourage less restrictive MHT use. It may be that it is still too early to see a rise in MHT prescribing following the publication of these findings, given the generally slow uptake of evidence into practice. Similarly, there was no change in prescribing of non-hormonal medications by early-career GP registrars. Our findings may inform the delivery of menopause management training for both early-career and established GPs.

Submitted by:

Parker Magin

Funding acknowledgement:

The ReCEnT project was funded from 2010 to 2015 by the participating educational organisations: General Practice Training Valley to Coast, the Victorian Metropolitan Alliance, General Practice Training Tasmania, Adelaide to Outback GP Training Program, and Tropical Medical Training, all of which were funded by the Australian Government Department of Health. From 2016-2019, ReCEnT was funded by an Australian Government Department of Health commissioned research grant and supported by GP Synergy Regional Training Organisation. GP Synergy is funded by the Australian Government Department of Health. Jasmine De Giovanni received a GP Synergy Medical Student Scholarship in relation to this work.